A quality improvement project regarding family communication within critical care

Introduction: Communication is central to high quality critical care (CC)1 and caring for family members is integral to the care of critically ill patients. Communication within the CC frequently does not meet families' needs,2 impacts informed decisions making3 and can result in psychological morbidity for patients and their families.4 During the COVID-19 pandemic communication was challenging with restricted family visiting. As part of our recovery strategy we aim to ensure that frequent, high quality communication remains a key aspect of critical care. There is currently no guidance relating to the frequency of family communication within critical care. Objective(s): Our aim was to review the frequency of family communication during CC admissions admission and to develop our own internal standards. Method(s): A retrospective audit was conducted of 110 admissions to Guys and St Thomas' CC from November 2021 - February 202. We reviewed all routine family discussions documented in the medical notes. Data regarding the patient's length of stay, time to first communication from admission, frequency of communication throughout admission and grade of clinician leading the communication was collected. Family discussion regarding adverse incidents and admissions less than 24hrs were excluded. If multiple communications occurred on the same day, the most senior communication was included. To complement the audit a short survey of the consultants, regarding expectations and standards of practice of family communication was completed. Result(s): 99 patients were included within the audit and 13 responses to the survey (34% response). The mean length of stay for all patients was 14 days for survivors and 16.5 days for those who died. 32% of patients received a document family communication within 24hrs of admission, 34% did not have a documented communication within 72 hours of admission. 58.3% of consultants felt a family update should happen within 24hrs of admission and 84.7% of consultants reported that families should be updated once every 3 days. On average families received a documented family communication every 5.5 days of a CC admission. When focusing just on patients who died there was an increase in the frequency of communication to once every 3 days. 23% of all documented family discussions were consultant led with the number rising to 44% in non-survivors. The audit also showed that the longer a patient stayed within critical care the less frequently a family communication became. The survey indicated that the two biggest barriers to family communication is time pressures and appropriate space. Conclusion(s): We demonstrated that documented family communication was less frequent than expected. To ensure that family commination remains a key component of CC within our department we have adopted or own internal standard of providing families with an update once every 3 days. We are exploring the role of communication facilitators5 and seeking patient/family feedback also to improve family communication further.

Sharing the knowledge and expertise of BSH members throughout the global Haematology community

'BSH Global Speakers' was established in 2015 as a core project of the BSH Global Haematology Special Interest Group (SIG). As the project enters its eighth year, we present an update and reflection on the successes and challenges encountered. Initially known as the 'Plenary Speaker Scheme', the project was developed following a stakeholder meeting in 2015 at the inception of the SIG. Haematology colleagues from the UK and low-and middle-income countries (LMIC) came together to discuss how the BSH may be best placed to support haematologists practicing in LMICs. Sharing of expertise and building collaborative networks were identified as key priorities. The 'Plenary Speaker Project' was conceived;BSH haematologists would be supported in delivering plenaries at the meetings of colleagues in LMICs, with the aim that each visit could act as a catalyst for creating networks and developing collaborative projects in education, research, and capacity building. We established a yearly cycle of inviting applications from LMIC societies for a funded speaker at their scientific meetings, selecting the most impactful meetings, then recruiting appropriate UK-based speakers. We place emphasis on the likelihood of ongoing collaborative working or other impacts, for example engagement with local haematology trainees. To date, ten speakers have represented BSH at the meetings of LMIC societies, presenting on diverse topics, from molecularly guided interventions to prevent relapse in AML, to adapting lymphoma treatment strategies for low resource settings. Recently we have opened applications to nurse specialists and scientists, with our first scientific speaker presenting in Thailand May 2023. The COVID-19 pandemic created significant challenges for the project due to the disruption in international travel and the cancellation of many haematology meetings around the globe. We were, however, able to adapt the project to support virtual speakers at meetings in South Africa, Vietnam, and Ghana. Although virtual meetings do not naturally lend themselves to collaborative working, we were pleased that a longer term joint educational program in haemoglobinopathy care has been established with the Vietnamese Society of Haematology as a result of BSH support. The impact of BSH Global Speakers is significant. Even at smaller meetings, speakers will have the ear of the majority of practicing haematologists in a country. From the relationships built between societies and speakers we have seen the development of fellowship programmes, online education programmes, laboratory support, and numerous networks for informal advice in clinical care, research, and more.

Scaffolding in an Online Service-Learning Environment Responsive to Community Challenges

Teaching a service-learning project in an online setting has its pedagogical advantages and challenges. These challenges become magnified when a disaster occurs, but they can also provide a critical avenue for academic instruction. One of these avenues is scaffolding or building on a new concept within instruction. Using the backdrop of a service-learning graduate course whose deliverable is tied to preparing a grant proposal for community partners, many of which were facing issues related to in-time disasters (i.e., hurricanes, public shootings, COVID-19), this chapter will discuss developing a course that engages in the scaffolding of assignments, and the importance of doing so for disaster resilience and preparedness. It will address theoretical structures of online scaffolding: conceptual, traditional, procedural, and metacognitive and see which ones may be present depending on the assignment or the event, discuss different tools in online scaffolding including conference forums and video production. Finally, it will discuss the importance of facilitating proper communication among all parties to build an effective deliverable for all involved. © 2023 selection and editorial matter, Lucia Velotti, Rebecca Morgenstern Brenner and Elizabeth A. Dunn;individual chapters, the contributors.

Micro-eliminating HCV in 8 diverse prisons that serve a general population of 3.7 million in the Yorkshire region of England

Background: National Health Service England (NHSE) plans to eliminate Hepatitis C (HCV) by 2025. With a reported HCV prevalence of about 6% in male prisons, and about 12% in female prisons, secure environments are an essential component of this elimination plan. Yorkshire is a region in England with a general population of about 3.7 M. PPG is the provider of healthcare to 9 prisons in Yorkshire, with approximately 6,000 residents, many of whom are current, or previous, substance users. Description of model of care/intervention: To support NHSE in the elimination of HCV, a partnership between Gilead Sciences, Practice Plus Group (PPG) and the Hepatitis C Trust (HCT) was formed in 2019. This partnership works with prison and hospital teams to optimise test and treat pathways for new prison admissions. In addition, whole prison HCV Intensive Test and Treat events (HITT programmes) were run in targeted prisons to ensure testing of residents who were incarcerated before these optimisations were implemented. Effectiveness: HCV screening, within 7 days of prison entry, increased from 27% in May 2019 to 93% in January 2022. This increase was achieved despite COVID-19 restrictions remaining in place since March 2020 across all English prisons. In addition, HITT programmes were used to test residents who were missed at prison entry. The overall result is that 8/9 prisons have achieved microelimination status, as defined by: >= 95% of prison residents tested within the previous 12 months, >= 90% of RNA positive patients treated or initiated on treatment and presence of a robust system to review ongoing testing and treatment performance to ensure these targets are maintained. Conclusion and next steps: Micro-elimination of HCV will now need to be maintained in these prisons by ensuring the uptake of HCV testing remains>95%. Plans are in place to micro-eliminate the final prison-which is a high-security prison presenting unique challenges to HCV micro-elimination.

Self-management interventions for people with pulmonary fibrosis: A scoping review

Introduction/Aim: Self-management is considered important in people with pulmonary fibrosis (PF);however, components of self-management that are relevant to PF are not well defined. This study aimed to identify the common self-management components used in PF. Method(s): A scoping review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The protocol was registered with Open Science Framework database (doi: https://doi.org/10.17605/OSF.IO/EUZ6S). A systematic search was conducted on August 16, 2022, using five electronic databases (Medline, Embase, PsychInfo, CINAHL and the Cochrane central register of controlled trials). Search results were screened and studies were included if they (i) described any educational, behavioural and support components that aimed at facilitating self-management;(ii) involved adults with PF;and (iii) employed quantitative, qualitative or mixed methods. Two researchers performed record screening and data extraction independently followed by discussions of discrepancies. Result(s): Of the 27081 records screened, 87 studies were included (39% observational studies, 26% randomised controlled trials). The most common self-management components were patient education (78%), information or support for managing physical symptoms (66%) and enhancing psychosocial wellbeing (54%). Majority of the included studies (71%) were rehabilitation programs with evidence of self-management training such as home exercise program and breathing training. Other studies included palliative care programs consisting of components such as patient education and care goal setting (12%), support programs for managing medication (4%), home-based self-monitoring training (4%), disease management programs (4%), mindfulness-focused stress reduction program (1%), telemedicine service delivered during the COVID-19 outbreak that included strategies to prevent infections and self-monitoring of clinical parameters (1%) and PF-specific educational and support website (1%). Over half of the interventions were provided by a multidisciplinary team. Conclusion(s): This review identified the common components used to promote self-management in PF. These findings help to guide the development of optimal interventions to support self-management in PF.

A novel cystic fibrosis-pregnancy service: Two-year review after introduction of elexacaftor/tezacaftor/ivacaftor

Background: As a quality service improvement response since elexacaftor/ tezacaftor/ivacaftor (ELX/TEZ/IVA) became available and the yearly average number of cystic fibrosis (CF) pregnancies (n = 7 pre-2020, n = 33 in 2021) increased significantly at an adult CF center (~600 people with CF), a monthly multidisciplinary CF-maternal health virtual clinic was established with antenatal virtual CF exercise classes dedicated to providing adaptive, specialist support to this cohort, aswell as outreach guidance and education to local obstetric teams. Method(s): This was a single-center retrospective reviewof Royal Brompton Hospital CF-Maternal Health multidisciplinary team clinic records and a patient survey from March 2020 to March 2022. Result(s): Of 47 pregnancies in 41 women (median age 30;) eligible for ELX/ TEZ/IVA at start of pregnancy, 40% (n = 19) were unplanned, and 19% (n = 9) used assisted conception. Three women with a history of infertility conceived naturally, having required assisted conception for previous pregnancies, and five women had multiple pregnancies during the study period. ELX/TEZ/IVA was continued in 60% (n = 28), delayed in 28% (n = 13), and stopped in 13% (n = 6) of pregnancies through maternal choice and careful clinical counselling. Pre-pregnancy pulmonary status was poorer in women who continued than in those who delayed or stopped (Table 1). Of those who stopped, 85% (n = 5) restarted because of pulmonary deterioration by the third trimester. Prenatal CF complications included at least one episode of minor hemoptysis in 21% (n = 9/41) of women, at least one infective exacerbation in 55% of pregnancies (n = 26/47), and noninvasive ventilation in one woman. Other pregnancy-associated complications included one case of ovarian hyperstimulation syndrome, one case of sub-segmental pulmonary embolism, and two cases of pregnancy-induced hypertension. Excluding 10 first trimester terminations, 10 current pregnancies, and one patient relocation, obstetric outcomes available for 26 pregnancies confirmed a live birth rate of 85% (n = 22/26) and a 15% first-trimester miscarriage rate (n = 4). Obstetric complications included preterm delivery rate of 23% (n = 6/26), including two cases of COVID infection resulting in two neonatal intensive care unit admissions, one case of endometritis after cesarean section, and a fourthdegree perineal tear. There were no ectopic pregnancies, maternal or neonatal deaths, or reports of infant cataracts or congenital malformations. Median gestational age was 37/40 weeks (range 29-40). Mode of delivery was via cesarean section in 45% (n = 10/22, of which twowere emergency) and vaginal in 55% (n = 12/22), of which 83% (n = 10/12) were via induction of labor for diabetes (CF or gestational) indication. Deliveries were supported and occurred equally at local obstetric units and in tertiarycare obstetric hospital settings (50%, n = 11/22). Patient-experience survey responses cited high levels of confidence in health optimization and prioritization during pregnancy and praised excellent inter-health care provider communication and peer-to-peer emotional support provided among expectant mothers in the virtual prenatal exercise groups. Table 1. Baseline demographic and clinical characteristics of elexacaftor/tezacaftor/ivacaftoreligible expectant mothers according to therapeutic decision (Table Presented) Conclusion(s): In the absence of clinical trial safety data, the novel approach of a dedicated CF-maternal health multidisciplinary team clinic with local obstetric outreach support has ensured regular specialist clinical and emotional peer-to-peer support for this cohort of women eligible for ELX/ TEZ/IVA to ensure optimal outcomes and experiences of their pregnancies, where appropriate, close to home.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Patient Factors Associated with Death of COVID-19 Patients in an Urban Emergency Department

Objectives: We aim to identify demographics, chief complaints, and comorbidities among patients who tested positive for COVID-19 in the University Medical Center New Orleans (UMCNO) ED and to identify which variables are associated with death. Background(s): On March 9, 2020, the novel coronavirus (COVID-19) breached Louisiana state lines, spreading to all 64 parishes within a month with New Orleans as the epicenter. Louisiana Department of Health data reveal that Black and elderly patients are disproportionately affected by the virus. Despite these findings, it is still largely unknown what other patient characteristics are associated with COVID-19 outcomes in the Louisiana population. Method(s): A retrospective chart review of the first 500 patients >/= 18 years old testing positive for COVID-19 at UMCNO-ED was conducted. We queried for patient characteristics, clinical care practices, and hospital courses. Data was stored in RedCap. Descriptive and multivariate analyses were conducted using de-identified patient data in Microsoft Excel and SAS 9.4. Logistic regression was used for associations with death. Reported odds ratios are unadjusted as no confounding variables were identified. Result(s): The 500-patient sample was predominantly female (56%) and Black (88%). The leading range for BMI was >35 (35%) and for age was 50-59 years (25%, mean=49). Of the 23 patients who died, 83% were black, and the leading age range was 60-69 (36%, mean=63). Pre-existing health conditions in descending order of frequency included: obesity, hypertension, and diabetes for the entire cohort (n=500), and diabetes, hypertension, and obesity for patients who expired (n=23). Common chief complaints in descending order of frequency were fever, flu-like symptoms, and cough for the entire cohort, and shortness of breath, fever, and cough for those who expired. The following patient characteristics were found to be associated with death: age > 65 (OR, 4.9;95% CI, 2.1;p=0.0002), shortness of breath (OR, 2.9;95% CI, 1.2;p=0.02), and history of diabetes (OR, 6.2;95% CI, 2.5;p=0.0001). Conclusion(s): Our study described the predominant demographics, pre-existing health conditions, and chief complaints of the first 500 patients to test positive for COVID-19 at UMCNO-ED. The factors associated with a higher likelihood of COVID-19-related death were identified. Further investigation into the health disparities experienced between patient populations is warranted, as they may be associated with higher incidences of COVID-19 infection and mortality.Copyright © 2023

Use of Contrast Media During CT-guided Thermal Ablation of Colorectal Liver Metastasis for Procedure Planning is Associated with Improved Immediate Outcomes.

PURPOSE: The aim of this study was to analyze the impact of using intra-procedural pre-ablation contrast-enhanced CT prior to percutaneous thermal ablation (pre-ablation CECT) of colorectal liver metastases (CLM) on local outcomes. MATERIALS AND METHODS: This retrospective analysis of a prospectively collected liver ablation registry included 144 consecutive patients (median age 57 years IQR [49, 65], 60% men) who underwent 173 CT-guided ablation sessions for 250 CLM between October 2015 and March 2020. In addition to oncologic outcomes, technical success was retrospectively evaluated using a biomechanical deformable image registration software for 3D-minimal ablative margin (3D-MAM) quantification. Bayesian regression was used to estimate effects of pre-ablation CECT on residual unablated tumor, 3D-MAM, and local tumor progression-free survival (LTPFS). RESULTS: Pre-ablation CECT was acquired in 71/173 (41%) sessions. Residual unablated tumor was present in one (0.9%) versus nine tumors (6.6%) ablated with versus without using pre-ablation CECT, respectively (p = 0.024). Pre-ablation CECT use decreased the odds of residual disease on first follow-up by 78% (CI95% [5, 86]) and incomplete ablation (3D-MAM ≤ 0 mm) by 58% (CI95% [13, 122]). The odds ratio for residual unablated tumor for larger CLM was lower when pre-ablation CECT was used (odds ratio 1.0 with pre-ablation CECT vs. 2.52 without). Pre-ablation CECT use was not associated with improvements on LTPFS. CONCLUSIONS: Pre-ablation CECT is associated with improved immediate outcomes by significantly reducing the incidence of residual unablated tumor and by mitigating the risk of incomplete ablation for larger CLM. We recommend performing baseline intra-procedural pre-ablation CECT as a standard imaging protocol. LEVEL OF EVIDENCE: Level 3 (retrospective cohort study).

Unwarranted Exclusion of Intermediate Lineage A-B SARS-CoV-2 Genomes Is Inconsistent with the Two-Spillover Hypothesis of the Origin of COVID-19

Pekar et al. (2022) propose that SARS-CoV-2 was a zoonotic spillover that first infected humans in the Huanan Seafood Market in Wuhan, China. They propose that there were two separate spillovers of the closely related lineages A and lineage B in a short period of time. The two lineages are differentiated by two SNVs;hence, a single-SNV A-B intermediate must have occurred in an unsampled animal host if the two-spillover hypothesis is correct. Consequently, confirmation of the existence of an intermediate A-B genome from humans would falsify their hypothesis of two spillovers. Pekar et al. identified and excluded 20 A-B intermediate genomes from their analysis. A variety of exclusion criteria were applied, including low read depth and the assertion of repeated erroneous base calls at lineage-defining positions 8782 and 28144. However, data from GISAID show that most of the genomes were sequenced to high average sequencing depth, appearing inconsistent with these criteria. The decision to exclude the majority of genomes was based on personal communications, with raw data unavailable for inspection. Multiple errors, biases, and inconsistencies were observed in the exclusion process. For example, 12 intermediate genomes from one study were excluded;however, 54 other genomes from the same study were included, indicating selection bias. Puzzlingly, two intermediate genomes from Beijing were discarded despite an average sequencing depth of 2175X;however, four genomes from the same sequencing study were included in the analysis. Lastly, we discuss 14 additional possible intermediate genomes not discussed by Pekar et al. and note that genome sequence filtration is inappropriate when considering the presence or absence of a specific SNV pair in an outbreak. Consequently, we find that the exclusion of many of the intermediate genomes is unfounded, leaving the conclusion of two natural zoonoses unsupported.Copyright © 2023 by the authors.

Adapting Undergraduate Research to Remote Work to Increase Engagement

Demand for undergraduate research experiences typically outstrips the available laboratory positions, which could have been exacerbated during the remote work conditions imposed by the SARS-CoV-2/COVID-19 pandemic. This report presents a collection of examples of how undergraduates have been engaged in research under pandemic work restrictions. Examples include a range of projects related to fluid dynamics, cancer biology, nanomedicine, circadian clocks, metabolic disease, catalysis, and environmental remediation. Adaptations were made that included partnerships between remote and in-person research students and students taking on more data analysis and literature surveys, as well as data mining, computational, and informatics projects. In many cases, these projects engaged students who otherwise would have worked in traditional bench research, as some previously had. Several examples of beneficial experiences are reported, such as the additional time spent studying the literature, which gave students a heightened sense of project ownership, and more opportunities to integrate feedback into writing and research. Additionally, the more intentional and regular communication necessitated by remote work proved beneficial for all team members. Finally, online seminars and conferences have made participation possible for many more students, especially those at predominantly undergraduate institutions. Participants aim to adopt these beneficial practices in our research groups even after pandemic restrictions end.

Functional recovery of hospitalised patients with covid-19: a prospective cohort study

Aim and Objectives: To characterize the functional recovery of hospitalized patients diagnosed with COVID-19 at 3-, 6-, 9- and 12-months post-discharge. Method(s): We are conducting a multi-regional prospective cohort study in hospitalized COVID-19 patients 18 years and older in Canada. Patients are assessed upon admission and at 3-, 6-, 9-, and 12-months follow-up. Data collection is completed via telephone interviews in addition to home visits. Outcomes include the Activity Measure for Post-Acute Care Mobility and Cognition scales and lung function. Result(s): Preliminary data from 242 hospitalized COVID-19 patients (60.1 +/- 13.0 yrs) indicate that the most common self-reported symptoms are fatigue (47%) and shortness of breath (35%) at 12-months follow-up. Our lung function data suggests that 39-46% of post-acute patients with COVID-19 have impaired FEV1 (<80% predicted), and 38- 49% have impaired FVC (<80% predicted) at 3-,6-, 9- and 12-month follow-up. At 12-months, 38-45% of patients continue to have clinically important deficits in cognition and mobility below premorbid levels, respectively, and 55.4% of patients report that COVID-19 continues to impact their daily life activities (Figure 1). Conclusion(s): There is a high prevalence of functional limitations in COVID-19 survivors over 12 months of followup. Our data support the need for multi-disciplinary rehabilitation for patients post-hospitalisation for COVID-19.

Plant power: SEEDing our future with plant-based eating

The climate crisis, coupled with the COVID-19 pandemic and the Black Lives Matter movement, are contributing to a shift in what people eat. For environmental sustainability, ethical, social justice, and health reasons, people are embracing plant-based diets, which involve consuming mostly fruits, vegetables, grains, and beans and little or no meat and dairy products. Drawing on insights from consumer psychology, this review synthesizes academic research at the intersection of food and consumer values to propose a framework for understanding how and why these values—Sustainability, Ethics, Equity, and Dining for health—are transforming what people eat. We term our model the SEED framework. We build this framework around a report assembled by the Rockefeller Foundation (2021) that describes how to grow a value-based societal food system. Finally, we highlight insights from consumer psychology that promote an understanding of how consumer values are shifting people's diets and raise research questions to encourage more consumer psychologists to investigate how and why values influence what consumers eat, which in turn impacts the well-being of people, our environment, and society. © 2022 Society for Consumer Psychology.

Going Green Post COVID-19: Employer Perspectives on Skills Needs

Achieving a just transition to a low carbon economy and society, in the wake of the COVID-19 pandemic, is arguably one of the greatest policy challenges facing governments. It is also of deep concern to businesses, employees and the organisations that represent them. Much of the focus, particularly at policy level, has been on the potential of this transition to create new jobs especially through the growth of renewable energy and clean technology. In this paper, we argue that this focus on ‘green jobs', and in particular new green jobs, grossly underestimates the skills needs of a future workforce able to deliver a transition to a more sustainable low-carbon economy. The focus of this study is to gain an understanding of what skills are required to support the transition beyond these sectors. It critically reports on the results of a series of in-depth interviews with senior managers in key organisations within Cambridgeshire and Peterborough, UK. It sheds a light on the significant employment transitions taking place in organisations who are not specifically focused on delivering ‘green' products or services. It finds widespread acknowledgement of the importance of a green recovery, albeit predicated by economic growth. The key skills needs reported, at all levels were likely to be ‘soft' transferrable skills rather than ‘hard' technical skills. COVID-19 was recognised as both a disrupter and as a catalyst for a green transition. © The Author(s) 2023.

Commonwealth Pharmacist Partnership develops antimicrobial stewardship and infection control in Zambia

Background: Misuse of antimicrobials combined with poor infection prevention and control (IPC) can result in antimicrobial resistance (AMR). Health partnerships are ideally placed to enhance antimicrobial stewardship (AMS) through sharing up-to-date evidence and implementing best practice. Purpose(s): Brighton Lusaka Pharmacy Link (BLPL) was awarded a Commonwealth Partnerships for Antimicrobial Stewardships Scheme (CwPAMS) grant to implement AMS at University Teaching Hospital (UTH) (THET, 2020). Pharmacists-led AMS prescribing and monitoring activities aim to implement a robust data collection system and measure the impact of interventions reducing misuse and overuse of antibiotics while increasing knowledge about on IPC and AMS. Method(s): BLPL conducted a three-day workshop in Zambia for pharmacists, physicians, nurses and allied healthcare professionals at UTH to enhance AMS and point prevalence surveillance (PPS). IPC training was provided by the experienced Ndola IPC team. Train the trainer workshops enables UTH to disseminate AMS, PPS, IPC and data collection standards. Result(s): Proactive MDT committee to manage AMS and IPC activities at UTH was established Specialist AMS pharmacist appointed Two Global-PPS undertaken Modified antibiotic prescribing chart introduced and audited-UTH antimicrobial guidelines updated AMS modular training programme for health care accredited by UNZAforCPD recognition-34 IPC trainers trained Bare-below-the-elbow dress code (BBE) adopted nationally by HOPAZ WHO hand-rub production expanded Conclusion(s): This model of pharmacist-led AMS demonstrates sustainability in locally driven AMS knowledge and seeded national IPC capacity-building whilst instigating behavioural change pertinent during the COVID-19 pandemic.

OUTPATIENT LETTERS IN REAL TIME FOR BETTER PATIENT OUTCOMES

The Sunshine Coast Hospital and Health Service commenced a six-month proof-of-concept to trial speech recognition and self-type software in 2020. This action was taken in response to an ageing medical transcription workforce;an increase in outpatient letters due to population growth and the novel coronavirus pandemic;and more timely transfer of care communication to GPs. The proof-of-concept presented the health service with a unique opportunity as no other public hospital in Queensland had leveraged speech recognition or self-type software for the production and distribution of outpatient letters. The proof-of-concept trial provided 18 clinicians with the choice to type or dictate outpatient letters, electronically sign, and distribute to referring general practitioners (GPs) in one transaction. The results of the proof-of-concept demonstrated a 39% uptake of speech recognition and self-type software, demonstrating an opportunity to supplement the medical transcription workforce to address the rising outpatient activity. The proof-of-concept also demonstrated an average reduction in transaction time of 25% from the baseline measure over the six-month trial period. This finding supports the timely transfer of communication to GPs. However, it will need to be carefully analysed against the participant frustrations of voice to text accuracy to minimisethe risk of poo r adoption. © Australasian College of Health Service Management. All rights reserved.

Propofol-Related Hypertriglyceridemia as a Risk Factor for Pancreatitis in Patients with Covid-19

INTRODUCTION: Hypertriglyceridemia is a known complication of propofol infusion, and higher levels of triglycerides are known to be associated with pancreatitis. Patients with severe COVID-19 pneumonia often require prolonged mechanical ventilatory support and often undergo prolonged sedation with medications such as propofol. In our study we looked to identify safe cut offs for triglyceride levels as well as cumulative dosing of propofol in order to minimize the risk of developing pancreatitis. METHOD(S): Utilizing our COVID-19 database from hospitals in the Steward Health Care Network we conducted a retrospective multi-center review to evaluate the instances of pancreatitis in critically ill patients with COVID-19 pneumonia who received propofol for sedation while intubated. We chart reviewed each patient and collected data regarding the number of days over which propofol was administered, cumulative doses of propofol, peak triglyceride levels, lipase levels, symptoms of pancreatitis and abdominal CT imaging consistent with pancreatitis. For the data analysis we used ROC analysis in conjunction with Youden's index to identify the optimal thresholds for propofol administration parameters and triglyceride levels that would offer maximal sensitivity and specificity for predicting pancreatitis. RESULT(S): We reviewed 499 cases of COVID-19 pneumonia and found 154 patients that were on propofol for sedation for a sufficient period of time. Among these we identified 6 cases of suspected pancreatitis. Using the ROC analysis and Youden's index we identified optimal cut-offs for peak triglyceride levels (688 mg/dl), number of days on propofol (4.5 days), Average daily propofol dose (3007 mg/ day), cumulative propofol dose (24,113 mg) to indicate low risk of pancreatitis. The NPVs for suspected pancreatitis for these cut-offs were found to be from 0.98 to 1. CONCLUSION(S): Our study suggests that patients who have triglyceride levels less than 688 mg/dl, have been on propofol for less than 4.5 days, received less than 3007 mg of propofol per day or have received less than 24113 mg in total of propofol may have a lower risk of developing pancreatitis. While these results are encouraging, larger prospective studies with more confirmed cases of pancreatitis are still necessary.

Enhancing quality biobanking through education

The importance of co-ordinated, robust sample collection for medical research has been highlighted during the COVID pandemic with the need for rapid, well curated samples and data. The knowledge and skills present within biobanks expedited such collections and the value of expert repository staff was recognised. Investing in staff is one of the most important activities a biobank can undertake as part of social sustainability. Biobank personnel are core to the success of the repository and a valued and engaged team is key to provide a solid foundation for the biobank to evolve and flourish. Supporting education gives the individual the opportunity for career development, the biobank a more stable workforce and has impact and value to both the biobank and host institution. Personnel come to biobanking via many varied routes, and it can be difficult when recruiting to benchmark an individual's knowledge of biobanking and associated processes. The Qualification in Biorepository Science (QBRS) is a new education tool that was jointly developed by the International Society for Biological and Environmental Repositories (ISBER) and the American Society of Clinical Pathology's Board of Certification (ASCP BOC). It provides a biobanking specific, international exam that 'professionalises' biobanking and allows remote learning to fit around daily tasks. All aspects of the biobanking pathway are covered in the syllabus and the exam is taken online, giving wide accessibility. The Wales Cancer Biobank sponsored a laboratory technician to take the test in 2021 and we present the impact and value of the QBRS qualification from a biobank's perspective. Funding(s): The Wales Cancer Biobank is funded by Health and Care Research Wales Conflict of Interest: None to disclose Copyright © 2022