Cost Evaluation of COVID-19 Remote Home Monitoring Services' Patients in England during Wave 2 from October 2020-April 2021

Objectives: During the COVID-19 pandemic, the NHS delivered a community-based remote home monitoring service for COVID-19 patients. The service came in two models characterised based on the referral method: home-based care to ensure the right people were admitted at hospital at the right time (named COVID Oximetry @ home (CO@h)) and facilitation of patients' transition when discharged home (named Covid-19 Virtual Ward (CVW)). Patients were provided with pulse oximeters and asked to regularly record and submit oxygen levels and other symptoms to a team of administrators and clinicians via digital means (tech-enable and analogue mode) and/or over the phone (analogue). Our aim was to evaluate the costs of implementing these services in England during wave 2 of the pandemic (October 2020-April 2021). Method(s): We used a top-down approach to describe the costs of setting-up and running the service. 26 sites reported the number of patients and staff members involved in the service, and other used resources. Descriptive statistics and multivariate regression analysis were used appropriately. Result(s): The mean cost per patient monitored was lower in the CO@h service compared to the CVW (527.5 vs. 599.1). The corresponding cost was lower for sites using tech-enabled and analogue data submission mode compared to sites using analogue-only mode for both CO@h (515 vs. 561) and CVW (584 vs. 612) services. The number of patients enrolled in the service and the service type significantly affected the mean cost per patient (b=0.62, p= 0.001;b=-457.99, p=0.05 correspondingly). Conclusion(s): Our analysis offers a model for future research since it covers sites of various sizes and raises questions about different practices within the overall remote monitoring services.Copyright © 2023

Patient and public involvement in the development, delivery and evaluation of a novel engagement intervention in early intervention in psychosis services

Background: The Early Youth Engagement (EYE) project co-developed the first engagement-focussed intervention derived from the perspectives of young people and their families in Early Intervention in Psychosis services. Patient and Public Involvement (PPI) in the EYE-2 study aimed to ensure that the voices of people experiencing first episode psychosis, and carers, were embedded in the refinement, delivery and evaluation of the Early Youth Engagement (EYE-2) approach across the UK. Method(s): The EYE-2 project used a multi-level PPI approach: Each of five sites had a PPI lead, trained and supported by senior PPI researchers. PPI leads convened local Lived Experience Advisory Panels (LEAPs), and co-delivered staff and researcher training. Practical challenges were identified and resolved. Results and Impacts: Tangible PPI impacts included: the co-produced revised booklets and EYE-2 website https://www.likemind.nhs.uk following workshops of over 40 people;the delivery of on average 52 peer-led intervention social groups at each site, allowing people to connect with peers with lived experience and build a sense of optimism, shared identity, interpersonal skills and problem-solving in a social environment, with activities driven by service users. Written outcomes included a PPI-led booklet on running peer-led social groups, a person-centred telephone interview for the HoNOS questionnaire for use during the Covid-19 pandemic, peer reviewed papers, blogs and video logs. Conclusion(s): PPI was integral to the delivery of the EYE-2 study;the multi-level approach facilitated a diversity of voices across different aspects of the study and ensured that people with lived experience shaped the intervention, research design and implementation.

ID: 206479 An Evaluation of Psychological Wellbeing in Neuromodulation Patients During a Global Pandemic

Introduction: Bart's Neuromodulation Centre is a center of excellence for research and innovation. In the UK, the NICE 159 guidelines have highlighted the importance of psychological and multidisciplinary assessment to ascertain the suitability of patients for Neuromodulation. The global pandemic of Covid-19 has had far-reaching physical, psychological, and socioeconomic implications. Despite the various limitations of running services during a pandemic, Barts Neuromodulation Centre maintained the importance of multidisciplinary assessment in the selection of patients suitable for this form of therapy. This paper presents psychological wellbeing outcomes of neuromodulation patients during this unprecedented period. Method(s): Data collection was gathered remotely between January 2021 to December 2021.N=178 completed questionnaires. The mean age was 55 years and 63% were female. Data was collected at baseline and in addition, post-implant data was obtained at 1,3,6 and 12 month follow up. As per NHS England outpatient guidance (2020), all data was completed remotely. All collected data was anonymized and data was stored on an encrypted database. Result(s): Results showed a 78% decrease in depression scores from baseline to 2 years+ and a 76% decrease in anxiety scores from baseline to 2 years+. Conclusion(s): The data demonstrates significant improvements in psychological wellbeing as shown in depression and anxiety scores after SCS therapy. Despite the global pandemic, there remains a strong demand for SCS and encouragingly showed significant improvements in psychological wellbeing. It would be useful to explore ways to improve patient compliance and explore broader parameters of outcomes. Disclosure: Angie Alamgir, PHD: None, Serge Nikolic, MD: None, Habib Ellamushi: None, Amin Elyas, FRCS: None, Joanne Lascelles, Clinical nurse specialist: None, Kavita Poply, PHD: None, Sanskriti Sharma: None, Alia Ahmad, MSc: None, Vivek Mehta: NoneCopyright © 2023

COVID-19 in Ultramarathon Runners: Findings of The Ultrarunner Longitudinal TRAcking Study

Purpose: Ultramarathon runners are a unique patient population who have been shown to be free of nearly all severe chronic medical conditions. The effect that COVID-19 infection has on this population and their running behavior is unknown. Method(s): The Ultrarunner Longitudinal TRACking Study (ULTRA Study) is the largest known longitudinal study of ultramarathon runners. Questions on general health status, running behavior, performance, and COVID-19 infection were included. Result(s): Six hundred sixty-two ultramarathon runners participated in the study. This group exercised an average of 10.0 hours per week, including running an average of 26.8 miles per week;52.1% of ultramarathon runners reported ever being symptomatic from a COVID-19 infection with 6.3% testing positive multiple times. Severe infection occurred in 0.3% (2 patients) requiring a total of 3 days of hospitalization. Of those who were infected, 84% were fully vaccinated at the time of their infection;67% of infections effected running for a mean of 33.1 days. The most common other symptoms included fever (73.3%), fatigue (68.7%), sore throat (67.5%), runny nose (67.0%), and cough (66.7%). Cardiovascular symptoms, which are of particular interest in the running population, included shortness of breath (46.4%), increased heart rate (45.2%), chest pain (34.2%), and wheezing (32.5%). Of 662, 48 (7.3%) of ultrarunners reported Long COVID (symptoms lasting more than 12 weeks). Conclusion(s): Severe COVID-19 infection is rare in ultramarathon runners, although symptomatic infection that affects running is common. These rates, along with Long COVID, are lower than is reported in the literature for the population on average. Significance: Ultrarunners are at very low risk of COVID- 19 symptoms requiring hospital care but significant risk of infection that effects running. Cardiovascular symptoms are common, and the long-term significance of these symptoms in runners is unknown.

Resource Utilization in a Post-pandemic World

Extracorporeal Membrane Oxygenation is a resource intensive therapy;heavily reliant upon specialized equipment, unique disposables, and skilled staff. The Covid-19 pandemic and following events exposed flaws in multiple phases of the care delivery system. The combination of high patient census, acuity, manufacturing delays, and supply chain disruptions led to our center's reassessment of the way in which limited resources are utilized. As a combined pediatric and adult center, we possess the ability to share resources amongst all patient populations. Currently, the majority of our equipment and disposables support a heavier use of Centrimag. We adjusted our general weight guidelines in order to best serve the most patients. (<8kg Sorin Rollerhead, 8-20kg Sorin Revolution, >20kg Centrimag.) Presently, a major challenge is the cessation of production of the -inch Better Bladder. The ECMO Coordinator team collaborated with key physician stakeholders. It was decided that the fluid reservoir and air trap benefits of a bladder outweighed the risks of running without one on our Sorin Rollerhead circuit. We designed a circuit with a 3/8 Bigger Better Bladder. Recognizing the increased risk of clotting with the 3/8 segment, we added a post-oxygenator shunt. This allows for adequate blood flow to maintain circuit integrity, while limiting the amount of flow to the patient. The nationwide nursing shortage is well-known. Though our multidisciplinary ECMO Specialist Team supports nursing and respiratory therapy, the nursing shortage still impacts our staffing models, resulting in the inability to safely staff bedside nurses and ECMO specialists. At times of high census, ECMO patients are cohorted into one geographical location. This allows for a temporary 2:1 staffing model for Centrimag patients. Our goal remains to staff pediatric cases as a 1:1 ECMO Specialist assignment. The ability to obtain this is assessed shift to shift;factoring patient stability, experience of the ECMO specialist, and unit staffing. The collaboration with ICU Nurse Managers, Hospital Supervisors and Central Staffing Office is imperative to the success of staffing model alterations. Our ECMO department has increased its FTEs, implementing a core team to be preassigned to two ECMO beds. The objective is to alleviate the burden on ICU staffing, limiting the number of nurses pulled from staffing grids. In uncertain times, flexibility is vital. It is important to remain vigilant and proactive. Our ECMO program feels that continuous assessment of supplies, equipment, and open communication has been the key to successfully serving our patients.

"Running makes me feel horizontal ellipsis ": The production of emotion through leisure

Using data from twenty 'running autobiographies' - written or voice-recorded reflections - we examine runners' changing emotional relationship to running during the COVID-19 pandemic. We review the complex, often fluid, and occasionally contradictory ways that leisure pursuits produce emotion, and how emotions shape subjects and communities. Mainstream conceptualisations of amateur running often frame it as a tool with which runners modulate their emotions. For example, running is commonly celebrated as a way of controlling stress or improving mental health. This approach is premised on the interiority of emotion - the idea that emotions reside within the runner. Conversely, our approach is concerned with how the practice of running and the circulation of the running body as an object produces emotion. We argue that understanding why and how people run, and what the running body does hinges on understanding the productive capacities of the running body - not only what emotions they bring into a run - and how, through its circulation, the running body produces social affects and emotions.

Outcomes of LEGA-C programs: a review of implementation science projects toward HCV elimination by 2030 in Asia

Background and Objectives: The WHO has identified HCV infection as a public health threat and set a global target for HCV elimination by 2030, yet currently only 11 countries are on track to achieve HCV elimination targets. Up to 60% of HCV + patients are lost to follow-up and remain untreated and this has likely been further exacerbated by the COVID-19 pandemic, which may have reduced HCV treatment urgency, causing many patients to delay care. To achieve the WHO goal, still many patients need to be screened and linked to care. Gilead has been running Local Elimination Programs Leading to Global Action in HCV (LEGA-C) to support implementation science projects toward HCV elimination. Here, we explore the outcomes of LEGA-C programs for patients with HCV especially in Asia. Method(s): The outcomes and impact were measured through the number of studies and patients to be reached;steps in the care cascade as well as efficacy of each model were assessed along with the presentations and publications from each study. Result(s): In total,[120 studies were supported. Of these, 18 have completed or are ongoing in Asia. Through July 2022, 175,192 persons were screened, 6,287 were HCV + and enrolled in a study, and 3,768 received treatment. A simplified screening and linkage to care/ minimal monitoring model was investigated in 8 studies and demonstrated that linkage to care with minimal monitoring could achieve antiviral response comparable to standard practice.[i] Four test-and-treat studies showed that aggressive screening and on-site treatment promotes HCV microelimination.[ii] Three outreach-andcallback studies showed demonstrated the feasibility of recruiting persons to HCV screening programs in community settings.[iii] Seven studies focused on special populations, and 4 of them described the characteristics of special populations with higher rates of HCV infection. Publications from these studies in Asia include 14 full articles, and these papers were cited a total of 56 times. Conclusion(s): The ongoing LEGA-C initiative is demonstrably contributing to the understanding, treatment, and ultimate elimination of HCV. Innovative ideas, active promotion of HCV testing, disease education, patient navigation, and care coordination in these programs led to increased screening and rates of linkage to care. Adopting and adapting effective strategies from these programs may be a feasible way to increase treatment numbers and improve patient outcomes, thus contributing to meeting the WHO goal of HCV elimination in Asia.

Investigating Novel Risk Factors for Training Injuries Among Runners of the New York City Marathon

Purpose: Given the high incidence of injury duringmarathon training, a better understanding of the factors associated with injury is needed. The purpose of the study was to investigate an expanded set of baseline factors of marathon runners to determine the association with injury during training. Method(s): Adult registrants of the 2022 New York City Marathon were recruited by email for a 16-week observational study. The baseline survey included demographics, running/injury/COVID history, race goal, orthotic use, grit scale, risk-taking scale, injury risk self-assessment, happiness and life satisfaction scales, and perceived risks of running. Injury surveys were collected weekly during training. Result(s): A total of 894 runners registered for the study and were uninjured at the start of the study. Average age was 44.5 years (standard deviation 11.8), 55% were female, and 76% had previously participated in a marathon. During the 16 weeks before the race, 221 of 894 (24.7%) experienced an injury, including 36 of 894 (4.0%) who did not participate in the race. Each of the baseline factors were assessed in a logistic regression model controlling for age, sex, body mass index, base weekly mileage, and number of prior marathons. The baseline factors associated with injury were orthotic use (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.12-2.74, P = 0.01), happiness (OR 0.71, 95% CI 0.58-0.88, P = 0.001), and injury risk self-assessment (OR 1.13 for each 10% selfassessed risk, 95% CI 1.05-1.21, P = 0.001). There was no association with age, sex, body mass index, running/injury/ COVID history, race goal, grit, risk-taking behavior, life satisfaction, and perceived risks of running. Conclusion(s): Although age, sex, experience, and history of injury have been previously identified as risk factors for running-related injury, this was not the case in this large cohort of runners training for a marathon. Instead, orthotic use and self-assessed risk of injury were associated with higher rates of injury training, and a higher level of happiness was associated with lower rates of injury. Significance: The results show the value of a comprehensive running injury risk assessment, which could be standardized to facilitate comparative research. Accounting for these factors is important when assessing future injury prevention interventions.

Measurement Uncertainty of D-Dimer Measured by the Particle Enhanced Immunoturbidimetric Assay

Objectives: D-dimer is a fibrin degradation product resulting from the degradation of fibrin polymers by plasmin. Although its main use is the evaluation of thromboembolic events, it is also used as an indicator of inflammation. In the recent COVID-19 pandemic, there has been a significant increase in its use as a biomarker. In this study, it was aimed to calculate the measurement uncertainty of D-dimer measured by particle enhanced immunoturbidimetric assay (PETIA). Materials-Methods: D-dimer measurements were made with the PETIA method (Improgen, Turkey) on the CoagXL (Diagon, Hungary) device installed in the Kulu State Hospital Laboratory. Uncertainty due to calibration and calibrator bias was calculated by running the Procal-D-dimer-DDI0511 (Improgen, Turkey) calibrator 10 times. Serocon external quality control data of the last 3 months were used for uncertainty arising from external quality control. Uncertainty due to repeatability was calculated using internal quality control data from the last 60 days studied with Serocon DDIM. Result(s): For D-dimer test, uncertainty due to repeatability was calculated as 0.0168, squared of uncertainty due to external quality control as 0.0123, uncertainty due to calibration 0.0250, and uncertainty due to calibrator deviation 0.0195. The standard uncertainty (uc) was 0.116 and the expanded uncertainty (%U) was calculated as 23%. Conclusion(s): In this study, the measurement uncertainty of the D-Dimer test measured by the particle-enhanced immunoturbidimetric assay was calculated as 23%. Interpretation by taking this measurement uncertainty into account, especially at medical decision levels, will contribute to the use of the measurement result for the benefit of the patient.

Impact of probiotic supplementation on exercise endurance among non-elite athletes: study protocol for a randomized, placebo-controlled, double-blind, clinical trial.

BACKGROUND: Some probiotics appear to improve athletic performance, endurance, and recovery after intense exercise. Other formulations may provide performance-related benefits via immune and gastrointestinal functions in athletic individuals. However, few formulations have been studied for both types of effects among non-elite athletes. The primary objective of this study is to assess the ergogenic effects of a probiotic on high-intensity endurance running performance in non-elite runners. Secondary objectives include assessment of perceived exertion, blood chemistry, immune and stress biomarkers, cold and flu symptoms, and gastrointestinal health after the probiotic intervention. METHODS: This 9-week randomized, placebo-controlled, double-blind, parallel trial will assess the ergogenic effects of a probiotic (5 billion colony-forming units/day, for 6 weeks) in healthy, non-elite runners (N=32; 18-45 years). Participants will be monitored via daily and weekly questionnaires during the 2-week pre-baseline, 6-week intervention, and 1-week washout. Questionnaires will inquire about activity, muscle soreness, gastrointestinal symptoms, cold and flu symptoms, stool form and frequency, and adverse events. During the pre-baseline visit, maximal oxygen uptake (V̇O2 max) is assessed to set appropriate individualized workload settings for the treadmill time-to-exhaustion endurance tests. These time-to-exhaustion endurance running tests will be completed at an intensity of 85% VO2max at baseline and final visits. During these tests, self-perceived exercise effort will be rated via the Borg Rating of Perceived Exertion scale and finger sticks assessing capillary blood glucose and lactate concentrations will be collected every 3 min. Additional questionnaires will assess diet and motivation to exercise. Body composition will be assessed using air displacement plethysmography at the baseline and final visits. Hypotheses will be tested using two-sided tests, and a linear model and with a type I error rate of α=0.05. Primary and secondary outcomes will be tested by comparing results between the intervention groups, adjusting for baseline values. DISCUSSION: These results will build evidence documenting the role of probiotics on running endurance performance and physiological responses to exercise in non-elite athletes. Understanding the potential mechanisms of probiotic effects and how they mitigate the intestinal or immune discomforts caused by running could provide additional strategy means to help runners improve their performance. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04588142 . Posted on October 19, 2020. PROTOCOL VERSION: July 2, 2021, version 1.2.

COVID-19 and the accounting impact during pandemic times

The objective of the current article is to present some of the main effects that the COVID-19 pandemic, between 2019 - 2021, had on the accounting records of entities and, that they should be recognized. either as an adjustment or as disclosures with the goal to comply with transparent accounting information and present its users with an adequate financial situation and its true performance. This essay is a result of investigations being conducted on different IFRS texts (issued by the IASB), as well as an analysis by the author regarding the norms and their expected account impact. It's important to mention that, the judgment or professional criteria from the entity's accountant, plays an important role at the moment to evaluate the present (and future) impact as it pertains to the application of the financial norms into this new reality produced by the pandemic. Therefore, COVID-19 affected not only people's health, but the world economy and-therefore- the economy of the companies' financial reflections, thus originating several changes in the accounting tasks and the closing of the financial statements, both in the accounting calculation, taxes and even in the labor fields. This article then seeks to measure such accounting impacts on the company's financial situation and its performance.

Food insecurity and eating behavior prior to the COVID-19 pandemic. An exploratory study in Venezuela.

Background: The aim of this research was to explore how food insecurity affected food behavior prior to the COVID-19 pandemic (year 2018-2019) in a sample of people residing in nine administrative regions of Venezuela. Method(s): 1099 people aged between 17 and 75 years participated, with a majority residing in the Andes, Capital and Central regions of the country. A reduced version of a modified national survey on living conditions (Encovi-2017) composed of 11 questions was administered. Estimates with chi square (chi2) were made to verify associations between the characteristics of the sample (age, region of origin and sex) with the approaches of the administered survey. Result(s): A high degree of food insecurity was observed as people reported concerns about food access (88.95%), or lack of them (55.79%), periods of food deprivation and alteration of eating patterns. Those participants under 21 years were more likely to alter their daily intake pattern (p = 0.01), with women being the most affected in terms of the family running out of food in the last three months (p = 0.020) and if in the last trimester a whole day had gone without eating (p = 0.05). Conclusion(s): The study shows that women and young people under 21 years of age or middle-aged adults and inhabitants of the Capital region turn out to be the people most affected by food insecurity as they consumed less food or ate fewer servings per day. The data reveal a worsening of the food situation.Copyright © 2022 Sociedad Espanola de Nutricion Comunitaria. All rights reserved.

Kidney stone detection using an optimized Deep Believe network by fractional coronavirus herd immunity optimizer

In this study, a computer-assisted kidney stone diagnosis system based on CT images has been proposed. The method is based on a combination of deep training and metaheuristics. The method aims to provide a customized Deep Believe Network (DBN) based on a fractional version of the coronavirus herd immunity enhancer to provide an efficient and reliable kidney stone diagnosis system. The designed method is then authenticated by running a standard benchmark called a "CT kidney dataset". Subsequently, a comparison is made between the results and some other state-of-the-art methods. Simulations show that the recommended DBN/FO-CHIO outperforms the other studied approaches in terms of efficiency with an accuracy of 97.98%. Moreover, the proposed DBN/FO-CHIO recall outperforms others with 92.99%, demonstrating its excellent accuracy compared to other comparison algorithms. Moreover, the higher specificity of the proposed method compared to the other evaluated approaches indicates its advanced event-independent value.Copyright © 2023 Elsevier Ltd

Croydon Neurology: Assessing the Impact of the Introduction of Patient Initiated Follow-Up

NHS England identified Patient Initiated Follow Up (PIFU) as part of NHS COVID-19 recovery, in line with the personalised- care agenda. We aimed to assess how the introduction of PIFU for neurology patients at Croydon University Hospital (CUH) has impacted patient outcomes, capacity and non-elective admissions. Data were extracted from electronic records on all patients booked into a CUH neurology PIFU appoint- ment from 1st June to 29th October 2021. Data were collected on the number of admissions or outpatient attendances for 5 years pre-PIFU appointment and compared with 0-6 months post-PIFU. 355 patients had a PIFU appointment at CUH neurology between 1st June and 29th October 2021. The most common neurological conditions prompting a PIFU appointment were epilepsy (40%), multiple sclerosis (22%) and Parkinson's disease (12%). The average number of outpatient appointments reduced from 11.0 pre-PIFU to 1.5 post-PIFU. The average number of ED attendances reduced from 3.1 pre-PIFU to 0.4 post-PIFU. Although there are significant limitations in this study (inadequate time since appointment, the pandemic), we remain keen on PIFU and had been running an advice line service before it was labelled as PIFU. Further follow-up data and patient satisfaction data is needed.

"Running makes me feel …”: The production of emotion through leisure

Using data from twenty ‘running autobiographies' – written or voice-recorded reflections – we examine runners' changing emotional relationship to running during the COVID-19 pandemic. We review the complex, often fluid, and occasionally contradictory ways that leisure pursuits produce emotion, and how emotions shape subjects and communities. Mainstream conceptualisations of amateur running often frame it as a tool with which runners modulate their emotions. For example, running is commonly celebrated as a way of controlling stress or improving mental health. This approach is premised on the interiority of emotion – the idea that emotions reside within the runner. Conversely, our approach is concerned with how the practice of running and the circulation of the running body as an object produces emotion. We argue that understanding why and how people run, and what the running body does hinges on understanding the productive capacities of the running body – not only what emotions they bring into a run – and how, through its circulation, the running body produces social affects and emotions. [ FROM AUTHOR] Copyright of Leisure Studies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The Role of Collaborative Observational Practice and Feedback-Discourse to Promote Remote Acquisition of Technical Surgical Skills.

INTRODUCTION: Acquisition of technical skills remotely in a decentralized model requires an efficacious way of providing feedback. The primary objective was to test the efficacy of various forms of feedback on the acquisition of surgical skills by medical students. METHODS: Forty volunteers were randomized to four experimental groups, differing from the nature of feedback (free text versus structured) and who provided the feedback (expert versus peer learners). They had to perform sutures and upload attempts on a learning management system to receive interactive feedback. The pretest and retention test performances were assessed. RESULTS: All groups significantly improved from pretests to retention tests; however, participants using checklist showed statistically lower improvements than the other groups, which did not differ from each other. CONCLUSIONS: Remote learners can acquire surgical skills, and most importantly, peers who provide feedback, are as effective as experts if they use open-ended comments and not checklists.

Impact of an online breathing and wellbeing programme (ENO Breathe)in people with persistent symptoms following COVID-19: a randomised controlled trial

Aims: ENO Breathe is an online breathing and wellbeing programme for people with Long COVID focusing on breathing re-training using singing techniques. Aim(s): to assess whether ENO Breathe improves health related quality-of-life (HRQoL) in people with persistent breathlessness following COVID-19. Method(s): A parallel-group, single-blind, RCT, comparing ENO Breathe(6 weeks) with usual care in adults, with persisting breathlessness +/- anxiety, following assessment at an NHS Long COVID clinic. Primary Outcome: change in HRQoL using the RAND SF-36 Mental(MHC) and Physical(PHC) Health Composite Scores. Secondary Outcomes: CAT, VAS for breathlessness (rest, walking, stairs, and running), Dysp-12, GAD-7. Participant experience was assessed using focus groups and free-text responses. Result(s): 150 participants (mean(SD) 49(12)years, 81% female, 320(127) days symptomatic;ENO Breathe(n=74), Control(n=76). ENO Breathe was associated with improvement in MHC of 2.42 points (95%CI 0.03 to 4.80, p=0.045), but not PHC 0.6 (-1.33 to 2.52, p=0.541). VAS breathlessness (running) favoured ENO Breathe -10.48(-17.23 to -3.73, p=0.003). Three participant experience themes were identified 1) improvements in symptoms;2) feeling that the programme was complementary to standard care;3) the particular suitability of singing and music to address their needs. Conclusion(s): An online breathing and wellbeing programme can improve the mental component of HRQoL and elements of breathlessness in people with persisting symptoms after COVID-19. Mind-body and music-based approaches, including practical, enjoyable symptom-management techniques may have a role supporting recovery.

The impact of a novel dermatology teaching programme on medical students' understanding of and engagement with dermatology

It is well recognized that dermatology education across the UK is variable, sparse and oftentimes entirely absent from undergraduate medical curricula. However, annually 24% of the population in England and Wales present to general practitioners with a dermatological complaint. This quality-improvement project (QIP) aimed to improve medical students' understanding of common dermatological presentations as defined by one university's curriculum. Teaching sessions were conducted with penultimate and final-year medical students on their clinical placements. A questionnaire was used to establish student confidence levels at baseline, and following each session relating to various learning outcomes. Session 1 covered describing lesions with interactive cases, while session 2 included Objective Structured Clinical Examination (OSCE)-style scenarios for mock examination. Quantitative data were analysed using Microsoft Excel and qualitative data analysed using framework theory. A total of 67 datasets were analysed for key curriculum aspects as per university dermatological curriculum. Mean quantitative self-reported confidence levels preteaching (mean across all domains 6.04), post-cycle 1 (mean 7.62) and postcycle 2 (mean 8.01). A statistically significant improvement was identified in confidence for the domains 'confident describing cutaneous signs' (P = 0.026;Mann-Whitney U-test), 'management of chronic dermatological conditions' (P = 0.028), 'management of acute severe dermatological conditions' (P = 0.003), 'management of common benign, premalignant and malignant skin conditions' (P = 0.014), 'management of immunobullous skin conditions' (P = 0.004) from baseline to cycle 1, and 'dermatological history taking skills' (P = 0.232), 'examining skin' (P = 0.008) and 'dermatological prescribing' (P = 0.004) from baseline to after cycle 2. Thematic analysis of open-question feedback revealed that students found this teaching session useful, particularly with the examination-style of the sessions. Key areas to improve on included inclusion of ethnic skin types in the teaching. The statistically significant increase in student confidence levels suggests that the teaching programme was successful, thus our QIP outcomes were achieved. Furthermore, one can assume running similar programmes across other medical schools would be beneficial, particularly as dermatology education is underrepresented and variable across medical schools' curricula. Use of visual aids and a problem-centred approach is an effective tool that can be easily integrated into dermatology teaching. We aim to pursue further work to complete additional sessions, particularly focusing on the inclusion of ethnic skin types, which was identified as a key improvement point from students and reflects existing literature. Given the restrictions imposed by the COVID-19 pandemic, e-learning is vastly developing and we could also consider, in a repeat cycle, the use of video technology to help provide educational equality.

A novel approach to systemic monitoring in a pandemic

One of the many logistical challenges facing our dermatology department during the COVID-19 pandemic was how to continue safely the systemic monitoring of dermatology patients on immunosuppressive medication and retinoids. The majority of these patients in our tertiary referral centre are entirely monitored by the hospital, with general practitioners having little/no capacity to manage shared care. Lack of ability to carry out routine face-to-face appointments acted as a catalyst for the service to evolve rapidly, from all monitoring appointments being clinician led to a structure whereby stable patients had at least one annual clinician review with regular monitoring appointments in between. We have created, assessed and adapted a new system for patients and staff. At the onset of the pandemic, to explain the new system to them, patients were contacted by letter and telephone. Initially, doctors made entries into patients' electronic notes to state which tests/follow-up they required. This was laborious, often missed and needed to be filled in for every visit. We therefore created a standard online proforma to check patients medication details/required tests, which could be updated easily. Although all clinician-led reviews remained with the patients' original team, blood/monitoring results for all patients were reviewed by one of four consultants as a planned activity and prescriptions were issued for home delivery if the results were satisfactory. Patients also completed a form each visit stating if they wanted to highlight any issues with their medication/condition to their doctor. Qualitative data were collected from patients and staff through a pre- and postchange questionnaire 6 weeks after roll out. The pre-proforma questionnaire identified concerns such as nurses' lack of confidence in which tests were required, prescription duplication/ error and patient confusion, particularly not being able to collect prescriptions on the day of monitoring, which resulted in some patients temporarily running out of medication. The post-electronic proforma questionnaire demonstrated a useful and easily accessible resource for the staff, which - on the whole - reduced workload. Although some patients struggled to adapt, the majority were satisfied. The COVID-19 pandemic has forced sudden changes in practice, but, in our experience, this can result in safe, more efficient and sustainable new ways of working. We demonstrate a system whereby patients can receive regular hospital monitoring without seeing the doctor at each visit. This is important when considering service provision throughout the ongoing pandemic and - given that consultant time is limited and costly - in considering future structuring of dermatology services.

Cerebral Air Embolism During a Flight

Introduction: We report a case of a 67 year old lady with an acute drop in conscious level whilst on a transatlantic flight. She had a background history of TII DM and recent mild COVID. Past surgical history of a gastric bypass, at which time a CXR had incidentally shown a bulla, with no underlying respiratory symptoms, or history of COPD. Method(s): On arrival in the emergency department, her GCS was 7/15, and she required immediate intubation. Non-contrast CT head showed multiple tiny gas locules in keeping with air emboli. CT Chest, Abdo, Pelvis showed an 88mm bulla within the left lung lingula with a bronchus and many large pulmonary vessels running on its edge. Result(s): It was thought the change in air pressure during the flight caused a communication to open between the bulla and the pulmonary circulation resulting in the release of air emboli. Conclusion(s): She required ITU admission for 8 days. After initial stabilisation she was stepped down to HASU. Neurologically she was dysphagic, dysarthric, quadriplegic and GCS 14 due to confusion. MRI whole spine ruled out spinal cord pathology. Repeat CT head showed air initially present had completely resorbed leaving multifocal, small areas of cortical and subcortical ischaemia in both cerebral hemispheres. MRI head confirmed innumerable small early subacute embolic ischaemic infarcts across multiple vascular distributions.