A regional clinical audit of the provision of adjuvant systemic anti-cancer treatment following lung cancer resection in eligible patients across Greater Manchester to support national benchmarking

Introduction: Adjuvant anti-cancer systemic therapy (SACT) following lung resection improves overall survival in stage II/II non-small cell lung cancer (NSCLC). The Getting It Right First Time (GIRFT) National Specialty Report for Lung Cancer recommends centres publish adjuvant SACT rates for National benchmarking and proposes a target of >40% of eligible patients undergo SACT. We report a regional audit into the uptake of adjuvant SACT in Greater Manchester (GM). Method(s): A retrospective case review of all patients undergoing curative-intent NSCLC surgery with a pathological stage of II/III from 01/01/21 to 30/04/21. Data collected included patient demographics, uptake of adjuvant SACT, reasons for no adjuvant SACT and tolerance and complications of SACT. Result(s): 58 patients underwent surgical resection within the audit period and were eligible for adjuvant SACT. Median age was 70 years (range 45 - 81) and 60% were female. 47% (27/58) commenced adjuvant SACT;41% (24/58) were treated with chemotherapy and 7% (4/58) were treated with tyrosine kinase inhibitors. 58% (14/24) of patients that commenced adjuvant chemotherapy completed 4 cycles. Carboplatin/Vinorelbine was the commonest regimen (82%, 18/22). There were no grade III-V complications and no chemotherapy-related deaths. Dose reduction due to toxicity was required in 14% (3/22). The reasons adjuvant systemic therapy was not given were patient choice in 32% (10/31), poor physical health such that risks outweighed benefits in 42% (13/31), and other reasons (e.g. need to treat synchronous primary tumours) in 26% (8/31). COVID-19 was not recorded as a cause for adjuvant omission/ dose reduction. Conclusion(s): This data provides national benchmarking information for adjuvant SACT in NSCLC and suggests the target of >40% is achievable and appropriate. Interventions that improve patient fitness pre- and post-operatively might increase adjuvant SACT uptake. This regional audit will be extended to review all eligible patients in 2021 and further data will be presented. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Age Management for the Common Good

In the aftermath of the COVID-19 pandemic and amid the present reconfiguring of corporate purpose, there is an opportunity to realign actions focused on prolonging working lives. We put forward a transformative agenda concerned with workforce ageing that aligns with contemporary expectations regarding sustainability, inequality, and emerging conceptualisations of management. In this article, the new concept of Common Good human resource management (HRM) is utilised as a potential means of encouraging business responses focused on grand challenges such as population ageing. We suggest how these principles might be applied to the issue of managing age in workplaces, to recast debate about issues of age and work, to be used as an advocacy tool encouraging employer engagement, while providing a framework that might direct organisational leadership. © The Author(s), 2023. Published by Cambridge University Press on behalf of UNSW Canberra.

EFFECT OF UPADACITINIB ON REDUCING PAIN IN PATIENTS WITH ACTIVE ANKYLOSING SPONDYLITIS AND INADEQUATE RESPONSE TO BIOLOGIC THERAPY

BackgroundPain is a debilitating symptom of ankylosing spondylitis (AS) that negatively affects patients' lives. Upadacitinib (UPA), a Janus kinase inhibitor approved for the treatment of AS and other inflammatory diseases, showed significant efficacy vs placebo (PBO) in the phase 2/3 SELECT-AXIS 1 study in patients with AS who were biologic-naive and in the phase 3 SELECT-AXIS 2 study in patients with active AS who had an inadequate response (IR) to biological therapy [1,2]. Improvement in pain outcomes with UPA was also previously demonstrated in the SELECT-AXIS 1 study [3].ObjectivesThe objective of this post-hoc analysis of SELECT-AXIS 2 was to evaluate the efficacy of UPA vs PBO on multiple pain assessments through 14 weeks in patients with IR to a biologic disease-modifying antirheumatic drug (bDMARD-IR).MethodsSELECT-AXIS 2 (NCT04169373) enrolled adults with active AS with IR to biological therapy, including patients who discontinued biologics due to lack of efficacy or intolerance [1]. Patients were randomized 1:1 to UPA 15 mg once daily (QD) or PBO for 14 weeks. Pain endpoints evaluated here included the proportion of patients achieving ≥30%, ≥50%, and ≥70% reduction from baseline, minimal clinically important difference (MCID, defined as ≥1 point reduction or ≥15% reduction from baseline), and much better improvement (MBI, defined as ≥2 point reduction and ≥33% reduction from baseline) in Patient's Global Assessment (PGA) of pain, total back pain, and nocturnal back pain on a 0–10 numeric rating scale [3,4]. Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 was used.ResultsA total of 211 patients received UPA 15 mg QD and 209 patients received PBO. Higher proportions of patients receiving UPA vs PBO achieved ≥30% and ≥50% reductions in PGA of pain, total back pain, and nocturnal back pain as early as week 2 that were sustained at all time points through 14 weeks (nominal P<0.05;Figure 1a-c). Achievement of ≥70% reductions in PGA of pain and nocturnal back pain were higher at week 4 and sustained thereafter (Figures 1a and 1c), and achievement of ≥70% reduction in total back pain was higher at week 2 and week 8, but not week 4, and sustained thereafter (Figure 1b). Results were similar for the proportion of patients achieving MCID and MBI, with improvements in PGA of pain, total back pain, and nocturnal back pain for UPA vs PBO as early as week 1 (MCID) or week 2 (MBI) that were sustained through week 14 (all nominal P<0.001;Table 1).Table 1.Achievement of MCID and MBI in Pain Outcomes at Week 14 (NRI-MI)Responder Rate (95% CI), %Pain OutcomesUPA 15 mgPBONominal P ValuePGA of painMCID81.0 (75.8–86.3)62.7 (56.1–69.2)<0.0001MBI60.7 (54.1–67.3)24.9 (19.0–30.7)<0.0001Total back painMCID80.1 (74.7–85.5)65.1 (58.6–71.5)0.0005MBI58.3 (51.6–64.9)25.4 (19.5–31.3)<0.0001Nocturnal back painMCID82.9 (77.9–88.0)61.3 (54.7–67.9)<0.0001MBI61.6 (55.0–68.2)32.1 (25.7–38.4)<0.0001MBI, much better improvement;MCID, minimal clinically important difference;NRI-MI, non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19;PBO, placebo;PGA, Patient's Global Assessment;UPA, upadacitinib.ConclusionIn patients with active AS who were bDMARD-IR, greater proportions of patients treated with UPA achieved rapid and clinically meaningful reductions in pain vs PBO as early as week 2 that were sustained through 14 weeks across multiple pain assessments.References[1]van der Heijde D, et al. Ann Rheum Dis. 2022;81(11):1515-1523.[2]van der Heijde D, et al. Lancet. 2019;394(10214):2108-2117.[3]McInnes IB, et al. RMD Open. 2022;8(1):doi:10.1136/rmdopen-2021-002049.[4]Salaffi F, et al. Eur J Pain. 2004;8(4):283-291.AcknowledgementsAbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this p blication. No honoraria or payments were made for authorship. Medical writing support was provided by M. Hovenden and J. Matsuura of ICON plc (Blue Bell, PA, USA) and was funded by AbbVie.Disclosure of InterestsXenofon Baraliakos Consultant of: Novartis, Pfizer, AbbVie, Eli Lilly, UCB Pharma, Galapagos, Janssen, Celgene, and Amgen, Grant/research support from: Novartis, Pfizer, AbbVie, Eli Lilly, UCB Pharma, Galapagos, Janssen, Celgene, and Amgen, Marina Magrey Consultant of: UCB, Novartis, Eli Lilly, Pfizer, and Janssen, Grant/research support from: Amgen, AbbVie, BMS, and UCB Pharma, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Organon, and Sanofi, Grant/research support from: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Sanofi, and Gilead, Kurt de Vlam Speakers bureau: Amgen, Celgene, Eli Lilly, Galapagos, Novartis, and UCB, Consultant of: Amgen, AbbVie, Celgene, Eli Lilly, Galapagos, Novartis, and UCB, Grant/research support from: Amgen, UCB, and MSD, Tianming Gao Shareholder of: AbbVie, Employee of: AbbVie, Anna Shmagel Shareholder of: AbbVie, Employee of: AbbVie, Ralph Lippe Shareholder of: AbbVie, Employee of: AbbVie, Ana Biljan Shareholder of: AbbVie, Employee of: AbbVie, Victoria Jasion Shareholder of: AbbVie, Employee of: AbbVie, Peter C. Taylor Speakers bureau: AbbVie, Consultant of: Lilly, AbbVie, Pfizer, Galapagos, Gilead, Janssen, GlaxoSmithKline, Sanofi, Fresenius, Nordic Pharma, UCB, and Biogen, Grant/research support from: Galapagos.

The great equalizer: A case study of distance learning in public schools

This exploratory case study aimed to understand how the sudden and abrupt transition to distance education due to the SARS-CoV-2 pandemic of 2020 highlighted the vast differences in levels of readiness for adopting distance education among the public-school districts throughout the State of Connecticut. It explores the reasons behind the inequities in the implementation of distance learning in public school districts. To develop a more detailed understanding of the problem, the research employs the exploratory approach to identify the contributing factors that render some districts more successful than others in their rollout of distance learning for their students. The experiences of school and district administrators as well their familiarity with advanced learning technologies are utilized. The basis of this study's conceptual framework consists of three streams: the history of public education delivery, perception and familiarity with modern learning, and modern learning and delivery modalities. The guiding research questions are as follows: 1. What defines distance learning in Connecticut public schools? 2. What factors contributed to the adaptation of distance learning from an administrative perspective? 3. What is the current perception of distance learning from critical stakeholders? (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Consequences of delayed care during the COVID-19 pandemic: Emerging research and new lines of inquiry for human biologists and anthropologists.

OBJECTIVE: Research regarding ongoing epidemic or pandemic events is often proximate, focusing on the immediate need to understand the epidemiology of the outbreak and the populations at highest risk for negative outcomes. There are other characteristics of pandemics that can only be uncovered after time has passed, and some long-lasting health consequences may not be directly linked to infection with or disease from the pandemic pathogen itself. METHODS: We discuss the emerging literature on observations delayed care during the COVID-19 pandemic and the potential population health consequences of this phenomenon in postpandemic years, especially for conditions such as cardiovascular disease, cancer, and reproductive health. RESULTS: Delayed care has occurred for various conditions since the beginning of the COVID-19 pandemic, but the drivers for those delays have yet to be thoroughly investigated. While delayed care can be either voluntary or involuntary, the determinants of delayed care often intersect with systemic inequalities that are important to understand for pandemic responses and future preparedness. CONCLUSION: Human biologists and anthropologists are well poised to lead the research on postpandemic population health consequences of delayed care.

Remote Instruction in Focused Assessment With Sonography in Trauma (FAST) Exams for Surgery Residents: A Pilot Study.

BACKGROUND: The Focused Assessment with Sonography in Trauma (FAST) exam is an important component to the evaluation of trauma patients. With advances in technology and meeting limitations due to COVID-19, remote instruction and learning have gained popularity. We sought to determine whether remote instruction of FAST exams was feasible as sustainable surgical education and a possible alternative to traditional in-person teaching. METHODS: General surgery residents completed a baseline survey and skills assessment on FAST exams and were then randomized to remote or in-person instruction. The remote group participated in an instructional session with a content expert through video conference and then practiced on a simulated mannequin while the expert remotely provided feedback. The in-person group received the experience with the content expert in the room. Both groups completed a post-course survey immediately after the session and a follow-up survey and objective assessment at six-months. Results were compared with two-way analysis of variance (ANOVA). RESULTS: 14 residents underwent the curriculum, seven in each group. There was a significant increase in self-reported confidence when comparing pre- and immediate post-course results for both the remote and in-person groups. At six months, confidence scores remained elevated and skill assessment scores improved, although the latter did not reach significance. There was no significant difference in post-course results between the groups. CONCLUSIONS: Remote instruction of FAST exams was feasible. Pilot data demonstrated an increase in confidence and suggest outcomes that are similar to in-person instruction, which has positive implications for future remote educational and potentially clinical initiatives.

Creative adolescent experiences of education and mental health during COVID-19: A qualitative study.

This qualitative study investigated creative adolescent perceptions of their educational and mental health experiences during the coronavirus disease 2019 (COVID-19) pandemic. Participants were 25 English-speaking adolescents from the Midwest in the United States. They were identified as creative by their teachers according to known creative profiles. Participants attended an all-day creative career workshop in the Spring 2021 semester. The five focus groups guided by semi-structured interviews conducted for this study occurred during the workshop. This study was phenomenological in nature with constructivist and transformative paradigms, and transcripts were analyzed using reflexive thematic analysis by the first, second, and third authors. Creative adolescents' education during the pandemic was marked by classroom changes based on COVID-19 policies, experiences of disconnection, disengagement, and disappointment, as well as feelings of empathy and appreciation for their educators. Creative adolescents experienced mental health challenges related to adjustment issues, powerlessness and hopelessness, and isolation. Implications of results are discussed.

The great equalizer: A case study of distance learning in public schools

This exploratory case study aimed to understand how the sudden and abrupt transition to distance education due to the SARS-CoV-2 pandemic of 2020 highlighted the vast differences in levels of readiness for adopting distance education among the public-school districts throughout the State of Connecticut. It explores the reasons behind the inequities in the implementation of distance learning in public school districts. To develop a more detailed understanding of the problem, the research employs the exploratory approach to identify the contributing factors that render some districts more successful than others in their rollout of distance learning for their students. The experiences of school and district administrators as well their familiarity with advanced learning technologies are utilized. The basis of this study's conceptual framework consists of three streams: the history of public education delivery, perception and familiarity with modern learning, and modern learning and delivery modalities. The guiding research questions are as follows: 1. What defines distance learning in Connecticut public schools? 2. What factors contributed to the adaptation of distance learning from an administrative perspective? 3. What is the current perception of distance learning from critical stakeholders? (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Risk perception, adaptation, and resilience during the COVID-19 pandemic in Southeast Alaska Natives.

Indigenous communities worldwide are at higher risk of negative pandemic outcomes, and communities Indigenous to the Arctic are disproportionately affected compared to national majorities. Despite this, their experiences have scarcely been investigated qualitatively and from their own perspectives. We collected and analyzed 22 structured interviews in three Southeast Alaska island communities (Sitka, Hoonah, and Kake) to learn about their perceptions of and experiences with the COVID-19 pandemic. Interviews were analyzed with thematic qualitative analysis in Dedoose. Four primary categories were identified within which to discuss risk and resilience in Southeast Alaska: (1) risk perception, (2) socioeconomic impacts, (3) reactions to public health guidelines, and (4) coping. Primary findings indicate that Southeast Alaska Native communities display considerable resilience and adaptive flexibility despite the significant adversity imposed by the COVID-19 pandemic. Southeast Alaska Native people use historical and traditional knowledge to culturally ground adaptive behaviors to cope with the threat of COVID-19. Interviewees expressed that adaptive, community-centered, and non-individualistic behaviors strongly tied to Native culture minimized the negative epidemiological impacts of the pandemic. Future research can more deeply explore the root causes of the need for adaptiveness and resilience, such as histories of colonialism and marginalization, to emergency situations in Indigenous communities.

Adolescent technology-use and creative activities during COVID-19: A qualitative study.

This study investigated how COVID-19 impacted creative adolescent engagement with their creative activities, as well as how they utilized technology to cope with the pandemic. Using qualitative methods, this study was guided by phenomenology using both constructivist and transformative paradigms. Participants were English-speaking adolescents from the Midwest in the United States. They were identified as creative by their teachers according to known creative profiles and were invited to attend an all-day creative career workshop over Zoom, where the focus groups occurred for this study. Five focus groups, consisting of 25 participants, were conducted, guided by semi-structured interviews. The transcripts from the focus groups were analyzed using reflexive thematic analysis by the first, second, and third authors. Results indicated that COVID-19 affected creative adolescent engagement with creative activities in positive and negative ways, caused changes in emotions and motivation, and increased virtual creative engagement. Creative adolescents coped with COVID-19 using digital technology to connect with others virtually, to engage in virtual creative expression, inspiration, and growth, and to meet their personal needs. Implication of results is discussed.

Incidence of venous thrombo-embolism in SARS COVID-19 in a district general critical care unit

Introduction: SARS COVID-19 is known to produce a hypercoagulable state in which micro and macro-thrombi form, leading to reduced arterial oxygen saturation, organ failure, and increased need for mechanical ventilation - all of which increase mortality. Currently there is conflicting evidence regarding the efficacy of heparin anticoagulation on the incidence of venous thrombo-embolism (VTE) in COVID-19 and throughout the pandemic clinical guidance for heparin use has been updated from standard to intermediate dosing for thromboprophylaxis. Studies show rates of 21-31%1,2 for symptomatic VTE in ICU COVID-19 patients receiving standard dose prophylactic dalteparin. Objectives: This service evaluation presents local data on incidence of VTE and mortality in critical care COVID-19 patients and provides a summary discussion of the latest trials on prevention of VTE in COVID-19 and their recommendations. Methods: A retrospective evaluation was undertaken on patients admitted to Barnsley Hospital Critical Care Unit during March - December 2020 with confirmed COVID-19 during wave one (27/03/20 - 14/06/20) and wave two (15/06/20 - 03/ 12/20) of the pandemic. The primary outcome was incidence of VTE, which was defined by either: D-dimer ≥ 3 mg/L;a positive ultrasound doppler (USS);or by computed tomography pulmonary angiography (CTPA). Mortality data was also collected. Results: Data was collected on 96 patients (n=73 male, n=23 female). VTE occurred in 30.2% of patients with n=14 confirmed by CTPA, n=1 confirmed by USS, and n=15 with D-dimer ≥ 3 mg/L (but not already confirmed by CTPA or USS). Male and female mortality in the intubated group for both waves was 58.3% and 56.0% respectively. Between waves one and two there was a 28% decrease in mortality across all patients, a 27% decrease in the rate of intubation, and a 20% decrease in mortality in the intubated-only population. Mortality across both waves in the standard and intermediate dalteparin dose populations was 67% and 19% respectively. Table 1 summarises mortality data for the different sub-populations. Conclusion: Our data shows a VTE rate consistent with the literature. Statistical analysis of the data was undertaken using Fisher's exact test. Overall mortality between waves one and two was not significantly different at the P<0.05 level. Reduction in mortality across both waves in the standard and intermediate dose dalteparin populations was significant at the P<0.01 level. However, due to advances in care developed throughout the pandemic, we cannot say if the reduction in mortality is due to the use of intermediate dose dalteparin, as there are other factors to consider. Despite this, its use, combined with other treatments, is consistent with an improved outcome in COVID-19 ICU patients. Current best evidence from INSPIRATION and REMAP-CAP/ATTACC/ACTIV-4a trials3,4 recommends giving treatment dose low-molecular-weight heparin (LMWH) to all COVID-19 hospitalised patients, but to reduce to intermediate dose if admitted to critical care/ICU providing there is no evidence of VTE, as defined above. Trials currently show no benefit of routine treatment dose dalteparin over intermediate dose in critical care for COVID-19 patients.

DISEASE ACTIVITY-GUIDED TAPERING of BIOLOGICS in PATIENTS with INFLAMMATORY ARTHRITIS: A RANDOMISED, OPEN-LABEL, EQUIVALENCE TRIAL

Background: Traditionally, biologics are maintained lifelong at standard dose in patients with infammatory arthritis (IA) when sustained low disease activity (LDA) is reached. However, evidence of possible tapering is emerging but data on the optimal approach is lacking. Objectives: The primary outcomes at 18 months follow-up are: Superiority: The proportion of patients reduced to ≤50% of their baseline biologic dose. Equivalence: Disease activity (rheumatoid arthritis [RA] and psoriatic arthritis [PsA]: Disease Activity Score28-C-Reactive Protein [DAS28-CRP] and axial spondyloarthritis [axSpA]: Ankylosing Spondylitis Disease Activity Score [ASDAS]). Methods: The BIODOPT trial was a randomised, open-label, equivalence trial (EudraCT 2017-001970-41). Eligible patients were adults with RA, PsA, or axSpA in LDA on stable biologic doses during ≥12 months. The randomisation ratio was 2:1 (tapering:continuation) stratifed by diagnosis, centre, and repeated biologic failures. In the tapering group, the biologic dosing interval was prolonged by 25% every four months until fare or discontinuation. The continuation group was kept on their baseline biologic dosing interval;however, a small increase was allowed (as usual practise) if requested by the patient. The sample size calculation was based on a pre-defned equivalence margin of ±0.5 disease activity points (<half of the minimal important difference in DAS28-CRP [>1.2] or ASDAS [>1.1]) yielding a power of 87% for 180 enrolled patients. All analyses were based on the intention-to-treat population. Continuous outcomes were analysed with repeated-measures linear mixed-effects models with group, diagnosis, centre, repeated biologic failures, time point, and the interaction between group and time as fxed factors and the baseline value of the relevant variable as a covariate. Categorical outcomes were analysed using logistic regression with missing data imputed as trial failures. Results: Between May, 2018, and March, 2020, 142 patients were enrolled of which 95 were randomised to tapering and 47 to continuation;inclusion was closed in April 2020 due to national implications of the coronavirus pandemic. At 18 months, signifcantly more patients in the tapering group (35 patients [(37%]) achieved a signifcant reduction in their biologic dose (≥50%) compared to the continuation group (one patient [2%]), absolute risk difference (RD) 35%, 95%CI: 24% to 45%, p<0.0001, Table 1. Furthermore, disease activity at 18 months was within the equivalence margins of ±0.5, mean difference between groups 0.08, 95%CI:-0.12 to 0.29;Table 1 and Figure 1. Flares were more frequent in the tapering group (39 [41%] vs 10 [21%], RD 0.20, 95%CI: 0.04 to 0.35, p=0.011) but managed with rescue therapy (e.g. biologic dose escalation or glucocorticoids) as only one patient (1%) in the tapering group and three patients (6%) in the continuation group lost therapeutic response and were switched to another biological agent. Conclusion: Across IA conditions, a signifcant reduction of biologic dose is possible with disease activity-guided tapering while maintaining a similar disease activity state compared to continuation of biologic as usual care.

Real-world use of different pembrolizumab regimens (3 weekly versus 6 weekly) in non-small cell lung cancer (NSCLC) patients

Background and objectives: Pembrolizumab monotherapy given 3-weekly (3w) (200mg) is approved for the treatment of nonsmall cell lung cancer (NSCLC). In June 2019, NICE endorsed the 6w regimen (400mg) based on computer modelling data (Lala, Eur J Cancer 2020), which has been used during the COVID-19 pandemic to reduce hospital visits. This study compared immune-related adverse events (irAEs), discontinuation rates, and patient experience of 3w vs 6w patients treated at The Christie NHS Foundation Trust, Manchester, UK. Methodology: Pharmacy records were used to identify NSCLC patients treated with pembrolizumab, 1st, 2nd or 3rd line. IrAEs and discontinuation rates were analysed using Kaplan Meier curves to compare the 3w vs 6w cohorts. A sample of the cohort who received 3w then 6w undertook a questionnaire assessing patient experience. Results: 38 patients received pembrolizumab 6w, and 91 received pembrolizumab 3w, of the 3w, 51 switched to 6w. Baseline characteristics were similar. Any grade irAEs and G1-2 irAEs were significantly higher in the 6w cohort (p=0.006 and p=0.04, respectively). Both cohorts showed low rates of G3-5 irAEs at 6 months, 2.3% vs 14.5%, 3w vs 6w, p=0.3. Discontinuation rates at 6 months due to any irAES, G1-2 irAEs or G3-5 irAEs were insignificant in both cohorts (3w to 6w respectively): 4.5% vs 11.2%, p=0.2;2.8% vs 8.7%, p=0.4;2.0% vs 2.5%, p=0.3. Quality of life questionnaires showed stability (60%) or improvement (20%) in the 6w cohort compared to 3w. 90% said their mental health did not differ between regimens. 45% and 40% of patients preferred 6w and 3w respectively, 15% had no preference. Conclusion: NSCLC patients treated with 6w pembrolizumab appear to experience more low-grade irAEs compared to 3w. Highgrade irAEs and discontinuation rates due to irAEs were insignificant in both cohorts. Patients preferred the 6w regiment and found it tolerable.

Creative adolescent experiences of education and mental health during COVID‐19: A qualitative study

This qualitative study investigated creative adolescent perceptions of their educational and mental health experiences during the coronavirus disease 2019 (COVID‐19) pandemic. Participants were 25 English‐speaking adolescents from the Midwest in the United States. They were identified as creative by their teachers according to known creative profiles. Participants attended an all‐day creative career workshop in the Spring 2021 semester. The five focus groups guided by semi‐structured interviews conducted for this study occurred during the workshop. This study was phenomenological in nature with constructivist and transformative paradigms, and transcripts were analyzed using reflexive thematic analysis by the first, second, and third authors. Creative adolescents' education during the pandemic was marked by classroom changes based on COVID‐19 policies, experiences of disconnection, disengagement, and disappointment, as well as feelings of empathy and appreciation for their educators. Creative adolescents experienced mental health challenges related to adjustment issues, powerlessness and hopelessness, and isolation. Implications of results are discussed. Practitioner points Creative adolescents' education was negatively impacted by the pandemic, but they experienced empathy and appreciation for their educators Creative adolescents experienced adjustment issues, powerlessness, hopelessness, and isolation amid COVID‐19 Results suggested potential risk and protective factors in adolescent mental health and educational experiences

Introduction: Pandemic Perspectives – Doing Research Differently During Covid-19*

This article situates, against the backdrop of the Covid-19 crisis and the many systemic inequalities the pandemic has highlighted, challenges and opportunities for researchers and commissioners of research. It provides examples from social science research of how researchers have demonstrated agility and adaptation during the pandemic in a range of contexts. It summarises findings and lessons around access and engagement, consent, ethics and incentives, and power and perspectives. It concludes that research supported by the Covid Collective is providing useful insights for doing research differently, which in turn provides real hope for research to help transform knowledge and transform lives. © 2022 The Authors. IDS Bulletin, Institute of Development Studies and Crown 2022.

Social Media for the Dissemination of Educational Videos About Inflammatory Bowel Diseases.

INTRODUCTION: To broadly disseminate 5 user-centered educational videos for patients with inflammatory bowel disease and their family and friends on social media. METHODS: Relevant social media users were iteratively identified based on their online behavior. For each video, 2 different accompanying texts were tested. RESULTS: We reached 4.2 million social media users of whom 320,302 watched at least 50% of the video. A short description resulted in higher view rates than posing an open-ended question. DISCUSSION: We showed the feasibility of large-scale dissemination of health-related educational videos through social media. Our findings can inform future online dissemination approaches of educational content.

An Unanticipated Worsening of Glycemic Control Following a Mild COVID-19 Infection.

We describe a case of acute-onset worsening of a patient's previously well-controlled type 2 diabetes mellitus (T2DM) following his recovery from a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 78-year-old male with a three-year medical history of well-controlled T2DM (controlled by diet and metformin) presented to the outpatient clinic to discuss his regularly scheduled six-month lab work. He mentioned having a mild coronavirus disease 2019 (COVID-19) infection lasting one week which required no medical treatment approximately two months before his current visit. His labs, taken one week prior to his current visit, were notable for fasting hyperglycemia, 301mg/dL, and an elevated hemoglobin A1C (HbA1C), 11%. A fasting blood glucose level was recorded at his current in-office visit and was found to be 403mg/dL. These findings were not anticipated - our patient reported no change in his meals, medications, or exercise routines. The only notable change he reported between visits was his COVID-19 infection. This case report explores the link between this virus and our patient's exacerbation of his previously well-controlled T2DM. Whether it be through insulin resistance or deficiency (or another unknown mechanism), our patient's prior novel COVID-19 infection could potentially be associated with his unprecedented altered glucose metabolism.

Levels of Burnout among Nurses During the COVID-19 Pandemic and Preference for Stress Management Strategies

Methods: This cross-sectional study recruited 314 nurses from two hospitals in the southeastern US. Measures were collected via an online survey after IRB approval and informed consent. The Copenhagen Burnout Inventory was used to measure burnout. Multiple choice questions from the survey inquired about preferred stress management strategies (e.g., exercise class, relaxation). Results: Participants were predominantly female, white, married, average age of 40.45 years, and 59% provided direct COVID-19 care. Average burnout score was 59.52 (SD = 19.00);70.9% reported moderate (47.1%) to high/severe (23.8%) burnout. Nurses indicated most interest in “restorative breaks at work” (53.8%), relaxation exercises (52.5%), music therapy (48.7%), exercise (48.1%), yoga (36.6%) and meditation (36.3%) to help manage stress. Logistic regression results showed that nurses' preferences were mostly independent of their levels of burnout (p > .05). Burnout was predictive of choosing restorative breaks (p = .021), meditation (p = .040), and nurses with higher burnout being more likely to choose restorative breaks (OR = 1.02), but less likely to prefer meditation (OR = .99). Background: Burnout is a protracted response to stressors at work, characterized by exhaustion and inadequacy1. During the COVID-19 pandemic, nurses' concerns leading to burnout include lack of resources, rapidly changing advice about the pandemic, and lack of organizational preparedness2. There is a need for interventions to reduce pandemic-related burnout3. This study explores the relationship between levels of burnout and nurses' preference for stress management strategies. This is a partial report of a larger study on COVID-19 stress in nurses. Conclusion: Frontline nurses experience significant burnout levels that warrant intervention. Nurses' top stress management preferences included organizational and individual strategies but were mostly independent of levels of burnout. Results highlight the need for restorative breaks at work, especially for those with higher levels of burnout.

Social support predicts sleep quality in people with multiple sclerosis during the COVID-19 pandemic.

BACKGROUND: Poor sleep quality is one of the most prominent patient-reported problems in people with multiple sclerosis (PwMS). The COVID-19 pandemic resulted in PwMS having less contact with physicians, therapists, support groups, and family, which led to decreased access to typical supports. The purpose of this study was to assess how social support impacted sleep quality during the COVID-19 pandemic in PwMS within the United States. METHODS: Anonymous surveys were utilized to gather data from February - May 2021 from 209 PwMS during their return appointments (face-to-face and virtual) at the University of Kansas Medical Center (KUMC)'s MS Clinic in the United States. SPSS 27 was used to run four regressions in order to determine if social support predicted sleep quality with and without the inclusion of covariates (age, education, disability, anxiety/depression). RESULTS: The results indicate that overall feelings of being socially supported predict sleep quality. Additionally, various facets of social support predict sleep quality, even when controlling for covariates. Interestingly, while depression and anxiety were significant predictors of sleep quality, those constructs do not attenuate the social support-sleep relationship. CONCLUSION: These findings will provide key information pertaining to the association between social support and sleep in PwMS during COVID-19 where typical supports were limited. Understanding the challenges facing those living with chronic illnesses, specifically PwMS, will help researchers and clinicians alike create interventions to promote social support in the midst of a global pandemic.