The utility of telemedicine in cystic fibrosis clinic visits

Background: Cystic fibrosis (CF) is a progressive, genetic, multisystem disease. Exacerbations lead to long hospital stays and significant morbidity and mortality. At the crux of pulmonary exacerbation prevention is serial monitoring of pulmonary function tests and frequent outpatient follow-up. Patients at the Helen Devos Children's Hospital CF clinic receive quarterly multidisciplinary care from a CF clinic, but this schedule was complicated by the COVID-19 pandemic because of concern of infection precipitating a pulmonary exacerbation. In lieu of in-person visits, telemedicinewas used to continue necessary monitoring. The purpose of this study was to assess the accessibility, efficacy, and comfort of telemedicine visits at the CF clinic from the patient and provider perspective. Method(s): CF clinic parents and providers completed an anonymous survey by mail or email over a 6-month period. Patient surveys used a 5-point Likert scale to assess responses in four categories-accessibility, functionality, safety, and overall satisfaction-and an open-ended question on patient opinions of their telemedicine experience. Descriptive statistics and comparative means were used to interpret the data. Result(s): Average patient agewas 9.7, average years since diagnosis was 9.5, 53% of patients were male, and average one-way distance traveled to the clinic was 70 minutes (range 15-240). Patients reported that they had few difficulties accessing in-person visits at the clinic. They also reported the telemedicine experience to be functional and easy to navigate. In terms of safety (perceived assessment of respiratory status, overall health, and patients concerns), patients reported feeling neutral to moderate. Patients reported being very comfortable with virtual visits and moderately likely to schedule telemedicine visits at the CF clinic in the future. There was no correlation between travel distance to the clinic and likeliness of scheduling virtual visits in the future, although older patients were more likely to schedule virtual visits in the future. A few factors could be in play here;patients reported in-person visits to be very accessible, reporting that they rarely missed scheduled visits. Some patients reported internet connection problems, which may be more prevalent in rural areas farther from the clinic. At the time of this survey, patients did not have in-home spirometry. Provider responses were overwhelmingly positive, with high opinions of effectiveness, safety, and overall satisfaction. Providers also reported a subjective decrease in no-show rates for virtual visits. Conclusion(s): Virtual visits were found to be functional and have no perceived negative effects on safety. Patients reported high levels of comfort with virtual visits, although they were only moderately likely to schedule virtual visits in the future. This data, in conjunction with the open-ended responses, can be used to improve the CF telemedicine experience;patients are currently offered virtual visits every 6 months.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Child Health and Illness

Child and adolescent health has improved globally over the last two decades;however inequities exist. These inequities may be magnified in the face of chronic illness and global pandemics [i.e., Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)- COVID-19]. Chronic illness will be explored in detail, with specific focus on pediatric chronic pain, cystic fibrosis (CF), and congenital heart disease (CHD). The existing literature surrounding the impact of the COVID-19 pandemic on children and adolescents will be reviewed. Future research directions and clinical implications with be discussed. © 2022 Elsevier Ltd. All rights reserved

A qualitative exploration of the experience and attitudes of exercise professionals using telehealth for people with mental illness

Purpose: Physical activity is an important component of treatment for people living with mental illness, and exercise practitioners are well placed to deliver these interventions. In response to the COVID-19 pandemic and associated lock-down regulations, exercise professionals have rapidly adapted to the online delivery of services to continue care for their clients. To date, the research surrounding the delivery of exercise sessions via telehealth for this population has been scarce. Therefore, this study aims to explore how exercise professionals working in mental health have adapted to telehealth, the barriers and facilitators they have experienced and the implications for the future. Design/methodology/approach: A qualitative study using semi-structure interviews was conducted. Interviews were audio recorded, transcribed and analysed using reflexive thematic analysis. Findings: Nine exercise physiologists working in mental health settings in Australia participated in the interviews. Two main themes were explored. The first related to the implementation of telehealth and was divided into four sub-themes: service delivery, accessibility and suitability, technology barriers and facilitators, adaptations to exercise prescription. The second theme related to attitudes and was categorised into two sub-themes: attitudes towards telehealth and future recommendations. Practical implications: Telehealth appears to be a feasible and well accepted platform to deliver exercise sessions for people with mental illness, and this study provides guidance for clinicians including service and training recommendations. Originality/value: To the best of the authors' knowledge, this is the first study to examine the experiences of exercise physiologists working in mental health and using telehealth. © 2022, Emerald Publishing Limited.

URBAN AGING RESIDENTS COALITION (UARC): A HYBRID MODEL TO BRIDGE THE TECHNOLOGY GAP

The COVID-19 pandemic spotlighted technology barriers for urban Black/African American older adults that lead to chronic stress, social isolation, and inability to fully engage with the world. In partnership with an African American older adult community leader, the Urban Aging Residents Coalition was founded in May 2020 to address engaging older adults with technology. A primary goal of UARC is to prevent social isolation and promote mental wellness through education. Using a hybrid model of videoconferencing and socially-distanced meetings, volunteer health professionals and community members (e.g., Information Technology Technician, Psychologist, and Nurse) delivered education to older adults. Participants also met for computer training to build confidence by sharing technology accomplishments with others (e.g., online bill paying). UARC has 75 active members and conducted over 12 videoconferences and in-person programming. The UARC project serves as a model for community/academic partnerships to support mental wellness and technology use in urban older adults.

WORK SMARTER NOT HARDER

Background: In 2014 we were a small team with only 1 WTE (Whole Time Equivalent) CNS (Clinical Nurse Specialist) and 2 WTE consultants for a population of 220,000. Most CNS clinic appointments were taken up for drug counselling. Waiting times were approx. 6 weeks for drug counselling. Consultants would often counsel for DMARDs. That year at a national meeting a virtual group MDT (multidisciplinary) was presented by the team at Manchester Royal infrmary (MRI). They used a good quality presentation for patients starting bDMARDs as a tool for drug counselling. After having to put on an extra clinic to counsel 5 patients, all for rituximab, frustratingly I asked why can't I get them all in the same room to save time? We needed to work smarter, not harder, utilise time & space to ensure best practice but also ensure gold standard, patient centered care continued. We modifed the format used at MRI to a face to face group education and counselling of patients to improve waiting times and patient fow. Objectives: Reduce the amount of clinic appointments used to counsel patients for sDMARDs (synthetic disease modifying anti-rheumatic drugs) and bDMARDs (biologic). Free up clinic appointments for follow up/review and fares. Standardise information given out to ensure they are all given the same gold standard information and education. Methods: We visited the team at MRI to view the format of their virtual clinic. It didn't meet the needs of our service so we modified and adapted the presentation.Set up a group education session to discuss the most common sDMARDs and bDMARDs used for Inflammatory Arthritis. I developed a power point presentation and booklet that can be used by CNS-ensuring the same information is given to every patient, both attending the group session and those not suitable for group session (ie Language barriers) who would be seen individually. We use a screening proforma to ensure safety of commencement for the individual prior to attending clinics which has a tick list for screening requirements. The session is undertaken in our education centre. Pre Covid the session could accommodate up to 10 patients per session per week, uptake on average 8-10 patients for sDMARDs and 5-6 for bDMARDs. We alternated biologic and sDMARD sessions, if demand required, we changed a session to accommodate. The room is booked for 1 hours every week, the sDMARD presentation lasts approximately/an hour & bDMARD session 50 minutes, time is allowed for group & individual questions if required at the end. This contrasts with 25 minute appointment for sDMARD & 50 minute for bDMARD counselling 1:1. The booklet, along with information pack, is given at the group session to all patients. This includes all the information the patient requires (advice line information, blood forms). Prior to the group clinic admin team prepare the patient packs for the CNS to give to patients. Results: We received 102 anonymous responses back from 136 patients asked. (75% response) Following these sessions we found less calls to the advice line regarding medication queries, able to add in further cDMARDs or switch to alternate due to S/Es over the telephone Feedback from patients.-120 comments received. Clear simple information about a number of possible drugs used to treat my condition not just the 1 I am prescribed. If my medication needs changing I already know about it. The lecture aspect of the types/contra-indications of meds was very useful & removed the 'fear' attached to these specialist drugs. The session with other patients present stopped me from feeling alone in this position. The booklet is brilliant as it includes everything that was in the session. Also it took away the 'fear' of the side effects. Conclusion: 7 years on we feel that Group Counselling has been a huge success, we noticed how successful this was once we had to deal with the pandemic and cancel the group sessions. Patients feedback proves that they like the session and fnd them valuable. Whilst being benefcial and impoving work productivity and streamling the service.

A qualitative exploration of the experience and attitudes of exercise professionals using telehealth for people with mental illness

Purpose: Physical activity is an important component of treatment for people living with mental illness, and exercise practitioners are well placed to deliver these interventions. In response to the COVID-19 pandemic and associated lock-down regulations, exercise professionals have rapidly adapted to the online delivery of services to continue care for their clients. To date, the research surrounding the delivery of exercise sessions via telehealth for this population has been scarce. Therefore, this study aims to explore how exercise professionals working in mental health have adapted to telehealth, the barriers and facilitators they have experienced and the implications for the future. Design/methodology/approach: A qualitative study using semi-structure interviews was conducted. Interviews were audio recorded, transcribed and analysed using reflexive thematic analysis. Findings: Nine exercise physiologists working in mental health settings in Australia participated in the interviews. Two main themes were explored. The first related to the implementation of telehealth and was divided into four sub-themes: service delivery, accessibility and suitability, technology barriers and facilitators, adaptations to exercise prescription. The second theme related to attitudes and was categorised into two sub-themes: attitudes towards telehealth and future recommendations. Practical implications: Telehealth appears to be a feasible and well accepted platform to deliver exercise sessions for people with mental illness, and this study provides guidance for clinicians including service and training recommendations. Originality/value: To the best of the authors’ knowledge, this is the first study to examine the experiences of exercise physiologists working in mental health and using telehealth. © 2022, Emerald Publishing Limited.

TELEMEDICINE and HIV CARE QUALITY MEASURES during the COVID-19 PANDEMIC

Background: During the COVID-19 pandemic, HIV care providers urgently adopted telemedicine as an alternative to routine in-person person visits to ensure continuity of care. We examined how introducing televisits at a community and an academic outpatient HIV clinic during the COVID-19 pandemic affected technical quality of care for persons with HIV (PWH). Methods: The study included all non-pregnant adult PWH who had at least two visits for HIV care in the 18 months prior to 3/13/2020 at the Howard Brown Health Centers (HB) and Northwestern University Infectious Disease Center (NU-IDC) and in Chicago, Illinois. HIV care quality indicators (described in Table) were calculated using data extracted from electronic medical records during 4 different time periods: 1. pre-pandemic (1/1/19-3/1/2020), 2. early pandemic (7/1/2019-9/1/2020), 3. mid-pandemic (1/1/2020-3/1/2021), and 4. current (7/1/2020-9/1/2021). Measures were compared between intervals 2-4 and interval 1 (pre-pandemic) using generalized linear mixed models to estimate differences in indicators across intervals within each site while controlling for multiple observations of individuals. Differences by age group, race, and sex at birth were also compared. Results: 6,447 PWH were included in the analysis. The proportion of televisits peaked between April-June 2020 (71-75% at HB 53-89% at NU-IDC) then declined by July-September (33-35%at HB, 10-15% at NU). Changes in quality care measures are shown in Table 1. There were significant declines in care utilization and disease monitoring measures in intervals 2,3 &4 compared to interval 1. The largest declines were observed in STI screening. Measures of HIV virologic suppression, BP control, and HbA1C <7% (in both persons with and without diabetes) were stable with no significant differences noted in these measures between interval 4 and 1. Similar trends were observed across all age, race and sex subgroups. Conclusion: During the COVID-19 pandemic and rapid implementation of televisits, indicators of care utilization and disease monitoring decreased compared to pre-pandemic levels. Despite these reductions, proportions with virologic, BP, and glycemic control remained stable among PWH. The effect of televisits as well as other patient factors on HIV quality indicators and their changes over time during COVID-19 need to be further examined.

The effect on the T-14 paediatric throat disorders outcome score of delaying adenotonsillectomy surgery due to COVID-19.

INTRODUCTION: Adenotonsillectomy is commonly performed for recurrent tonsillitis and obstructive sleep apnoea. These conditions may improve with age. The COVID-19 pandemic led to all UK elective surgery being suspended. This study aimed to determine whether delaying surgery had any effect on a patient's symptoms using the validated T-14 paediatric throat disorders outcome test. METHODS: Patients completed a T-14 questionnaire when the child was listed for surgery; this was repeated on the revised surgery date and a paired t test was used to compare the responses. RESULTS: Questionnaires were completed by 29 patients a mean of 6.4 months apart. There was a significant improvement in scores (p<0.02) for five domains: eating habits, visits to a doctor/A&E, antibiotics for less than 2 weeks, chronic infections and school missed due to sore throats. CONCLUSIONS: This study demonstrates that following delays resulting from the COVID-19 pandemic, paediatric patients experienced an improvement in some aspects of their quality of life while awaiting tonsillectomy and/or adenoidectomy. This was most apparent in quality-of-life measures relating to recurrent tonsillitis, namely visits to a doctor/A&E, antibiotics for less than 2 weeks, chronic infections and school missed due to sore throats. Patients may experience an improvement in some of their individual symptoms, in particular their infective symptoms, during an observation period.

Efficacy of Hexetidine, Thymol and Hydrogen Peroxide-Containing Oral Antiseptics in Reducing Sars-Cov-2 Virus in the Oral Cavity: A Pilot Study.

BACKGROUND: Studies have demonstrated the role of sputum as a site of severe acute respiratory syndrome-coronavirus-2 (SARSCoV-2) transmission. However, there is limited literature on the virucidal efficacy of oral antiseptics against SARS-CoV-2 virus. This study investigated the virucidal efficacy of three oral-antiseptics compared to a placebo-control in the sputum of SARS-CoV-2 infected individuals. METHODOLOGY: A pilot study of adults with SARS-CoV-2 positive results, as determined by reverse transcription-polymerase chain reaction (RT-PCR) of <7 days. The oral antiseptics investigated were: Hexetidine (0.1% w/v); Thymol (0.063% w/v) and H2O2(1.5%) compared to de-mineralized sterile water (Placebo-control). The primary outcome measure was the proportion of negative RT-PCR results at 15-mins, 30-mins, 1-hour, 2-hours and 4-hours After Oral antiseptics Interventions (AOI) compared to the placebo-control. Statistical analysis was done using STATA 15.0 software with p-values of <0.05 considered statistically significant. RESULTS: Data from a total of 66 participants that were RT-PCR SARS-CoV-2 positive at baseline (0-min) was analysed. At 15-mins AOI, the highest proportion of negativation from sputum samples was observed in the Hexedine group, with 69.2% of the baseline PCR positive cases converting to negative compared to 46.7% in the placebo-control group. In addition, H2O2 demonstrated efficacy at 2-hours AOI compared to placebo-control (62.5% vs 37.5% respectively) and other oral-antiseptics. Across all time-points, the oral-antiseptic groups compared to the placebo-control group, there was no statistically significant difference in the proportion of sputum samples which converted to a negative status (p>0.05). CONCLUSION: The findings in this study suggest there was no significant difference in the proportion of participants who converted to a negative sputum status across the treatment groups at various time points. Future studies could compare the cycle threshold (ct) viral titre values of sputum samples to determine quantitative differences.

CONTEXTE: Des études ont démontré le rôle des expectorations comme un site de transmission du syndrome respiratoire aigu sévère-coronavirus- 2 (SRAS-CoV-2). Cependant, il existe peu de documentation sur l'efficacité virucide des antiseptiques oraux contre le virus du SRASCoV-2. Cette étude a examiné l'efficacité virucide de trois antiseptiques oraux par rapport à un contrôle placebo dans les expectorations de personnes infectées par le SRAS-CoV-2. MÉTHODOLOGIE: Une étude pilote menée auprès d'adultes dont les résultats sont positifs pour le SRAS-CoV-2, tels que déterminés par la réaction en chaîne de la polymérase par transcription inverse (RT-PCR) pendant 7 jours. Les antiseptiques oraux étudiés étaient : Hexetidine (0,1% p/v) ; Thymol (0,063% p/v) et H2O2 (1,5%) par rapport à l'eau stérile déminéralisée (Placebo-contrôle). Le principal critère d'évaluation était la proportion de résultats RT-PCR négatifs 15 minutes, 30 minutes, 1 heure, 2 heures et 4 heures après les interventions antiseptiques orales (AOI) par rapport au contrôle placebo. L'analyse statistique a été réalisée à l'aide du logiciel STATA 15.0, les valeurs p de <0,05 étant considérées comme statistiquement significatives. RÉSULTATS: Les données d'un total de 66 participants qui étaient positifs à la RT-PCR SARS-CoV-2 au départ (0 minute) ont été analysées. Au bout de 15 minutes, la plus forte proportion de négativation des échantillons d'expectoration a été observée dans le groupe Hexedine, 69,2 % des cas positifs au départ par PCR devenant négatifs, contre 46,7 % dans le groupe témoin placebo. En outre, l'H2O2 a démontré son efficacité à 2 heures après l'apparition de la maladie par rapport au groupe placebo (62,5 % contre 37,5 % respectivement) et aux autres antiseptiques oraux. Pour tous les points temporels, les groupes d'antiseptiques oraux comparés au groupe placebo n'ont pas présenté de différence statistiquement significative dans la proportion d'échantillons d'expectoration qui sont devenus négatifs (p>0,05). CONCLUSION: Les résultats de cette étude suggèrent qu'il n'y a pas de différence significative dans la proportion de participants qui sont passés à un statut négatif d'expectoration dans les groupes de traitement à différents moments. Les études futures pourraient comparer les valeurs du titre viral au seuil de cycle (ct) des échantillons d'expectoration afin de déterminer les différences quantitatives. MOTS CLÉS: SRAS-CoV-2, antiseptiques oraux, hexétidine, peroxyde d'hydrogène.

A multi-centre, randomized, double-blind, placebo-controlled clinical trial of the efficacy and safety of chloroquine phosphate, hydroxychloroquine sulphate and lopinavir/ritonavir for the treatment of COVID-19 in Lagos State: study protocol for a randomized controlled trial.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that was first identified in Wuhan, Hubei, China, in December 2019. It was recognized as a pandemic by the World Health Organization on 11 March 2020. Outbreak forecasting and mathematical modelling suggest that these numbers will continue to rise. Early identification of effective remedies that can shorten the duration and severity of illness is critical for Lagos State, which is the epi-centre of the disease in Nigeria. METHODS: This is a multi-centre, randomized, double-blind placebo-controlled superiority trial. The study investigates the efficacy of chloroquine phosphate, hydroxychloroquine sulphate and lopinavir/ritonavir added on to standard of care compared to standard of care only in patients with COVID-19 disease. The primary outcome is the clinical status of patients measured using a 7-point ordinal scale at day 15. Research participants and clinicians will be blinded to the allocated intervention. Outcome measures will be directly assessed by clinicians. Statistical analysis will be done by a team blinded to the identity and allocation of research participants. Data analysis will follow intention-to-treat methods, using R software. DISCUSSION: The current study is of strategic importance for Lagos State in potentially curbing the health, social and economic burden of COVID-19 disease. Should the current study demonstrate that either of the three intervention drugs is more efficacious than standard therapy alone, the State Ministry of Health will develop an evidence-based guideline for the management of COVID-19 in Lagos State. The findings will also be shared nationally and with other states which may lead to a standardized national guideline for the treatment of COVID-19 in Nigeria. TRIAL REGISTRATION: Pan African Clinical Trials Register PACTR202004801273802 . Registered prospectively on April 2, 2020.

Changes in objectively-measured adolescent sleep and light exposure during the COVID-19 pandemic

Introduction: U.S. adolescents have high rates of insufficient sleep. School closures and stay-at-home orders were implemented to mitigate disease spread during the Coronavirus 2019 (COVID-19) pandemic. Without the restriction of imposed early school start times, we hypothesized that adolescents would have longer, later, and less variable sleep compared to pre-COVID-19. We further hypothesized these changes would be associated with increased and later light exposure. Methods: High school students age 14-19 years with <7h sleep on school nights completed two weeks of at-home monitoring. The Pre-COVID-19 week took place between October 2018-February 2020 and the COVID-19 week occurred in May 2020 during statewide stay-at-home orders. Participants wore an accelerometer to assess sleep and light exposure while completing a concurrent sleep log. Paired-samples t-tests examined differences in sleep and light between Pre-COVID-19 and COVID-19. Pearson correlations assessed associations between change in sleep and change in light. Results: Participants (N=16) were 16.5 ±1.2-years-old at Pre- COVID-19, 70.6% female, 68.8% White, and 25.1% Hispanic. Youth were participating in online learning due to in-person school closures and only 2 participants (14.3%) had a set start time, while the remainder reported learning per their own schedule. Youth obtained approximately one hour more weekday sleep per night during the COVID-19 week compared to Pre-COVID-19 (p<0.001). Bed and waketimes were significantly delayed on weekdays and weekends during COVID-19 compared to Pre-COVID-19 (p< 0.01). The greatest change was a delay in weekday waketime of 2.9±0.9h (p<0.001). Social jetlag during COVID-19 was reduced by 1/3 compared to Pre- COVID-19 (p=0.02). Average 24h lux levels were 2.5x higher during the COVID-19 week compared to Pre- COVID-19 (p=0.008). Change in average lux and timing of light were not significantly associated with change in sleep duration or timing. Conclusion: An unintended effect of the switch to online learning may have been affording adolescents the opportunity to obtain longer and more regular sleep. Understanding the impact of these changed sleep behaviors on daytime functioning, academic performance, and health outcomes is particularly urgent as schools plan for the remainder of the academic year and eventual return to in-person learning.

Dynamics of Leukocyte Subpopulations Reconstitution Predict Infection Propensity in a Multiethnic Real World Cohort Treated with Anti-CD19 CAR-T Cell Therapy (Axicabtagene-Ciloleucel)

Background: Adoptive immunotherapy using CD19-targeted Chimeric Antigen Receptor T-cells (CAR-T) has revolutionized the treatment of relapsed/refractory diffuse large B-cell lymphoma (DLBCL). We have demonstrated the efficacy of FDA-approved axicabtagene ciloleucel (Yescarta) in a multiethnic New York City underserved population with 80% complete response (CR) rate in the first ten patients treated at our institution (Abbasi et al., 2020). There is limited data on the propensity of infections and lymphohematopoietic reconstitution after Day 30 (D30) following CAR-T cell therapy. In this study, we evaluated the prevalence and nature of infectious complications in an expanded cohort of DLBCL patients treated with CD19 CAR-T therapy and its association with the dynamics of leukocyte subpopulation reconstitution post-CAR-T cell therapy. Methods: We conducted a retrospective study of patients who received CAR-T therapy at our institution between 2018-2020. Variables collected include patient demographics, absolute neutrophil (ANC), lymphocyte (ALC) and monocyte counts (AMC) at Day 30, hematologic reconstitution (ANC≥ 1500/µL) at Day 90 (D90), presence or absence of infections after D30 by clinical and/or microbiological parameters. Associations between presence of infection and D30 ANC, ALC, AMC, ANC/ALC ratio, AMC/ALC ratio were assessed using Kruskal-Wallis test. Association between infection and hematologic reconstitution at D90 was done using Chi-square test. Kaplan-Meier curves with log-rank test were used to evaluate overall survival (OS) and progression-free survival (PFS). Results: Nineteen patients were evaluated in our study, consisting of 42% (8) Hispanic, 32% (6) Caucasian, 21% (4) African-American, and 5% (1) Asian subjects. Based on clinical and microbiologic data, 47% (9) developed an infection after D30 (infection group) while 53% (10) of subjects remained infection-free after D30 (non-infection group). The most common infection type observed was viral (11 patients) followed by bacterial (8 patients) and fungal (3 patients) (Table 1). Of 25 total infectious events, 44% (11) were grade 1 or 2 and 48% (12) were grade 3 with 10 being viral in etiology. Two deaths occurred due to an infectious process. Three patients tested SARS-CoV-2 positive and were hospitalized with COVID-19 pneumonia. Median OS and PFS has not been reached in either group. To determine the kinetics of lymphohematopoietic reconstitution and its association with infection risk, we evaluated the relationship between cytopenias and rates of infection after D30. Notably, compared to non-infection group, infection group had a higher median ALC (1000/µL vs 600/µL p=0.04), a lower median ANC/ALC ratio (1.4 vs 4.5 p<0.01) and a lower median AMC/ALC at D30 (0.36 vs 1.33, p=0.01) (Table 2). In addition, patients in the infection group had a lower rate of hematologic reconstitution (ANC >1500/µL) at D90. We observed that only 22% (2) of patients had recovered ANC > 1500/µLin the infection group as opposed to 80% (8) in the non-infection group at D90 (p= 0.038). Rates of cytokine release syndrome (CRS) were comparable between the two groups (55.6% vs 70% p=0.52). Surprisingly, rates of immune-effector cell associated neurotoxicity syndrome (ICANS) was lower (55.6%) in the infection group compared to (90%) non-infection group (p=0.09). Fourteen of 19 patients had follow-up over one year, of which 8 (57%) remained in complete remission (CR). Conclusions: We demonstrate an infection rate of 47% (9) beyond D30 in patients undergoing CD19 CAR-T. Increased ALC, lower ANC/ALC and AMC/ALC ratios at D30 may be predictive of infectious complications. Median OS has not been reached in our cohort. Given the potential clinical impact, our observations should be corroborated using larger datasets. [Formula presented] Disclosures: Steidl: Pieris Pharmaceuticals: Consultancy;Bayer Healthcare: Research Funding;Stelexis Therapeutics: Consultancy, Current equity holder in private company, Membership on an entity's Board of Directors or advisory committees;Ai eron Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Janakiram: ADC Therapeutics, FATE therapeutics, TAKEDA pharmaceuticals: Research Funding. Verma: BMS: Consultancy, Research Funding;acceleron: Consultancy, Honoraria;Janssen: Research Funding;stelexis: Current equity holder in private company;Medpacto: Research Funding.

Telephone-delivered compassion-focused therapy for adults with intellectual disabilities: a case series

Purpose: Services are increasingly exploring the use of remote conferencing to deliver psychological interventions, which have become particularly important given the COVID-19 pandemic and infection control guidelines. This paper aims to explore the feasibility, acceptability and preliminary effectiveness of delivering psychological therapy remotely to adults with intellectual disabilities (ID). Design/methodology/approach: As part of routine practice within an adult ID community health service, this paper develops a six-session programme based on compassion-focused therapy (CFT) and delivered it to six clients. Clients completed the psychological therapy outcome scale for ID 2nd edition, at assessment, pre- and post-therapy, as well as a feasibility and acceptability measure. Findings: Six clients engaged in telephone therapy;four clients individually, while the remaining two were supported by their caregiver. Most clients found the intervention helpful, enjoyable and were pleased that they received telephone-delivered psychological therapy. A reduction was observed at post-therapy in distress (g = 0.33) and risk (g = 0.69). No difference was reported in psychological well-being. Five clients were subsequently discharged from psychological therapy. Originality/value: To the knowledge, this is the first study examining the use of telephone therapy (including CFT) for individuals with ID. Findings add to the growing evidence suggesting individuals with ID can benefit from receiving adapted psychological therapies. Research is required to further explore the effectiveness of remote-therapies, who would most likely benefit from this approach and how remote treatments could be used within existing pathways. © 2021, Emerald Publishing Limited.

Increased incidence of idiopathic paediatric facial palsy during the coronavirus disease 2019 pandemic.

BACKGROUND: Bell's palsy is a lower motor neurone facial weakness of unknown aetiology, although reactivation of a virus within the facial nerve has been proposed. METHODS: A prospective study was conducted of Bell's palsy cases presenting to our paediatric ENT unit over a 19-week period, from February to June 2020. Patients were invited for severe acute respiratory syndrome coronavirus-2 antibody testing. A text-message questionnaire was sent to other ENT centres to determine their observational experience. RESULTS: During the study period, 17 children presented with Bell's palsy, compared with only 3 children in the same time period in the previous year (p < 0.0001). Five patients underwent severe acute respiratory syndrome coronavirus-2 antibody testing, the results of which were all negative. Four out of 15 centres questioned perceived an increased incidence in paediatric Bell's palsy. CONCLUSION: Clinicians are encouraged to be vigilant to the increase in paediatric Bell's palsy seen during the coronavirus disease 2019 pandemic, which may represent a post-viral sequela of coronavirus disease 2019.

Predictors of COVID-19 information sources and their perceived accuracy in Nigeria: Online cross-sectional study

Background: Effective communication is critical for mitigating the public health risks associated with the COVID-19 pandemic. Objective: This study assesses the source(s) of COVID-19 information among people in Nigeria, as well as the predictors and the perceived accuracy of information from these sources. Methods: We conducted an online survey of consenting adults residing in Nigeria between April and May 2020 during the lockdown and first wave of COVID-19. The major sources of information about COVID-19 were distilled from 7 potential sources (family and friends, places of worship, health care providers, internet, workplace, traditional media, and public posters/banners). An open-ended question was asked to explore how respondents determined accuracy of information. Statistical analysis was conducted using STATA 15.0 software (StataCorp Texas) with significance placed at P<.05. Approval to conduct this study was obtained from the Lagos State University Teaching Hospital Health Research Ethics Committee. Results: A total of 719 respondents completed the survey. Most respondents (n=642, 89.3%) obtained COVID-19-related information from the internet. The majority (n=617, 85.8%) considered their source(s) of information to be accurate, and 32.6% (n=234) depended on only 1 out of the 7 potential sources of COVID-19 information. Respondents earning a monthly income between NGN 70,000-120,000 had lower odds of obtaining COVID-19 information from the internet compared to respondents earning less than NGN 20,000 (odds ratio [OR] 0.49, 95% CI 0.24-0.98). In addition, a significant proportion of respondents sought accurate information from recognized health organizations, such as the Nigeria Centre for Disease Control and the World Health Organization. Conclusions: The internet was the most common source of COVID-19 information, and the population sampled had a relatively high level of perceived accuracy for the COVID-19 information received. Effective communication requires dissemination of information via credible communication channels, as identified from this study. This can be potentially beneficial for risk communication to control the pandemic. © Olufemi Erinoso, Kikelomo Ololade Wright, Samuel Anya, Yetunde Kuyinu, Hussein Abdur-Razzaq, Abiodun Adewuya. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 25.01.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/)