Similar symptoms at 3 months post discharge in ICU, COVID-19 ICU, and COVID-19 patients that received non-invasive ventilation in high dependency areas

Introduction: It is well documented that survivors of ICU admissions struggle to return to pre-admission level of function because of both physical and psychological burden. Current guidance therefore recommends a follow-up service to review patients 2-3 months post discharge from ICU [NICE 2009]. Prior to 2020 University Hospitals Bristol and Weston (UHBW) had no such service. With the increase in patient numbers seen during the COVID-19 pandemic, funding was received to provide a follow-up clinic to COVID-19 survivors. Spare clinic spaces were used for non COVID ICU patients. Objective(s): To review symptoms reported by patients in the following 3 groups, COVID-19 patients treated in ICU (COVID ICU), COVID-19 patients treated with continuous positive airway pressure ventilation in high dependency areas (COVID CPAP) and non COVID-19 ICU patients (ICU), at 2-3 months post discharge from UHBW. Method(s): Referred patients had an initial phone call at 8 weeks post discharge. The call identified both physical and psychological symptoms. Advice regarding recovery, signposting to resources and onwards referrals to appropriate specialities were provided. If symptoms indicated, patients would then be referred into the multidisciplinary team follow up clinic. Here they met with an intensivist, clinical psychologist, physiotherapist, occupational therapist, speech and language therapist and dietitian. Result(s): As Graph 1 shows all 3 patient groups had a wide variety of ongoing symptoms at 2-3 months post discharge. Fatigue was the most common symptom reported in all 3 groups. Breathlessness was the second most common symptom reported by COVID patients but was less frequently reported in the ICU population who had a variety of non-respiratory related reasons for admission. COVID ICU patients more commonly reported ongoing problems with their swallowing, voice and communication compared to the COVID CPAP group, most probably due to invasive ventilation. Psychological burden post critical illness was high in all 3 groups. More than 20% of all patients scored =10 on a PHQ-9 depression scale showing moderate to severe depression. More than 15% of all patients scored =10 on a GAD-7 showing moderately severe to severe anxiety. COVID ICU group had the highest incidence of post-traumatic stress disorder (PTSD). This may be linked to the higher level of delirium we saw in this group, as a result of change in practice, such as full PPE and absence of visiting during the pandemic. ICU patients presented with a significantly higher percentage of physiotherapy needs. This is likely because patients with the longest and most complex ICU admissions were selected for the clinic. Sleep likely goes under reported in these results as we only began questioning specifically about this later on in the clinic. Conclusion(s): This data goes some way in supporting current literature that the rehabilitation needs of COVID ICU patients equal that of ICU patients (Puthucheary et al 2021). It also shows the need to follow up patients who receive advanced respiratory support outside of the ICU environment, as their symptoms, and therefore rehabilitation needs are very similar to ICU patients at 2-3 months post discharge.

ICU follow-up clinic provides the opportunity to recognise and address symptoms post critical illness, which may otherwise have been missed

Introduction: It is well documented that survivors of ICU admissions struggle to return to pre-admission level of function because of both physical and psychological burden. Current guidance therefore recommends a follow-up service to review patients 2-3 months post discharge [NICE 2009]. Prior to 2020 University Hospitals Bristol and Weston had no such service. With the increase in patient numbers seen during the COVID-19 pandemic, funding was received to provide a follow-up clinic to COVID-19 survivors. Objective(s): To provide a service that supports and empowers patients with their recovery from critical illness. Improving quality of life, speed of recovery and reducing longer term health care needs. Method(s): Referral criteria for the clinic included COVID-19 patients who received advanced respiratory support within intensive care and the high dependence unit. 8 weeks post discharge patients had a telephone appointment where ongoing symptoms could be identified. Advice around recovery, signposting to resources and onward referrals to appropriate specialities were provided. At 10 weeks post discharge patients had lung function tests and a chest X-ray which were reviewed by respiratory consultants. Based on the combination of these assessments, patients would be discharged or referred into the multidisciplinary team (MDT) follow-up clinic. The face to face clinic consisted of appointments with an intensivist, clinical psychologist, physiotherapist, and occupational therapist. Where needed patients would also be seen by a speech and language therapist or dietitian. Patients were seen only once in follow up clinic but again would be referred onto appropriate services within trust or the community, including but not exclusively community therapy services, secondary care services, SALT, dietetic or psychology clinics. Result(s): One of the key outcomes was the need for 147 onward referrals (an average of 1.13 referrals per patient). This included, 31 referrals to musculoskeletal physiotherapy outpatients for problems originating or made worse by their admission. 20 referrals to secondary care, including cardiology and ENT. 16 referrals to community occupational therapy, for provision of equipment, home adaptations and support in accessing the community. Subjectively, patient feedback was excellent. When asked what they felt was the most valuable thing they had taken from the clinic they reported: "Reassurance";"To know I'm not alone, others feel like this";"They listened to me and gave advice";"The ability to ask anything I wanted and the obvious kindness and support from all the clinicians I saw". Conclusion(s): Onward referral rates made by the follow-up clinic highlight the many issues faced by patients following discharge from ICU and hospital. With timely recognition and management, we can prevent a majority of these symptoms manifesting into chronic problems. This has the potential to lower the long-term burden on health care and improve quality of life for patients in both the short and long term. Without the follow-up clinic, these issues may have been missed or delayed. This reinforces the importance of the follow-up clinic and the need for ongoing investment.

Doing More with Fewer: Optimizing Value with Limited Numbers of Autopsies

The value of autopsy is best demonstrated when the procedure is competently practiced in an appropriate clinical setting. Autopsy performance is expectedly restricted when a death raises certain forensic, religious, legal, or safety concerns. Additionally, limiting the scope of postmortem examinations to deaths that fulfill various clinical indications for the procedure will be important moving forward. This is especially true as institutions that finance autopsy services face uncertain and likely difficult financial conditions in the wake of the coronavirus disease 2019 pandemic. Autopsy pathologists should actively engage with clinicians in promoting responsible autopsy practice and delivering quality postmortem care. Using a problem-oriented autopsy record, thoughtfully evaluating postmortem histology, and purposefully reporting autopsy findings can help pathologists provide valuable data to autopsy's various stakeholders. Copyright © Wolters Kluwer Health, Inc. All rights reserved.

Quality Improvement in the Placental Pathology Process: An Interdisciplinary Approach

Background: The placenta functions to provide fetal nutrients, adapt its nutrient supply to match extraction, and mount key inflammatory responses. Placental pathology exams can offer insights and explain long- and short-term adverse events for both birther and fetus. The combination of recent indication developments (i.e. COVID-19) and varying education around pathology reports is resulting in increased pathology workload, result turnaround times, and timing of family consults. For placental pathology to guide clinical decision-making, order indications must be informative to decrease pathologist workloads reviewing electronic record, and timely reports must be returned. The objective of the study is to identify gaps in the workflow of placental pathology processing to facilitate informative orders, improve interdepartmental communication, and educate for better clinical counseling. Method(s): Quality improvement (QI) fishbone diagrams outlined problems and solutions for timely pathology report turnarounds. 3 mixed-methods surveys were sent to UW pathology and general obstetrics (Ob) residents, maternalfetal medicine (MFM) and neonatal intensive care (NICU) fellows, and attending Ob and MFM providers to identify knowledge gaps, preferred educational tools, and free text thoughts about interdepartmental communication around placental pathology. Rates were compared by Chi2, Likert scale data were compared by Mann-Whitney. Result(s): Survey response rates from pathology trainees, combined Ob, MFM, and NICU trainees, and the Ob attendings were 23.8%, 27.2%, and 50%, respectively. Sufficiency of placental education for Ob and MFM trainees and attendings was rated 1.95/10 (n=21) and 5.5/10 (n=8), respectively. Delivery attending Ob/MFM providers rated their confidence family counseling as 4.86/10 (n=14), with MFM providers' expressed rating higher (7/10, n=5) than Ob (3.67/10, n=9). Overall, interdepartmental communication surrounding placentas was rated an average of 1.9/10 (n=30). 4 Ob residents reported receiving no training on the topic. 3 Ob providers expressed that reports often provided no clinically relevant data. Conclusion(s): Utilizing survey responses, 4 interventions were chosen to improve education and communication, including the use of a .placentalpath SmartPhrase, a teaching tool, updated indication guidelines, and regular joint interdisciplinary perinatal case conferences on relevant topics. Future directions include implementing, following, and assessing the effectiveness of these instruments.

An update on digital interventions in speech and language therapy.

Due to the COVID-19 pandemic, digitalization in speech language therapy has progressed rapidly. Teletherapy, in particular, has become part of regular speech language therapy, as it has been reimbursed by German health insurance companies since March 2020. At the same time, political innovations such as the E-Health Act (E-Health-Gesetz, 2015), the Act to Improve Healthcare Provision through Digitalization and Innovation (Digital Healthcare Act - DVG, 2019), and the law on digital modernization of healthcare (DVPMG) (2021) offered new opportunities but also generate (future) tasks for speech and language therapists. For example, since the DVG was approved, applications (apps) can be prescribed by physicians and the statutory health insurance pays for them. In addition, speech language therapists are also to be connected to the telematics infrastructure starting in 2026. These and other digital innovations offer a variety of opportunities for improved care in speech language therapy but also incorporate new duties and responsibilities in the professional range of tasks of speech and language therapists. In order to be able to specify requirements and critically accompany (new) technological developments, it is highly relevant that speech language therapists acquire a critically reflected attitude towards digital technologies to acquire or expand digital competence. In addition, goal-oriented political frameworks and specifications are of enormous importance for successful implementation of digital technologies in speech language therapy.Copyright © Hippocampus Verlag 2023.

Introducing the speech therapist in the Neonatology Unit: an innovative way to support breastfeeding in healthy newborns even during COVID-19 pandemic

Objective. The aim of the study was to intercept early problems and difficulties in onset and stabilization phases of breastfeeding, in a population of healthy full-term newborns - during the COVID-19 pandemic - through a Clinical Governance Project, supported by the Department of Neonatology and Pediatrics, which introduced a speech therapist, as part of the professional team acting synergistically with neonatologists, pediatricians, pediatric nurses, midwives and gynecologists. Materials and Methods. Over a period of two months (2020), n = 72 newborns, 38 males and 34 females, were recruited (mean age:1.3 days) in the Departments of Neonatology and Obstetrics and Gynecology of Castelli Hospital, ASLRM6. Lingual frenulum neonatal screening (Martinelli, 2015) was administered to all the newborns and the frenulum was classified as normal, doubtful or impaired. Breastfeeding difficulties were evaluated and speech therapist counseling was performed, to support early onset and stabilization of breastfeeding. Results. Lingual frenulum screening resulted normal in 36 (50%), doubtful in 20 (28%) and impaired in 16 (22%) of total newborns. An alteration of both lingual and upper labial frenulum was found in 16 (22%) of the newborns studied. n = 23 newborns (32%) showed alterations able to hinder breastfeeding: these cases were successfully managed by helping the mothers to change the breastfeeding position, adopting a rugby hold position. Conclusions. According to our preliminary results, speech therapist counselling, in the critical COVID-19 pandemic, allowed early detection of lingual frenulum alterations, and their impact on the onset of breastfeeding. We found that altered lingual frenulum was associated with breastfeeding difficulties: in these patients, speech therapist intervention resulted useful in managing early breastfeeding problems.

The Impact of the COVID-19 Pandemic on the Quality of Life of Laryngectomized Patients

Introduction: Quality of life is a state of complete physical, mental and social well-being. Due to the COVID-19 pandemic, which led to changes in the daily routine, there was a change in the psychosocial functioning of individuals. Given that laryngectomized patients belong to a vulnerable group that requires psychological support after surgery, specific epidemiological measures during the COVID-19 pandemic could only further increase the fear and reluctance that is especially pronounced after surgery. Aim(s): The aim of this study was to investigate whether there was a link between the quality of life of laryngectomized patients and the COVID-19 pandemic. Method(s): The literature review was performed through the Google Scholar Advanced Search search engine and the Consortium of Libraries of Serbia for Unified Acqusition - KoBSON. Result(s): The first wave of the COVID-19 pandemic significantly disrupted the emotional well-being of patients with head and neck cancer. These patients became even more anxious due to the high mortality from the COVID-19 viral infection, hospital occupancy and missed therapeutic examinations. The need for togetherness, impaired concentration and attention, irritability and fear that family members might suffer from a deadly disease were the most common behavioral problems identified during the COVID-19 pandemic. Conclusion(s): The psychological burden associated with the direct and indirect effects of the COVID-19 pandemic should not be overlooked, given the fact that laryngectomized patients have twice the risk of suicide compared to patients who have undergone other types of cancer. Assessing the quality of life in laryngectomized patients is very important because it enables the timely identification of mental disorders and suggests the necessary support measures.Copyright © 2022 Sciendo. All rights reserved.

ICT usage in aphasia rehabilitation-beliefs, biases, and influencing factors from the perspectives of speech and language therapists

Background: The use of digital technology is promoted as an efficient route for the delivery of intensive speech and language therapy in aphasia rehabilitation. Research has begun to explore the views of people with aphasia (PwA) in relation to Information and Communication Technology (ICT) usage in the management of aphasia but there is less consideration of the prescribers' views, i.e., speech and language therapists (SLTs). Aim(s): We aimed to explore SLTs' views of ICT use in aphasia management and identify factors that influence their decisions to accept and integrate ICT in aphasia rehabilitation. In addition, we considered the findings in the context of the Unified Theory of Acceptance and Use of Technology (Venkatesh, Morris, Davis & Davis, 2003). Methods & Procedures: Speech and language therapists (n = 15) from a range of clinical and geographical settings in the Republic of Ireland were invited to participate in one of four focus groups. Focus group discussions were facilitated by an SLT researcher and were audio-recorded and transcribed. Analysis was completed following Braun and Clarke's six phases of thematic analysis (Braun and Clarke, 2006). Outcomes & Results: Four key themes were identified;i. Infrastructure, Resources, and Support, ii. SLT beliefs, biases and influencers, iii. Function & Fit, and iv. ICT and Living Successfully with Aphasia. The SLTs discussed a wide range of factors that influence their decisions to introduce ICT in aphasia rehabilitation, which related to the person with aphasia, the SLT, the broad rehabilitation environment, and the ICT programme features. In addition, several barriers and facilitators associated with ICT-delivered aphasia rehabilitation were highlighted. Conclusion(s): This research highlights a range of issues for SLTs in relation to the use of ICT in aphasia rehabilitation within an Irish context. The potential benefits of using ICT devices in rehabilitation and in functional everyday communication were discussed. However, SLTs also identified many barriers that prevent easy implementation of this mode of rehabilitation.Copyright © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Digital Pathology Training Effectiveness for the Evaluation of Pd-L1 Expression in Multiple Tumor Indications

Background In-person pathologist trainings during the COVID- 19 pandemic became impossible, necessitating a shift to remote-digital whole slide image (WSI) training. High concordance between WSI and glass slide scores from the same specimens stained with PD-L1 IHC 22C3 pharmDx (SK006) across multiple tumor indications supported the validity of digital training.1 However, in-person microscope (glass-slide) training versus remote-digital (WSI) training effectiveness must be assessed. Collated testing data on specimens (SK006 stained) spanning multiple indications scored by external pathologists during Agilent led training and testing (T&T) sessions via glass slides were compared to sessions utilizing WSIs. Methods Stained slides (30 unique specimens per tumor indication) were scanned on an Aperio AT2 scanner to generate WSIs for digital T&T. Remote T&T sessions used WebEx and PathcoreScholar's online platform to discuss scoring guidelines and WSI training cases. Subsequently, external pathologists evaluated WSIs in PathcoreScholar for PD-L1 expression using either Tumor Proportion Score (TPS) or Combined Positive Score (CPS) scoring algorithms and interpreted these scores at predefined cutoffs (figure 1). In both glass and WSI scoring test modalities, passing is defined as inter and intra-observer overall agreement (OA) >=85%. Training effectiveness pass rates from glass slide data (2018-2020) and WSI data (2021- 2022) spanning multiple indications and scoring algorithms were calculated and then compared using the Fisher-Freeman- Halton test, with a significance threshold of 0.05. Only data from initial pathologist tests were included in the pass rate calculation;data from re-tests executed after initial test failure were excluded. Results The differences between pass rates for microscope (glass slide) and digital (WSI) testing were not statistically significant (p-value > 0.05) (tables 1 and 2). Testing pass rates for indications scored with TPS or CPS using microscope glass slide vs digital WSI T&T was not statistically significant (pvalue > 0.05) (table 3). Conclusions No statistically significant differences in pathologist training effectiveness for PD-L1 were observed between remote and in-person trainings across multiple tumor indications, scoring algorithms, and cutoffs. These results demonstrate the effectiveness and equivalency of remote-digital pathologist trainings for evaluation of PD-L1 expression as detected by PD-L1 IHC 22C3 pharmDx in multiple tumor indications when compared to in-person-microscope glass slide T&T. Use of digital training and scoring proficiency testing can provide pathologists around the world with access to high-quality, interactive training from leading experts in PD-L1 expression evaluation.

Effect of COVID-19 on the Incidence of Postintubation Laryngeal Lesions

Introduction: Critically ill patients intubated in the intensive care unit experience prolonged intubation leading to increased frequency of laryngeal injuries, and there is an increasing need for intubation and mechanical ventilation currently due to the COVID-19 pandemic. It is important to fill the literature gaps regarding the incidence of laryngeal injury following prolonged intubation due to COVID-19. Method(s): This study is a retrospective review of patients with swallowing, voice, or airway concerns identified by their primary physician or speech-language pathologist who were evaluated using flexible laryngoscopy from August 14, 2020, to August 18, 2021. A total of 25 patients with COVID-19 and 27 patients without COVID-19 were included. Specific injuries evaluated for were edema/erythema, granulation tissue/ ulceration, posterior glottic stenosis, subglottic stenosis, vocal cord immobility, and vocal cord paralysis. Severe lesions were those that caused significant airway obstruction or required operative treatment or tracheostomy dependence. Result(s): Within the COVID-19 group, 80% of patients had laryngeal injury, with 45% of these in the severe category. In the non-COVID-19 group, 62.9% of patients had a laryngeal injury, with 23.5% being severe. Mild injuries were seen in 44% of COVID-19 patients and 48% of non-COVID-19 patients. The most common injury category seen was granulation tissue/ulceration. Patients with severe injuries were intubated for 6 to 39 days (mean 14.8), those with mild injuries were intubated for 0 to 31 days (mean 10.4), and patients with no injuries were intubated for 0 to 34 days (mean 9.53). Conclusion(s): Patients who were intubated for COVID-19 were more likely to have severe clinically significant laryngeal injuries than non-COVID-19 patients, even when they were intubated for similar amounts of time. Interestingly, the incidence of mild injuries was similar between the 2 groups. Based on these results, it may be beneficial to have a lower threshold for performing flexible laryngoscopy on postintubated COVID-19 patients to evaluate for laryngeal injury. This would allow for earlier intervention and, it is hoped, reduction of morbidity.

Diagnostic Yield Vs Diagnostic Accuracy for Lung Nodule Biopsy Evaluation: Evidence Supporting a Pragmatic End Point for Future Studies

SESSION TITLE: Lung Nodule Biopsy: Yield and Accuracy SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: A variety of endpoints have been used to evaluate the diagnostic performance of navigational bronchoscopy for sampling peripheral pulmonary lesions (PPLs), including diagnostic yield (rate of biopsies with a specific diagnosis that facilitates clinical decisions) and diagnostic accuracy (yield plus a follow-up to assess for false negative/positive initial results). There is also significant variation in what non-malignant findings are considered diagnostic, especially regarding nonspecific inflammatory changes. We hypothesized a diagnostic yield definition excluding nonspecific findings as diagnostic would lead to few false negative PPL biopsies. METHOD(S): Our center maintains a prospective cohort of consecutive PPLs targeted via navigational bronchoscopy. Diagnostic yield was defined as specific findings readily explaining the presence of a PPL (malignancy, organizing pneumonia, granulomatous inflammation, frank purulence, other specific finding) permitting management without immediate additional diagnostic intervention. "Other specific finding" required pulmonologist and lung pathologist agreement. All other findings were considered non-diagnostic. RESULT(S): A total of 450 PPLs biopsied 2017-2019 with complete two-year follow-up were included in the analysis. Ultimately, 274 of 450 (60.9%) PPLs were determined to be malignant. Diagnostic biopsies were obtained in 331 cases (73.6%). There was a single false-positive among 228 malignant biopsies (0.4%, carcinoid tumor on cytopathology, alveolar adenoma on resection surgical pathology). Among 223 PPLs without malignant diagnosis at initial bronchoscopy, 48 were later determined to be malignant. Most (n=39) exhibited nonspecific abnormalities on initial pathology. Two of 104 specific benign biopsies were false negative (1.9%). Both demonstrated organizing pneumonia on initial pathology but re-biopsy months after index bronchoscopy revealed Hodgkin's lymphoma and metastatic renal cell carcinoma, respectively. The sensitivity, specificity, and positive predictive value of specific benign findings for an ultimately benign nodule were 58% (95% CI, 51-66%), 95% (86-99%), and 90% (70-97%). The sensitivity, specificity, and positive predictive value of nonspecific benign findings for an ultimately benign PPL diagnosis were 32% (95% CI, 25-39%), 19% (9-33%), and 20% (16-24%). CONCLUSION(S): A definition of diagnostic yield excluding nonspecific benign findings had low false positive/negative rates. If bronchoscopy is not diagnostic of malignancy, a specific benign finding was highly predictive of an ultimately benign PPL, while nonspecific findings poorly predicted benignity. CLINICAL IMPLICATIONS: This definition of diagnostic yield could be used as the primary outcome in future studies, permitting distribution of reliable diagnostic results without requiring years of follow-up. DISCLOSURES: No relevant relationships by Joyce Johnson No relevant relationships by Robert Lentz No relevant relationships by Kaele Leonard No relevant relationships by See-Wei Low PI ofan investigator-initiated study relationship with Medtronic Please note: >$100000 by Fabien Maldonado, value=Grant/Research Support PI on investigator-initiated relationship with Erbe Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Consulting relationship with Medtronic Please note: $5001 - $20000 by Fabien Maldonado, value=Honoraria co-I industry-sponsored trial relationship with Lung Therapeutics Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Board of director member relationship with AABIP Please note: $1-$1000 by Fabien Maldonado, value=Travel Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee No relevant relationships by Briana Swanner Copyright © 2022 American College of Chest Physicians

The perspectives of speech-language pathologists: Providing teletherapy to patients with speech, language and swallowing difficulties during a COVID-19 context.

BACKGROUND:  The coronavirus disease 2019 (COVID-19) pandemic has had a huge impact on every facet of life. This directly included the delivery of health care from allied health professionals such as speech-language pathologists (SLPs) in South Africa. Research has shown that there is limited research done locally on the impact of COVID-19 relating to stroke care. Consequently, this results in a lack of research on the provision of speech, language and swallowing intervention using teletherapy after a stroke from an SLP point of view. OBJECTIVES:  The aim of this study was to explore the experiences of SLPs with regard to their use of teletherapy in a COVID-19 context when providing speech, language and swallowing intervention for patients after a stroke. METHODS:  This study made use of a qualitative approach. An electronic questionnaire was sent to SLPs inviting them to participate in the study. Purposive sampling was used to recruit participants and thematic content analysis was used to analyse the open-ended qualitative questions. RESULTS:  The findings show that SLPs experienced a variety of facilitators and barriers to using teletherapy. Additionally, issues of access differ across the private and public sector SLPs for both the clients and the SLPs. CONCLUSION:  The current study provided research in the field of teletherapy, which is relatively new in the South African context. The study, whilst small in scale, provided some insight into the changes experienced from the shift to teletherapy.

A SINGLE CENTER COHORT ANALYSIS COMPARING ENDOSCOPIC ULTRASOUND FINE NEEDLE ASPIRATION BIOPSY FOR SOLID PANCREATIC LESIONS USING RAPID ON-SITE EVALUATION (ROSE) WITH IN-ROOM PATHOLOGIST VS TELECYTOLOGY

Background: Rapid On-Site-Evaluation (ROSE) with an in-room pathologist (ROSE-P) has been shown to improve the diagnostic yield of specimens obtained from patients undergoing Endoscopic Ultrasound Fine Needle Aspiration Biopsy (EUS-FNAB) of pancreatic lesions. Recently, there has been an increased interest and utilization of telecytology (ROSE-T) to address social distancing during the COVID-19 pandemic and to optimize clinical workflows. With ROSE-T, a technician equipped with a video conferencing capable microscope unit prepares the EUS-FNAB cytology slides, which are then examined by Cytopathologists remotely. The purpose of this study is to compare diagnostic outcomes of ROSE-P prepandemic with ROSE-T during the COVID-19 pandemic. Methods: A single-center mixed retrospective-prospective cohort study of patients who underwent EUS-FNAB of solid pancreatic lesions with ROSE was conducted. All patients who underwent EUS-FNA were entered into a prospective database. The retrospective arm was patients who underwent ROSE-P pre-pandemic, whereas the prospective arm was patients who underwent ROSE-T during the pandemic. 165 patients in each group were needed to detect a 10% difference in diagnostic yield between the two groups, based on sample size calculation. An interim analysis was performed based on available data. Statistical analyses were performed using descriptive statistics and univariate analysis. Results: A total of 295 patients were enrolled in the study. 168 (57%) were in the ROSE-P group and 127 (43%) in the ROSE-T group. ROSE-T was associated with significantly more needle passes than ROSE-P (3.7 vs 3.0, p<0.0001). There was increased use of 22-gauge needle and decreased use of 25-gauge needles with ROSE-T during the pandemic (p = 0.012). There was no difference in age (63.4 vs 66.3, p=0.14), gender (43.5% vs 48.8 female gender, p=0.36), means mass size (27.2 vs 27.5 mm, p=0.14), mean procedure time (48.2 vs 46.2 minutes, p=0.92), adverse events (0.6% vs 0%, p=0.38), or diagnostic yield (97% vs 98.4%, p=0.38) between ROSEP and ROSE-T respectively. Conclusion: Rapid on-site evaluation using Telecytology was associated with more needle passes and more frequent use of 22-gauge needles as compared to ROSE-P;however, there was no difference in other important outcomes such as diagnostic yield, procedure time, and adverse events. (Table Presented)

Online workshop proposal on sleep hygiene during the COVID-19 pandemic

Introduction: Inadequate sleep habits can compromise the quality of sleep and performance in activities of daily living of the individual, even more, considering the COVID-19 pandemic, which significantly interfered in the sleep and mental health of the population. Objective: To encourage the perception of habits that negatively influence the sleep quality of young people during social isolation in times of COVID-19. Methods: A workshop was proposed through the Youtube platform, during a scientific event on “Mental Health”. Two speech therapists organized a workshop with the theme “Sleep care practices”. The theme was divided into three parts. First, the basic concepts in sleep, the notion of sleep phase distribution, and consequences of sleep deprivation were addressed. The second part included the explanation and stimulation for self-application of the Mini Sleep Questionnaire (MSQ) from the Epworth Sleepiness Scale (ESS). This MSQ questionnaire was selected because, in addition to being self-administered, it assesses the frequency of sleep-related complaints and the ESS Scale subjectively assesses excessive daytime sleepiness. Finally, the third and last part consisted of reflections on sleep hygiene, with tips on how to improve these behaviors and habits. Results: The interactive proposal based on practice in brainstorming, aimed to generate reflections to participants, seeking to highlight inappropriate points in their routines, in order to enable a new planning of behaviors related to habits that influence the various aspects of sleep hygiene. In eight days of making the video available on the aforementioned platform, 3,624 views and 388 likes were achieved. The total video time was 22 minutes and 20 seconds, with the first part having 5 minutes and 21 seconds, the second part with 6 minutes and 6 seconds and the third with 11 minutes. Conclusion: Through information and communication technologies it was possible to encourage and raise awareness of a considerable population with regard to practices favorable to quality sleep, in a short period of time.

The State of Hospital Infection Services in the UK: National Workforce Survey 2021

Introduction: With the evolution of centralised ‘hub and spoke’ microbiology services, the expansion of infectious diseases as a medical specialty and the advent of joint infection training pathways, the infection services within the United Kingdom (UK) are experiencing a period of rapid change. Despite this, to date there has been no comprehensive description of the distribution of specialty staffing and service provision across the country. To this end, the British Infection Association (BIA), in conjunction with the Royal College of Pathologists (RCPath), has undertaken a national survey of National Health Service (NHS) infection services. Methods: Questions were compiled following consultation with an expert panel including BIA Council members. An online survey was distributed to clinical leads at all UK NHS acute trusts or health boards with inpatient beds and data were collected between April and August 2021. Results: The overall response rate was 72% (108 respondents). The median number of infection consultant full time equivalents (FTE) per service was 6.1 overall (5.6 per 1000 acute beds) although this varied between the devolved nations and was lowest in centres with microbiology specialists only. Forty-three services had three or fewer FTE medically qualified infection specialists. Overall, 17.5% of all funded FTE consultant-level posts were vacant, although this was markedly higher for microbiology-accredited posts (20.3%) than for infectious diseases (ID) (9.3%) or medical virology (14.6%). There were fewer vacancies in centres with ID-accredited consultants;median 1.0 (IQR 0–2.2) versus those with microbiology only;1.8 (IQR 0–2.9). Distribution of non-consultant staff was extremely heterogenous with 44 services having none and 25 having one or less FTE (most of which employed microbiology-only accredited consultants). 30% of organisations reported at least one vacant training post. Half of the responding organisations reported at least one consultant accredited in ID but only 28 provided inpatient care with a total of 520 ‘dedicated’ ID beds, of which 235 were negative pressure side-rooms. Geographically, several large areas of the country lacked inpatient ID capacity and/or ID-accredited consultant expertise. The burden of laboratory-related and reporting work in relation to staffing levels is disproportionately greater at smaller centres;there are a median 7.7 (IQR 5.9–9.5) hours/person/week at centres with three or fewer consultants and 4.0 (IQR 2.1–6.3) at larger centres. Conclusion: Microbiology specialists continue to provide the bulk of infection services across the UK and there is marked geographical variation in staffing with regards to other specialities. With Core Infection Training now producing dual-accredited consultants, there is an untapped potential to expand inpatient ID service provision although the requirement for placements on an existing inpatient ID unit may be limiting this currently. There are extremely high vacancies rates across the country but smaller, microbiology-only centres are hardest-hit with many barely attaining the consultant numbers required to staff a safe on-call rota. Workforce planning with utilisation of the valuable expertise of non-medically-trained staff, such as Clinical Scientists, is urgently needed. The results of this survey, in conjunction with Best Practice Standards recently published by the BIA, RCPath and Royal College of Physicians can inform commissioning and delivery of infection expertise in the context of the aftermath of the COVID-19 pandemic.

Promoting telehealth knowledge, attitudes, and practice by an interprofessional online course

Introduction: The needs and challenges of community-based child development units transitioning to telehealth, starting with the COVID-19 outbreak and later on, led to a collaboration among a governmental, philanthropy, and a non-profit professional organization to develop a practical inter-professional online course. The course aims were to enhance knowledge, attitudes, and willingness to engage in pediatric telehealth and form a professional supporting network. Participants and Methods: 96 pediatric professionals, including occupational therapists (33%), physical therapists (16%), speech and language pathologists (25%), social workers (17%), and developmental psychologists (9%), responded to a survey before and after participation in a 30-hour online training. The training included best practices in telehealth delivered via lectures followed by online discussions to foster sharing of ideas, networking, and empowering participants to translate actions in practice. Results: Significant increases (p <0.01) were found in participants' knowledge of best practices, planning and managing care, working with diverse populations, technology, and guidelines. Participants reported a significant increase in positive attitudes and emotions towards telehealth. Most participants (72%) reported that they plan to use telehealth in their routine practice;27% reported maybe. Feedback on the learning experience was positive, and most learners wrote the course advanced their skills and exceeded their expectations. Conclusion: Training can. Online learning tailored to the learners' needs can promote knowledge, attitudes, and willingness to incorporate telehealth in routine care and foster networks that empower participants to gain and implement practical skills to improve the quality of care.

Placental pathologies and fetal outcome in pregnant women with COVID-19: A retrospective study

Objective: To describe histopathologic findings in the placentas in women with coronavirus disease 2019 (COVID-19) during pregnancy. Methods: In a cross-sectional study, 38 pregnant women with COVID-19 and undergoing delivery between March 2020 and January 2022, were included. The patients had positive polymerase chain reaction (PCR) test for SARS-CoV-2 infection and the placentas after delivery were sent for histopathologic evaluation based on the Amsterdam Placental Workshop Group Consensus Statement and assessed by two pathologists. Results: Our results showed that maternal vascular malperfusion was the most common and was present in 17 cases (44.7%). These features included accelerated villous maturation (36.8%) distal villous hypoplasia (5.3%), placental infarction (5.3%) and intervillous fibrin deposition (10.5%). Other pathologic findings included focal calcification (10.5%), intravillous congestion and hemorrhage (10.5%), sub-chorionic hemorrhage (5.3%), acute villitis, chronic histiocytic intervillositis and delayed villous maturation each in one case (2.6%). Twelve out of 38 cases showed no significant pathologic changes. Fetal outcomes included neonatal intensive care unit admission rate of 13.2%, dyspnea 31.6%, newborn's anosmia 7.9%, intrauterine fetal demise 2.6%, asphyxia 2.6% and neonate COVID infection 5.3%. Conclusions: Microvasculopathy, as a sign of maternal vascular malperfusion, is a common finding in placentas from SARS-CoV-2 positive pregnant women in the present study. Further studies with larger sample sizes and comparative studies between COVID-19 positive and negative, as well as information from patient follow-up are suggested.