Buzzo or Eureka - Robot that Makes Remote Participants Feel More Presence in Hybrid Discussions

Teleconferencing technology has been widely used in the context of the covid-19 pandemic. However, local and remote participants always have a poorer experience of hybrid discussion for various reasons in the leaderless group discussions with mixed online and offline members. In this paper, this phenomenon is explored through an early pilot study. We found problems with the lack of presence of remote participants in hybrid discussion sessions, as well as unclear information about the status of members. To solve such problems, we've designed a social robot called SNOTBOX. The bot indicates the participation status (marginalized or not) of the remote participant using "Buzzo" and the remote participant's desire to be heard through a "Eureka". We used both representations to attract the attention of local participants as a way to enhance the presence of remote participants in the conference. SNOTBOX is easy to produce and allows for DIY customization, and also supports multi-participant online discussions. © 2023 IEEE Computer Society. All rights reserved.

Skills Training in Affective and Interpersonal Regulation Narrative Therapy Delivered via Synchronous Telehealth: A Case Study of a Rural Woman Veteran With Complex Posttraumatic Stress Disorder

The International Classification of Diseases-11 th Revision (ICD-11) includes the diagnosis of complex posttraumatic stress disorder (CPTSD). Clinical practice guidelines support the use of phased care for individuals with CPTSD. This case study illustrates the use of synchronous telehealth to deliver phased treatment to a rural woman veteran with CPTSD. Mrs. A experienced sexual, physical, and emotional abuse throughout her life, perpetrated by family members, intimate partners, and military authority figures. She sought treatment for posttraumatic nightmares and body image issues;she also had pain related to fibromyalgia and chronic migraine headaches. Mrs. A participated in 19 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative therapy via synchronous telehealth. Trauma and eating disorder symptoms were assessed before and after treatment and the patient demonstrated clinically significant improvement on measures of these disorders. Patient-provider working alliance and quality of life were assessed post-treatment. Synchronous telehealth use drastically increased with the onset of COVID-19;however, little information on treating CPTSD via synchronous video teleconferencing is available. This case study illustrates an evidence-based, phased therapy for CPTSD while highlighting the feasibility and value of in-home delivery of psychotherapy for CPTSD via synchronous telehealth.Copyright © The Author(s) 2023.

A Rapid Evaluation of Virtual Grief Cafes across Two National Public Health Organisations

Introduction Restrictions during the COVID-19 pandemic adversely impacted bereavement as: visiting the dying, funerals, family meetings, access to bereavement services were disrupted. Pandemic work at Public Health England and Test and Trace was unrelenting. Enforced home working enhanced isolation. Many colleagues experienced difficult bereavements with little access to normal support networks. Aims To further understand how a workplace grassroots virtual grief cafe can support the bereaved. Methods A grassroots group of bereaved staff and/or with bereavement expertise, established virtual bereavement cafes in May 2021, run by staff for staff. MS Teams (video teleconferencing, chat, signposting to resources) provided a safe, supportive meeting space. Facilitated Cafes are held fortnightly, with mental health first aiders present. Ground rules emphasised respect, confidentiality, the validity of all types of grief and all deaths (pre or during the pandemic). Chat and emojis offered support. Post cafe email and phone follow-up was offered. Additional themed cafes supported: Grief Awareness Week, the Queen's death, Pregnancy or Infant loss and bespoke sessions run for teams whose colleague had died. A rapid qualitative thematic evaluation to better understand participants experience of grief and how the cafes have helped was carried out in 2022. Results Between 9-34 staff attend with new participants at each session. All types of grief have been experienced: anticipatory, complicated, cumulative and disenfranchised grief - often in combination. Participants' feedback has been thematically grouped related to their experience of the Grief Cafes, specific workplace challenges, and the impact of the pandemic on grief. Conclusions There is a significant level of unresolved and complex grief following the COVID-19 pandemic in workingage people. Impact Virtual cafes provide critical emotional support in geographically dispersed organisations. They work best linking with and driving compassionate workplace policies.

Radiotherapy teaching during COVID-19: An emergency teaching response

Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in more than six million deaths in the first two years, a third of the estimated number of cancer-related deaths during this time. It directly impacted radiotherapy training in Africa. Aim(s): This study evaluated the changes applied to the Access to Care Cape Town Radiotherapy training programme during the pandemic. Setting(s): The training platform prior to March 2020 was used as a baseline and compared with the programme status in January 2022, representing the emergency teaching model. Method(s): Five themes were investigated: computer hardware and software changes;e-Learning resources;programme and curriculum changes;challenges experienced and alignment with modern medical education principles. Result(s): Reconfiguration of the computer laboratories was required, including additional computer monitors, web cameras and headsets, as well as installation of screen recording and teleconferencing software. The EclipseTM radiotherapy treatment planning laboratory was reconfigured for remote student access, with simultaneous monitoring by local assistants. Online learning was augmented by adding the University of Cape Town VulaTM system as resource, and courses restructured for delivery of short blocks. Five new courses were developed, including collaborations with international training partners, showing good alignment with the principles of modern medical education. Conclusion(s): Reconfiguration was performed at a manageable cost but required a high level of information technology support. Connectivity and bandwidth issues remain a challenge, as well as online engagement. Contribution: Despite these challenges, the virtualisation allowed for continued training between March 2020 and December 2021, with 18 departments attending remote teaching courses. Copyright © 2022. The Authors.

Consulting with Children and Parents to Cocreate Resources About Receiving Paediatric Outpatient Parenteral Antimicrobial Therapy (Opat)

Aims We aim to showcase how we engaged with children and their parents via a teleconferencing platform (Zoom) using the power of illustration to trigger their recall of going home on outpatient parenteral antimicrobial therapy (OPAT). This co-creative consultation work was conducted to address the need, identified by children and parents in a previous research study, for enhanced preparation and information about OPAT. Methods Children (n=4) who had received OPAT and their parents (n=4) were invited to participate by clinicians in the OPAT team at the children's tertiary centre. The children were sent specifically designed activity sheets asking them about their experiences in advance of an online activity consultation via Zoom. There was no set schedule for the online activity, instead conversation was triggered by the researchers asking the children about their drawings and responses in their completed activity sheets. Meanwhile, the illustrator listened, shared their screen, utilised the children's drawings and words and created new images that brought to life, in realtime, the experiences children and their parents shared. Children and their parents were in control of the process as they could direct, confirm or alter the drawings that appeared on the screen and ask for text to be added. Results The freely available, co-developed resources include a 3-minute long animation (figure 1) and an information leaflet (figure 2), has been designed by and for children and their parents. Although remote engagement with children has become more commonplace, the use of real-time, co-creation based on children's illustrations and augmented by professional illustration and animation during the online activity is novel. The strengths (e.g. children enjoyed the approach) and limitations (e.g. reliance on stable Wi-Fi) of this approach have been explored. The findings from this consultation aligned with and added depth to understanding the experiences of children and parents about being at home on OPAT. Link to animation: https://www.youtube.com/watch? v=JERVuqmLLDM Link to information leaflet: https://figshare.edgehill.ac.uk/ articles/figure/Things-you-might-like-to-know-about-having- your-medicine-at-home-information-leaflet-OPAT-/ 19180895/1 872 Figure 1 872 Figure 2 Conclusion The COVID-19 pandemic has had a profound impact on the way consultation activities are conducted. This illustration driven, virtual consultation method with children receiving OPAT and their parents was successful and allowed the co-creation of free resources for other children and parents to use. Rather than constrain what was done, using virtual methods meant that children and their parents were able to engage with and co-create ideas for resources from the comfort of their own homes.

The Reduced Environmental Impact of American Radium Society's 2021 Virtual Annual Meeting

Background: In response to the threat of the COVID-19 pandemic, the 2021 American Radium Society (ARS) Annual Meeting transitioned to a virtual, online conference. As medical conferences around the world have transitioned to virtual formats, numerous benefits have been uncovered;however, the environmental effect of reduced travel on carbon emissions remains largely unknown. Today, it is estimated that conference attendance accounts for 35% of a scientist's total carbon footprint [1]. Given that the climate crisis is a growing threat to human health and oncology outcomes [2], it is imperative to begin to quantify, understand, and promote sustainable practices. Objective(s): We aim to highlight the reduced travel-related greenhouse emissions associated with the transition of ARS's 2021 Annual Meeting to a virtual platform in comparison to the 2019 in-person conference in Monarch Beach, California. Method(s): Data from the attendees of the ARS Annual Meeting was collected from 2019 and 2021 (the conference was cancelled in 2020). The distance traveled per attendee to the 2019 location (Dana Point, CA) and the 2021 intended conference location (Lahaina, HI) was estimated using the location of the attendees' home institutions. The mode of transportation was hypothesized based on distance traveled (automobiles < 300 miles;airline >= 300 miles). Approximate carbon dioxide (CO2) emissions were calculated using the Environmental Protection Agency's Greenhouse Gas Tools [3,4]. For the 2021 virtual conference, it was assumed that no travel took place. Alternatively, the associated CO2 emissions were estimated based on assumed internet usage (8 hours/day for the 3-day conference period) and food delivery (5 miles) for one meal which was sent free to each attendee. Additionally, the distance that would have been traveled by attendees to Hawaii was estimated. Result(s): A total of 591 conference attendees were identified, 253 in 2019 and 338 in 2021. For the 2019 in-person conference, the total carbon footprint for all assumed methods of transportation was determined to be 187,935.9 lbs of CO2 emissions, with an average of 820.7 lbs of CO2 emissions per attendee. Total emissions were equivalent to the emissions of 18.5 passenger vehicles for one year. Alternatively, the CO2 emissions spared during the 2021 virtual conference was estimated to be 519,153.5 lbs, the equivalent of 51 passenger vehicles for one year. However, emissions related to teleconference internet streaming and food delivery accounted for a total of 2,693.0 and 1535.8 lbs of CO2. Conclusion(s): Incorporating options for virtual attendance at academic conferences has the potential to significantly reduce carbon emissions. However, many believe that virtual networking cannot replace in-person interactions particularly for early-career attendees. Regardless, our professional societies have an obligation to investigate and promote greater sustainability of our annual meetings.

Adaptations in the PURE registry in response to the COVID 19 pandemic: The impact of well-designed modifications in real-world data collection in a psoriasis registry

Introduction: PURE is an international registry of adult patients with moderate-to-severe psoriasis treated with secukinumab (Cohort 1) vs other approved therapies (Cohort 2). The SARS-CoV-2 (COVID-19) pandemic necessitated adaptations in the collection of data enabling continued, successful monitoring of patients in the registry. This presents an overview of these changes and their impact on the PURE registry. Materials and methods: This ongoing registry enrolled 2362 adult patients with moderate to severe psoriasis (1:1 ratio;secukinumab: other treatments) from 81 community and hospital sites. As a noninterventional study, PURE registry allowed for flexibility in the visit schedule and type of visit (remote visits vs face-to-face) per routine practice. This enabled monitoring of patient outcomes during the pandemic at sites where appropriate resources and capabilities were available to perform virtual visits (video teleconferencing, or through phone calls with photographs). The video conference/photographs should have ensured that the investigator was able to assess the disease activity and its extent. The eCRF was modified to record the type of visit (Remote or On-site) and COVID-19 related adverse events (AE). This included diagnostic testing, symptoms, and concomitant medications. Clear definitions for suspected/confirmed and symptomatic/asymptomatic COVID-19 diagnoses, and the associated data entry instructions with clear illustrative examples were provided. COVID-19 related outcomes are being reported separately at this congress. Conclusions: Adaptations to PURE registry successfully enabled continued follow-up of psoriasis patients through the COVID-19 pandemic. The COVID-19 AE data provides us with the opportunity to explore the impact of the pandemic on patients with psoriasis treated with secukinumab.

Tunisian first COVID-19 Intra-Action Review, March-July 2021

Introduction/ Background: The objective of the Intra-Action Review (IAR) was to review the Tunisian COVID-19 national preparedness and response best practices and challenges to adjust the response to the crisis and impact of COVID-19 pandemic on health systems. Methods: RIA is an interactive and structured methodology, developed by WHO to identify best practices and challenges in a response to an ongoing crisis. The first RIA on COVID-19 response in Tunisia was carried out, under the Tunisian Ministry of Health in cooperation with the German Biological Safety Program and the Biosecurity Cooperation Project in Tunisia, from March 30 to July 1, 2021. Four pillars of the Covid-19 response were selected for review: coordination, laboratory, points of entry, and logistic support. Results: The RIA identified 24 best practices, 23 challenges and 23 recommendations to improve the current response by adopting appropriate actions for immediate, mid and long-term implementation. The best practices include: availability of a prevention, preparedness, response and resilience plan (2P2R), an Early Warning, Alert and Response System (EWARS);regular weekly teleconference “EPICOV”;trained Rapid Response Teams (RRTs), Field epidemiologist and laboratory staff, decentralization of SARS-CoV-2 testing;and an efficient stock management system. The most important challenges were leadership and coordination mechanism, legal framework, human resources, and genomic-sequencing surveillance capacity. Impact: The RIA was an opportunity to analyze the operational capacity of the Tunisian health system to respond to the pandemic in collaboration with other relevant sectors. The results of the RIA will serve to adjust the national response to Covid-19. Conclusion: The recommendations target a legal framework, a quality assurance management system and an Integrated Disease Surveillance and Response (IDRS) system. The RIA recommended also to enhance coordination within and between pillars;and mobilize funds to support 2P2R, EWARS, IDRS and human resources and provide a basis for future joint activities.

Mentoring Quality Improvement Teamsin Ethiopia via a Virtual Partnership Between the American Academy of Pediatrics and the Ethiopian Pediatric Society

Background: Despite a marked decline in worldwide under-five mortality over the past 30 years, the largest proportion of these deaths remain neonates. In 2018, 4 million (75% of all under-five deaths) infants died worldwide [1]. The neonatal mortality rate in Ethiopia was 28.1 per 100 live births, compared to 17.7 globally and 27.2 in Africa, ranking 23rd for highest neonatal mortality [2]. The Ethiopian Pediatric Society (EPS), entered a virtual partnership with the American Academy of Pediatrics (AAP) in 2020 to provide educational and practical support to clinicians in Ethiopia to perform quality improvement (QI) research. QI training for clinicians at eight Ethiopian sites is modeled on Project ECHO (Extension for Community Healthcare Outcomes) [3]. ECHO improves capacity for specialists to deliver care to underserved communities via collaboration with local clinicians using video teleconferencing, which has been a particularly advantageous tool to continue global health work during the COVID-19 pandemic. The goal of this project is to support local Ethiopian providers in designing, implementing, and assessing a QI intervention. Methods: We adapt the Project ECHO model to have U.S. neonatology faculty-fellow teams mentor clinicians from 8 hospitals in Ethiopia. Using video conferencing and regular contact through mobile devices, teams work to identify gaps in care, create SMART aim statements, identify key stakeholders and barriers to change, and implement interventions. Interventions are measured with a phone application, Liveborn, which allows instant transmission of data internationally. Sites provide monthly progress updates to the EPS. AAP/EPS leadership, U.S.-based faculty-fellow teams, and QI team leaders meet monthly via video conference for didactic sessions on QI methodology followed by teams presenting their progress, which promotes discussion and collaboration between the sites, AAP/EPS leadership, and U.S. mentorship teams to address any barriers. Results: Teams identified compliance with delayed cord clamping (DCC) and skin-to-skin (STS) after delivery as a gap by independently collecting local data. QI teams are currently still implementing interventions and measuring improvement. Teams have identified several barriers, the most common cited being stakeholder buy-in and logistic challenges in implementation. During monthly meetings, teams continually discuss and brainstorm ways to address barriers overall and among individual sites. Conclusion: Via the ECHO model, the AAP and EPS are supporting Ethiopian QI teams in designing and implementing QI interventions despite the limitations imposed by the COVID-19 pandemic. Challenges to this mentorship process include communication barriers (language, internet network) and perception of lack of need by Ethiopian clinicians for U.S. mentorship. Using the ECHO model, all teams have defined SMART aims, begun to implement interventions, and are now collecting compliance data.

LESS ISMORE: DEPRESCRIBING PPIS IN A RESIDENT PRIMARY CARE CLINIC DURING THE COVID-19 PANDEMIC

BACKGROUND: Medication reconciliation is a important part of primary care, yet good prescribing practices are not often a focus of residency training. This study aims to raise awareness among resident physicians around polypharmacy and deprescribing by targeting a common class of medications, proton pump inhibitors (PPIs). PPIs are often continued longer than appropriate and can have side effects when used long-term. We present a quality improvement (QI) project aimed at deprescribing non-indicated PPIs in a resident clinic. As residency education has increasingly relied on teleconferencing to adapt to the COVID-19 pandemic, this study is the first to describe the use of virtual education sessions to reduce rates of inappropriate PPI use. METHODS: We implemented an IRB-approved QI project at a federally qualified health center that serves as the continuity clinic site for 46 internal medicine residents. From 9/2021 to 10/2021, residents participated in a 10-minute virtual education presentation on an evidence-based PPI deprescribing algorithmat the beginning of a clinic “huddle” session. Pre-and post-education surveys were administered to assess resident knowledge of and comfort level around deprescribing PPIs. Data were collected from our electronic medical record from 7/1/21 (start of academic year) through 1/1/22. RESULTS: Comparison of pre-and post-education surveys showed improvement in resident knowledge of PPI side effects (27% correct on pre-education survey vs 98% post), indications for long-term PPI use (7% vs 62%) and guidelines around re-assessment of PPI use in patients with GERD (49% vs 78%). After the education session, residents reported increased comfort with deprescribing PPIs (5.8 out of 10 pre-education vs 7.9 post). PPI utilization decreased by 13% across all ages from 9/1/21 to 1/1/22. Residents deprescribed PPIs for 56 patiens;there were 14 new PPI prescriptions. Rates of PPI deprescribing were higher in adults under 65-years-old (14%) compared to adults 65-years-old and older (11%). CONCLUSIONS: Deprescribing can be effectively incorporated into the residency curriculum during the COVID-19 pandemic through brief, virtual teaching sessions. The sessions increased resident knowledge and comfort around deprescribing PPIs, as demonstrated by a reduction in PPI utilization over a short period of time.

A national pediatric otolaryngology fellowship virtual dissection course using 3D printed simulators.

OBJECTIVE: Our objective was to create and evaluate a novel virtual platform dissection course to complement pediatric otolaryngology fellowship training in the setting of the COVID-19 pandemic. METHODS: A four-station, four-simulator virtual course was delivered to pediatric otolaryngology fellows virtually using teleconferencing software. The four stations consisted of microtia ear carving, airway graft carving, cleft lip repair, and cleft palate repair. Fellows were asked to complete pre- and post-course surveys to evaluate their procedural confidence, expertise, and attitudes towards the course structure. RESULTS: Statistical analysis of pre-course survey data showed fellows agreed that simulators should play an important part in surgical training (4.59 (0.62)); would like more options for training with simulators (4.31 (0.88)); and would like the option of saving their simulators for later reference (4.41 (0.85)). Fellows found the surgical simulators used in the course to be valuable as potential training tools (3.96 (0.96)), as competency or evaluation tools (3.91 (0.98)), and as rehearsal tools (4.06 (0.93)). Analysis showed a statistically significant improvement in overall surgical confidence in performing all four procedures. CONCLUSION: This virtual surgical dissection course demonstrates 3D printed surgical simulators can be utilized to teach fellows advanced surgical techniques in a low-risk, virtual environment. Virtual platforms are a viable, highly-rated option for surgical training in the setting of restricted in-person meetings and as a mechanism to increase access for fellows by reducing costs and travel requirements during unrestricted periods.

PROVIDING GERIATRIC ONCOLOGY CARE USING TELEMEDICINE FOR OLDER PATIENTS WITH CANCER DURING THE COVID-19 PANDEMIC IN MEXICO

Introduction Telemedicine has played a pivotal role during the COVID-19 pandemic, but concerns exist about digital technology use among older adults, particularly those from resource limited settings. We aimed at understanding the feasibility of carrying out telemedicine interventions for older Mexican adults with cancer and limited access to technology. Methods Prospective study of telemedicine visits for patients aged ≥65 years with colorectal and gastric cancer at a Mexico City geriatric oncology clinic between 03/2020 and 03/2021. We evaluated contact methods, barriers for consultation, and the ability to undertake complex interventions such as geriatric assessments (GA) or chemotherapy (CT) prescriptions. Results Forty-four patients (median age 75) were included. The total number of visits was 167, with a median of 3 visits per patient. The preferred method of communication was WhatsApp videochat in 75%, followed by Zoom in 23%. 50% of visits took place using a family member's device. A GA (activities of daily living, nutritional assessment, psychological screening, falls assessment, polypharmacy review) was undertaken in 80% of visits, and CT was prescribed in 32%. Only 2.4% of visits could not be completed, and minor problems existed in 18%, the most relevant one being connection failures. Conclusions Telemedicine using freely available teleconference apps allowed for the completion of complex tasks, such as a GA and CT prescription in a population of older adults with low exposure to digital technology.

EXPLORING PATIENT EXPERIENCES WITH A TELEHEALTH BEHAVIOURAL SWALLOWING INTERVENTION FOR THE PRO-ACTIVE TRIAL IN PATIENTS WITH HEAD AND NECK CANCER

Introduction In response to COVID-19, a rapid shift was made to deliver behavioural swallowing therapy in the PRO-ACTIVE trial via a TeleHealth (TH) approach. Patient experiences with TH were explored. Methods A theory-guided qualitative approach explored the perspective of consenting participants who received at least one TH swallowing therapy session. Patients participated in a one-time semi-structured interview. Interview transcripts were analyzed for content and theme using a multi-step consensus process to build a coding framework and key messages. Results Eleven participants recounted their TH experiences and reported feeling satisfied, comfortable and confident with the session(s). Facilitating factors included: previous experience with teleconferencing, access to optimal equipment, clinician skill, and caregiver assistance. TH was considered beneficial to reduce commuting time, potential exposure to COVID19, energy expenditure and also allow caregiver participation. Limitations were also identified, including lack or poor previous experience with technology, and less opportunity for personalization. Participants indicated that use of audio alone was less preferred than an audio/video platform. Conclusions Patients reported overall that TH sessions did not compromise their clinical learning experience when compared to in-person sessions. Patient feedback about TH provides an important perspective to inform best practices for care delivery.

Launching a Virtual Bereavement Café Developed and Run by Staff, for Staff, in 2 National English Public Health Organisations During the COVID-19 Pandemic

Background/aims: The COVID-19 pandemic has adversely impacted bereavement experience by restrictions: visiting the dying, funerals, family meetings, access to bereavement services. Public health work on the pandemic and other essential functions has been unrelenting. Enforced home working enhanced isolation. Many colleagues were experiencing difficult bereavements with little access to support. Methods: A grassroots group of bereaved staff or with expertise in bereavement established an infrastructure to run Virtual Bereavement Cafes by staff for staff across the 2 national public health organisations. The Chief Executive gave support. MS Teams (video teleconferencing, chat and signposting to resources) was used to provide a safe, mutually supportive space for staff to meet virtually. Cafés were 45 minutes every fortnight, facilitated with mental health first aiders present. Ground rules emphasised respect, confidentiality, the validity of all types of grief and all deaths whether pre or during the pandemic. Chat and comforting emojis were used to offer support. Post café support was provided via email and/or a call. Results: 10 cafés were held May to September 2021. Attendance 14 to 34 with new staff at each. Topics emerged from shared experiences, including anticipatory, complicated, cumulative and disenfranchised grief. Thematic synthesis of discussions and chat identified isolation, distress from limited funeral attendance, presence at death, and lack of workplace understanding. Conclusions: Virtual Bereavement Cafés have provided key emotional support during the pandemic. Improvements identified for implementation include: technical enhancements with use of interactive technologies to dynamically identify topics for discussion;increased facilitator capacity to enable break out groups and more monitoring;debrief sessions for facilitators to support their wellbeing;themed sessions publicised in advance, including practical topics;increased signposting to resources. The Cafés will now implement the learning.

TRAINING, INITIATION AND ONE-YEAR FOLLOWUP OF INSULIN PUMP THERAPY BY TELEMEDICINE

Background and Aims: During the recent COVID-19 pandemic, telemedicine has been used in type 1 diabetic patients to monitor and check metabolic balance, through specific platforms for downloading data. Aim of our study is to describe the experience of remote training, initiation and one-year follow-up of insulin pump therapy and continuous glycemic monitoring in four poorly controlled type 1 diabetic patients, presenting several hypoglycemic episodes. Methods: In April 2020 four patients were determined to be CSII therapy candidates, primarily to reduce hypoglycemic episodes. The remote training consisted of 3 or 4 sessions focused on self-management of advanced insulin therapy and technical aspects of pumps. They occurred in patients' homes using Skype™ for synchronous teleconferencing. After the training, two patients transitioned to the MiniMed 670G system, one to Omnipod and one to Accu-Chek Solo. Insulin pump informations and CGM data were remotely downloaded, and follow-up telemedicine visits were scheduled. Results: As early as two weeks after the insulin pump has been implanted, a hypoglycemic episode reset was recorded in all patients and the time in range (TIR) was greater than 90% in three of the four patients. During one-year remote follow-up, all patients maintained a satisfactory %TIR and glycemic variability, with a limited number of hypoglycemic events. One patient had COVID-19 disease and one became pregnant: these conditions were well managed by telemedicine service. Conclusions: These findings support the effectiveness of telemedicine for remote training, initiation, and follow-up of insulin pump therapy, ensuring a positive control of glycometabolic outcomes.

A NOVEL ONE-DAY VIRTUAL-LIVE HYBRID TRAINING COURSE IS FEASIBLE AND HAS A POSITIVE IMPACT ON COLONOSCOPY KEY PERFORMANCE INDICATORS OF EXPERIENCED ENDOSCOPY TRAINEES

DDW 2022 Author Disclosures: Louise Krott: NO financial relationship with a commercial interest ;Lynn Debels: NO financial relationship with a commercial interest ;Christophe Schoonjans: NO financial relationship with a commercial interest ;John Anderson: NO financial relationship with a commercial interest ;Roland Valori: NO financial relationship with a commercial interest ;Lobke Desomer: NO financial relationship with a commercial interest ;David Tate: NO financial relationship with a commercial interest Introduction: Colonoscopy is a complex practical skill, which is highly operator dependent. The consistent attainment of key performance indicators (KPIs) by a colonoscopist depends primarily upon training. Local factors, outside of a trainee’s control, may mean their training is unstructured and contingent upon the observed practice of a small number of trainers. This is particularly true given current travel restrictions imposed by the worldwide COVID-19 pandemic. We sought to demonstrate the feasibility and impact of a one-day virtual-live colonoscopy-training course with remote, experienced trainers. Aims and methods: 6 endoscopy trainees [Belgium] underwent a one-day course (the intervention) involving training by consciously competent colonoscopists who were physically remote [United Kingdom]. The intervention comprised 5 interactive sessions on colonoscopy theory combined with 6 live sessions, where trainees performed colonoscopy in their local endoscopy unit, receiving real-time instruction and performance enhancing feedback via a tele-conference monitor situated next to the endoscopic image. Trainers and the five trainees not doing the colonoscopy could follow the procedure in real-time including room view, view of the magnetic colonoscope imager and the endoscopic image. Colonoscopy KPIs were assessed on trainee-performed colonoscopies [unsedated or midazolam/fentanyl sedation] for 3 weeks prior and 4 weeks after the training. Qualitative trainee and trainer feedback regarding the course was obtained. Results: 6 experienced colonoscopy trainees (median 26 months prior-training) underwent the intervention. Trainees performed 60 colonoscopies, (33 pre-, and 27 post-training). Favorable trends in cecal intubation rate (CIR) and adenoma detection rate (ADR) were observed, (91% vs 96% (P=0.386), and 39% vs 63% (P=0.069) respectively). A trend to improved endoscopist-reported comfort scores ([Gloucester Comfort Score (GCS)>3] 18% vs 11% (P=0.375)) and nurse-reported comfort scores (GCS>3 22% vs 8% (P=0.189)) was observed (Table 1). Course participants and trainers alike reported globally favourable qualitative experiences with the expert trainers finding the format feasible and specifically mentioning they could focus on the training without distraction due to reduced cognitive load. Conclusions: Standardization of colonoscopy training is critical to the consistent attainment of KPIs by practicing colonoscopists and improving patient experience. This is the first demonstration of delivering live colonoscopy training remotely: an approach acceptable to trainees and trainers that has a positive impact on KPIs. Pending larger studies focused on efficacy, this approach has the potential to create a standardized curriculum for colonoscopy training, removing the barriers of travel, and allowing expanded exposure to consciously-competent expert trainers. [Formula presented]

Participatory health research under COVID-19 restrictions in Bauchi State, Nigeria: Feasibility of cellular teleconferencing for virtual discussions with community groups in a low-resource setting.

INTRODUCTION: During the COVID-19 pandemic, researchers have used Internet-based applications to conduct virtual group meetings, but this is not feasible in low-resource settings. In a community health research project in Bauchi State, Nigeria, COVID-19 restrictions precluded planned face-to-face meetings with community groups. We tested the feasibility of using cellular teleconferencing for these meetings. METHODS: In an initial exercise, we used cellular teleconferencing to conduct six male and six female community focus group discussions. Informed by this experience, we conducted cellular teleconferences with 10 male and 10 female groups of community leaders, in different communities, to discuss progress with previously formulated action plans. Ahead of each teleconference call, a call coordinator contacted individual participants to seek consent and confirm availability. The coordinator connected the facilitator, the reporter, and the participants on each conference call, and audio-recorded the call. Each call lasted less than 1 h. Field notes and debriefing meetings with field teams supported the assessment of feasibility of the teleconference meetings. RESULTS: Cellular teleconferencing was feasible and inexpensive. Using multiple handsets at the base allowed more participants in a call. Guidelines for facilitators and participants developed after the initial meetings were helpful, as were reminder calls ahead of the meeting. Connecting women participants was challenging. Facilitators needed extra practice to support group interactions without eye contact and body language signals. CONCLUSIONS: With careful preparation and training, cellular teleconferencing can be a feasible and inexpensive method of conducting group discussions in a low-resource setting.

Concept Adaptation and Pilot Application of an Interdisciplinary Intervention for the Prevention of Falls in Community-Dwelling Older Adults during COVID-19 Pandemic

Introduction: Falls are a major health problem in older adults, leading to serious injuries and burdening their quality of life and functionality. Social isolation is predictive of falls, so a need for effective distance interventions is of great importance in this vulnerable population. Methods: An interdisciplinary programme for falls prevention was designed in community-dwelling older adults at falls risk, including physical exercise, nutritional education and falls prevention training. Screening measurements took place before and after the intervention for a complete assessment of the participants' physical, mental and social state. The implementation of the programme coincided with the lockdown due to the COVID-19 pandemic and this led us to a forceful transformation to a pilot digital programme. Thus, the new version of the programme had driven us to minimize face-to face contact and at the same time ensure that the participants' healthcare and social support needs were addressed. Moreover, new engagement techniques had to be used. Therefore, a digital platform was created and hosted by the FFN Greece website and 6 zoom teleconferences were organized with health professionals (orthopaedic, social worker, geriatrician, nutritionist). In addition, the participants could communicate with a psychologist and had zoom dancing lessons once a week. The digital educational material was adapted in order to provide the participants with health information regarding copying with falls incidents during the pandemic home restriction. Results: 20 people participated in the programme (95% women, mean age: 69 years). Among the most important results of the intervention were: The reduction of Fear of Falls (FES-I mean score before and after the intervention 28.1 vs 26.3, respectively);The improvement of important aspects of quality of life (SF-36 Physical Functioning mean score and SF-36 Emotional Well-being mean score before and after the intervention 81.8 vs 88.2 and 75.0 vs 90.2, respectively);The improvement of nutritional habits (Mediterranean Diet Scale mean score before and after the intervention 32.2 vs 34.2, respectively). Conclusion: This pilot programme indicates that health professionals need to be vigilant in adapting falls prevention programmes effectively, even in unpredicted situations like the recent COVID-19 pandemic. The results were encouraging, since there were no falls incidents, the physical, the emotional well-being of the participants and their falls related knowledge and skills were improved.

Pre-COVID-19 pandemic vs. post-COVID-19 pandemic: Sustained participation of minorities in research in a CAP accredited biorepository in UC San Diego, California

Background: The UC San Diego (UCSD) Moores Cancer Center Biorepository (BR) is a College of American Pathologists (CAP)-accredited core providing a full array of biological samples services including tissue biobanking. Informed consent (IC) is obtained through an IRB-approved protocol. The MORE (Minorities Outreach Repository Effort) Initiative was launched in 2018 as an effort to increase the enrollment of minorities, and has since shown an accrual increase 213% as compared with previous years. As the ongoing COVID-19 pandemic has affected enrollment in many research studies we decided to reevaluate subject accrual. Methods: Data analysis was performed for Pre-COVID-19 pandemic enrollment from July 2019 to March 2020 and Post-COVID-19 pandemic enrollment from March 2020 to December 2020. Patients from the oncology clinics were identified by the BR or the treating teams, and pre-screened for potential enrollment. Eligible patients were interviewed by coordinators and an IC was obtained. In the IC, the patients were given the option of sharing the tissues for research with university researchers (UR) and/or for-profit (FP) organizations. Race and ethnicity data were acquired from the Epic electronic medical record (EMR). Patients were interviewed in English, Spanish, Russian, Vietnamese, Farsi, Tagalog, Simplified Chinese, or Arabic. Due to interviewing restrictions during the pandemic, protocol was amended to add added the possibility of remote IC via video/phone teleconferencing. Results: Global patient participation decreased by 30% due to the pandemic, with pre-COVID rates at 107.88 patient/month and Post-COVID rates of 31.25/month (69.56 ±38.31). Enrollment of Hispanic populations has remained remarkably similar (22 %;22.18 ±0.18) for the same period. When compared with pre and post pandemic participation, data showed no significant difference among races (p=0.99). There was a slight increase in the rate of acceptance to share specimens with UR among Hispanics (30% Pre-COVID vs. 33% Post-COVID). The non-Hispanic cohort was associated with an increase (19% vs. 33%, p= 0.33) in their resistance to share with FP collaborations in Post-COVID-19 pandemic participation (Pre- COVID-19 19% vs. Post-COVID-19 30%). Conclusions: The MORE initiative is an efficient and effective way of increasing and sustaining the participation of minorities, despite COVID-19 research restrictions. Our ongoing efforts are focused on enhancing remote consenting methodologies, increasing subjects' participation, and sustaining minority involvement in research for biobanking.