Child, adolescent, and parent mental health in general population during a year of COVID-19 pandemic in belgium: a cross-sectional study

Background: This study aims to evaluate the mental health status of children, adolescents and their parents during the first year of COVID-19 pandemic in Belgium. Method(s): Analysis compared results before and during the second national lockdown, which started on November 2nd 2020. A cross-sectional online survey was conducted between May 2020 and April 2021. Result(s): Two hundred and eighteen adults and 273 children fully completed the survey. Almost one in five children (17.9%) presented moderate-to-severe scores of depression. Adolescents presented a higher level of depression than children (p = 0.007). The rate of moderate-to-severe depression scores (10.8% to 21%, p = 0.007) and internalized symptoms increased during the second lockdown (p < 0.001). Parents' depression (p < 0.001) and anxiety (p = 0.027) levels also increased during the second lockdown. Logistic regression showed that the use of psychotropic medication in parents and parents' depression scores were risk factors for children to have worse depression scores. Conclusion(s): The second lockdown appears to worsen the effects of the pandemic on children's and parents' mental health. There is a need to implement specific interventions targeting both children/adolescents and their parents to support them during lockdown periods and improve mental health outcomes.Copyright © 2022, The Author(s).

Experiences of patients from minority ethnic backgrounds in the stem cell transplant pathway during COVID-19

Background: Stem cell transplantation is a potentially life-saving intervention for patients with blood cancer. Research suggests that there are existing disparities in access, care and treatment experiences, with patients identifying with a minority ethnic heritage reporting greater disadvantage compared to patients from white British, Irish or Northern European backgrounds. Although we know that the COVID-19 pandemic has been challenging for patients, less is known about the experiences of patients from specific ethnic communities. Method(s): In this research, we undertook 1-1, semi-structured interviews with eight patients within the stem cell transplant pathway who identify with a minority ethnic background. Interviews took place online, between May and November 2021. The interview questions explored views on aspects of the pandemic, including access and experience of care delivery, intervention, mental health and financial impact. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Result(s): The majority of patient participants were female (75%), and identified with a Black African or Caribbean heritage (75%). Four themes were identified from the data: (1) 'Lack of suitable donors' described the challenges of finding a stem cell donor and the importance of raising awareness of stem cell donation specifically within minority ethnic communities;(2) 'Experiences of care' explored patients' experiences of the healthcare system from pre-diagnosis to post-treatment, including how the COVID-19 pandemic had made some aspects of care easier but acted to disrupt others;(3) 'Intense and unpredictable process' described the nature of living with blood cancer and how this has impacted upon patients' lives including the extent to which they had been able to access and make use of advice to help keep them safe during the pandemic;and (4) 'Coping mechanisms' identified the factors which helped patients' to understand and adjust to living with their diagnosis and the treatment process. Conclusion(s): Patients in the stem cell transplant pathway often experience intense treatment regimens, debilitating symptoms and long hospital stays, which has a significant impact on their lives. Minority ethnic patients describe facing additional challenges in relation to health inequalities both within and outside of the pandemic. Seeking support from family, peers or community organisations can help buffer the negative impacts of living with blood cancer and multiple disadvantages, but such support was more difficult to access during the pandemic. This had psychological consequences for patients who are already within an intense emotional journey. Pandemic recovery plans should address mental health support as a priority.

COVID-19 vaccination rates in people living with HIV in north east England

Background: People living with HIV (PLWH) are at increased risk of severe COVID-19. The UK recommends vaccination against COVID-19 for PLWH with two primary doses, a booster dose, then seasonal boosters (i.e. four doses by Autumn 2022). Vaccination uptake in the UK has been lower among non-white minority ethnic groups than in the white British population, despite these groups having a higher risk of severe COVID-19. Method(s): We evaluated vaccine uptake by PLWH attending treatment services at two NHS Trusts in North East England. To ensure representation of minorities, alternating PLWH from white and ethnic minorities (excluding white minorities) were purposively selected for review from the HIV and AIDS Reporting System;vaccination data were obtained from regional integrated care records. Result(s): 200 PLWH were included. 103 (51.5%) were from ethnic minority groups, of whom 78 (75.7%) were of black African ethnicity. Vaccination rates in the total population and among ethnic groups are shown in the table below. Similar proportions of white and minority ethnic background PLWH had received up to two vaccinations. These proportions among white PLWH were similar to those reported in the general English population, while fewer Black African PLWH were unvaccinated than in the general population (14.1% vs. 26%, data not shown). Vaccine uptake among PLWH diverged beyond 3 doses, with white people being almost three times as likely to have received four doses (OR 2.92;95% CI 1.63 to 5.19;pvalue for difference in distribution across all doses=0.005). Conclusion(s): Although ethnic minority PLWH were less likely to be fully vaccinated than white ethnicity PLWH, the proportion of unvaccinated black African PLWH was lower than that reported from the general population. This could infer that regular contact with healthcare professionals coupled with consistent promotion of vaccination by HIV clinicians can improve uptake. (Table Presented).

Fostering the Next Generation of Healthcare Leaders in a Pandemic World

Purpose of Study: Since the COVID pandemic began, there have been a dearth of opportunities for pre-medical students to work with practicing physicians. This is even truer in health care shortage areas such as California's impoverished San Joaquin Valley where the majority of its residents live below the poverty line and face a number of socioeconomic and educational hardships. Inequitable educational opportunities, lack of STEM identity, as well as lack of access to local mentors contribute to underrepresentation of individuals with diverse racial and ethnic backgrounds in STEM professions, including medicine. In partnership with the UCSF Fresno Department of Pediatrics we created a summer virtual Medical Education Apprentice Fellowship to help address some of these issues. Methods Used: This seven-week summer program was directed towards disadvantaged high school and undergraduate students living in the San Joaquin Valley. Four pediatric subspecialists, 4 medical students, 64 undergraduate students, and 4 high school students participated in the program. Participants were divided into specialty teams based on their interests, with each team (burn surgery, endocrinology, gastroenterology, or pulmonology) led by a medical student and faculty. Overall, this program had three primary components: (1) creating animated medical education videos for use in clinics, (2) hosting patient case study series, and (3) providing mentorship and professional development. Summary of Results: Forty-seven percent of students reported being the first in their family to pursue a STEM-related field. Prior to entering this program, only 50% of students felt strongly confident in their ability to be successful in a STEM-related field, and only 30% had a mentor that they fully trusted for guidance and resources. After completing the seven week program, 93% of students reported that they felt the program allowed them to explore medicine in innovative ways, 88% reported that they had made fruitful connections and now have a mentor and resources to guide them, and nearly 75% of students indicated a desire to address the social and health needs of the San Joaquin Valley as a healthcare professional. Conclusion(s): Our Medical Education Apprentice Fellowship provided disadvantaged students in the San Joaquin Valley with an opportunity to improve their digital literacy skills and medical knowledge while receiving mentorship from medical students and physicians. Grassroots programs such as this that form collaborative partnerships between students and health care professionals can be used to foster future healthcare leaders in order to address the health provider shortage in the San Joaquin Valley while providing underrepresented youth the chance to become healthcare champions.

Changes in demographic and smoking history trends in patients referred to a London thoracic malignancy specialist centre between 2010-2021: The Guy's Cancer Centre experience

Background In the UK it is estimated that 10-15% of lung cancer cases occur in never-smokers. This study demonstrates the changes of the demographic characteristics, including the smoking status, of all the patients referred to the thoracic malignancy unit at Guy's Cancer Centre, South East London, between 2010 and 2021. Methods We included patients with a documented ICD10 diagnosis of bronchus and lung malignancy who were referred to Guy's thoracic malignancy unit from 2010 until 2021. A total of 6861 patients with a diagnosis of lung cancer were identified. We collected baseline demographic and clinical characteristics, including smoking status and socio-economic status for all the patients. Descriptive statistics were utilised to highlight the dynamic changes over the years of the referred patients. Results The number of referrals per year remained overall stable from 2010 until 2019, with a decrease in the number of referrals in 2020 and 2021, most likely due to the COVID-19 pandemic. We observed a gradual increase in the percentage of never smokers among the lung cancer patients: 5%, 8%, 10% and 13% of the referred patients were never smokers in the years 2010, 2015, 2018 and 2021 respectively. Median age remained stable across the years (range 68-71 years). Male percentage was 56%, 55%, 53% and 53% in 2010, 2015, 2018 and 2021 respectively. From the patients that we had a documented ethnic background the proportion of White/Black/Asian/Other or Mixed ethnicity remained stable across the years with a median 87%, 7%, 3%, and 3% respectively. The most common histological diagnosis was adenocarcinoma, followed by squamous cell carcinoma and small cell lung carcinoma. Conclusions The proportion of never-smoking to smoking related lung cancer has gradually increased between 2010 and 2021. There was little variability in age, sex and ethnic background. Never-smoking lung cancer is a distinct biological entity, therefore, further research should focus on the understanding of the aetiology and the risk factors leading to the development of lung cancer, in the absence of a history of tobacco exposure. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.Copyright © 2023 International Association for the Study of Lung Cancer. Published by Elsevier Inc.

COVID-19-INDUCED IMMUNOSUPPRESSION LEADING TO SECONDARY INFECTION AS DISSEMINATED COCCIDIOIDOMYCOSIS

SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Coccidioidomycosis caused by the fungi C. immitis and C. Posadasii is well known to be endemic to the Southwest United States. Less than 1% of these infections will manifest as extrapulmonary symptoms and multiple sites causing dissemination fungemia [1]. Risk factors for disseminated infection include exogenous immunosuppression, immunodeficiency, pregnancy, and ethnic backgrounds of African and Filipino descent [2]. CASE PRESENTATION: A 39-year-old previously immunocompetent Congolese male with recent onset of recurrent skin abscess, and positive testing for COVID-19 three week prior (not treated with steroids). He presents with shortness of breath, back pain, fevers after recently migrating from the Southwest region to the Midwest. Upon admission imaging with Computed Tomography (CT) revealed extensive pulmonary infiltrates (Fig 1), intra-abdominal abscesses, and magnetic resonance imaging revealing (MRI) osteomyelitis of the thoracic (Fig 2) and lumbar spine (Fig 3). His work of breathing continued to worsen, requiring prompt intubation, and he was initiated on a broad-spectrum antimicrobial regimen, including fluconazole, voriconazole, cefepime and vancomycin. Immunoglobulins, HIV and oxidative burst testing was unremarkable. Cultures from image-guided aspiration of the psoas abscess, incision, and drainages of skin abscess and bronchoalveolar lavage fluid were all positive for coccidioidomycosis, transitioned to amphotericin B. Course complicated with the development of multidrug-resistance pseudomonas aerogenes VAP treated with inhaled tobramycin and meropenem. He developed progressive acute respiratory distress syndrome with refractory hypoxemia. After 3 weeks of antimicrobial and anti-fungal treatment, a decision was made to transfer the patient to a lung transplant center, however, due to ongoing fungemia, he was deemed to be not a candidate for extracorporeal membrane exchange and lung transplantation. About a month into his hospitalization, the family decided to withdraw care. DISCUSSION: Reactivation of latent coccidiomycosis has been largely studied in the immunosuppressed population that includes HIV, hematological malignancies, and diabetes mellitus, however little is known about this fungal infection in the immunosuppressed state in the setting of COVID-19. Thus far only two case reports have been reported of co-infection if COVID-19 and pulmonary coccidioidomycosis [3]. The days of the COVID-19 pandemic might contribute to further delays in diagnosing this fungal infection due to similarities of pulmonary manifestation. CONCLUSIONS: This case demonstrates a COVID-19 infection leading to an immunosuppressed status resulting in disseminated infection from reactivation of latent coccidiomycosis. As a result, physicians must maintain a high level of suspicion for superimposed fungal infections in those with even relative immunosuppression from a recent COVID infection. Reference #1: Odio CD, Marciano BE, Galgiani JN, Holland SM. Risk Factors for Disseminated Coccidioidomycosis, United States. Emerg Infect Dis. 2017;23(2):308-311. doi:10.3201/eid2302.160505 Reference #2: Hector RF, Laniado-Laborin R. Coccidioidomycosis–a fungal disease of the Americas. PLoS Med. 2005;2(1):e2. doi:10.1371/journal.pmed.0020002 Reference #3: Shah AS, Heidari A, Civelli VF, et al. The Coincidence of 2 Epidemics, Coccidioidomycosis and SARS-CoV-2: A Case Report. Journal of Investigative Medicine High Impact Case Reports. January 2020. doi:10.1177/2324709620930540 DISCLOSURES: No relevant relationships by Stephen Doyle No relevant relationships by Connor McCalmon No relevant relationships by John Parent No relevant relationships by Jay Patel No relevant relationships by Angela Peraino No relevant relationships by Keval Ray

Trajectories of UCR as a measure of biological mechanisms underlying ethnicity associated outcomes in COVID-19

Introduction: Patients with Black and Asian ethnic background have been disproportionately affected by COVID-19 with increased disease severity, organ failure, intensive care admission, and premature mortality. 1-3 The urea-to-creatinine ratio (UCR) has been described as a biochemical signature of persistent critical illness, its hallmark catabolic state and late mortality during prolonged ICU stay.4 Low serum creatinine reflecting reduced muscle mass, which declines rapidly in acute severe illness in combination with net muscle protein breakdown which contribute substrate for increased hepatic urea synthesis, results in markedly elevated UCR. Objectives: To assess UCR as a candidate biological feature driving ethnicity associated outcomes of COVID-19 disease. Methods: Prospective analysis using registry data from all patients aged ≥16 years with an emergency admission to hospitals within Barts Health NHS Trust with SARSCoV-2 infection during 1 January 2020 - 13 May 2020 (wave 1), and 1 September 2020 -17 February 2021 (wave 2). Trajectories of routine haematology and clinical biochemistry blood results during hospital admission were assessed, and distinct phenotypes defined using unsupervised longitudinal clustering techniques using day 0 to 15 results.We determined distribution of identified phenotypes within patients categorised by ethnic group. Multivariable logistic regression accounting for predefined baseline risk factors was used to assess association between ethnicity, phenotypes, and 30-day mortality. All analyses were performed using R software v4.02 and the kml package for clustering. 5 Results are presented as n (%) and adjusted odds ratios (OR) with 95% confidence intervals. Results: We assessed 459 (wave 1) and 1337 (wave 2) patients after excluding those with unknown ethnicity and those with <7 blood results. Three clusters were identified based on trajectories of UCR. In wave 1, 48.1% of patients had persistently low levels of UCR (A), 38.6% had higher but stable levels (B), and 13.3% had the highest levels peaking after day 7 (C). In wave 2, three clusters were identified in similar proportions: 42.8% (a), 45.1% (b), 12.1% (c). In wave 1, patients in cluster C compared to A had the highest risk of death at 30 days (OR 4.59 [2.27-9.26], p<0.001). In wave 2, both clusters b (OR 1.58 [1.18-2.12], p< 0.001) and c (OR 3.96 [2.62-5.99], p<0.001) had higher risk of death compared to a. Distribution of cluster membership varied by ethnic category. In both waves, greater proportions of patients within cluster A/a were observed in patients with Black ethnicity (65.5% wave 1, 61.1% wave 2) compared to Asian (50.0% wave 1, 37.3% wave 2) and White (39.7% wave 1, 39.6% wave 2) ethnicity. Black ethnicity patients also had lowest proportions in cluster C/c (6.9% wave 1, 6.3% wave 2) compared to Asian (17.4% wave 1, 14.2% wave 2) and White (13.2% wave 1, 12.9% wave 2) ethnicity. Inclusion of UCR trajectory attenuated the higher risk of death seen in Asian patients in wave 1. Conclusion: Phenotypes based on UCR trajectories during hospital admission are associated with adverse outcomes following COVID-19 infection. Further work is needed to understand phenotypes of prolonged COVID-19 disease muscle wasting and its association with longerterm outcomes.

The impact of mentoring on early career faculty: Assessment of a virtual mentoring program

Background: Participation in mentorship programs for early career physicians may be crucial to developing key skills and professional networks to navigate racial, ethnic and gender leadership disparities in medicine. A 6-month virtual facilitated peer mentorship program was developed and piloted through the Society for Neuro-Oncology (SNO) Women & Diversity Committee. The evaluation of the program's feasibility to positively impact early career physicians, investigators and trainees is presented here. Methods: We designed and conducted a virtual mentoring program pilot open to SNO's multidisciplinary members in residency, fellowship, or early career phase, leveraging peer-mentoring sessions with mid-to late-career physician mentors. A curriculum with online resources was provided recommending groups meet for 6 sessions: 3 involving the mentor and 3 dedicated to peer-mentoring. Group assignments were based on time-zones and interests. Pre- and post-participation surveys assessed mentee experience. Descriptive statistics were used to assess participant demographics and survey results. Results: Our call for participation was broad;all 20 mentee applicants participated in 5 groups. Mentees were 90% women and 60% were from diverse racial and ethnic backgrounds. Most were aged 31-40 (75%) and junior faculty (50%) in neuro-oncology (65%). The 5 senior mentors (3 men and 3 of diverse race and ethnic backgrounds) practiced either neuro-oncology (3), neurosurgery (1) or radiation oncology (1). The proportion who reporting having a signature lecture increased from 15% to 62% during the pilot. A large majority reported their participation was worthwhile (85%), that they would participate again (92%) and would recommend it to others (92%). Feedback themes included positive personal growth, peer support, networking and job opportunities, access to CV reviews, lack of and desire for late career female mentors, and virtual scheduling constraints. While the pilot was limited by several variables, it was timely to connect participants in Q3 of 2020 early in the COVID-19 global pandemic. The virtual meeting environment created a venue to share and discuss topics such as worklife balance, burnout, leading through change and social connection. Despite not achieving 100% professional concordance, participants found the experience worthwhile. The tools and curriculum of topics provided was implemented differently across groups, leading to varied experiences. Finally, we did not have 100% post pilot follow up despite multiple attempts limiting our complete understanding of the pilot. Conclusions: This virtual mentorship pilot program proved feasible and of value in development of early career women and diverse individuals. A resource toolkit has been designed to scale and diffuse.

Remote Consultations (RCs): a Survey of Oncology Practices and Patient Experience

Purpose: The COVID-19 pandemic brought rapid changes to NHS services and practices, including recommendations for shielding and conversion to RCs. This project was set up to explore the patient experience of RCs at NMUH, yielding both quantitative and qualitative accounts, to identify possible areas for improvement. Methods: Participants were recruited from breast, gastrointestinal and lung oncology clinics between April and June 2021. Suitable patients took part in an anonymous telephone survey conducted by an independent researcher, 48–72 h following their consultations. Three broad areas including practical aspects of communication, patient autonomy and control during the consultation and patients’ emotional experiences were evaluated. Results: 51 participants were recruited into the study (63% women, varied ethnic backgrounds, age range 41–88 years). 98% of participants reported no concerns about privacy or confidentiality, with 42–58% strongly agreeing with statements regarding autonomy. Overall, 90% (n = 46) reported RCs as being good, very good or excellent. Good aspects included: feeling safer, reduced travel, flexibility and reduced waiting in hospital. The main concerns were: communication challenges, inability to follow-up if they forgot something, not having family members or carers present, less personal consultations and not being examined. Timing of the appointment was a key point of dissatisfaction. Qualitative data including patient quotes provided real insight into the patient experience. Lack of key worker support was identified as a major cause of concern for patients. Conclusion: This study was practice changing. A new ‘Cover Letter’ entitled ‘How to get the most out of your remote consultation’ was created and sent with outpatient appointment letters. This project also identified an urgent need for recruitment. Overall, selective RCs should be considered as standard practice in the future, which will enable reduced cancer waiting times, unnecessary exposure of vulnerable patients and improved patient experience by minimising hospital visits.

Tourfor Diversity in Medicine & Pediatric Mentoring Circles: Bringing Pediatric Advising and Mentoring of Premedical Students to the Virtual World

Background: To strengthen the pathways for diverse applicants to health professional school, we need to rethink traditional strategies for providing outreach as current measures haven't met the growing needs. The Tour for Diversity in Medicine (T4D) was established as a grassroots effort to mediate pipeline leakiness through a mission to educate, inspire, and cultivate future health professionals of diverse racial and ethnic background. Coronavirus, though, changed the landscape of engaging with students. In April 2020, T4D conducted new virtual sessions beginning with Instagram live interview sessions. This progressed to a virtual mentorship conference, #VirtualT4D, which engaged with >1300 viewers over four days, including high school, undergraduate, and medical students from diverse backgrounds across the globe. To strengthen the pediatrician pipeline, T4D adapted its model to provide pediatric careerspecific mentorship virtually through the Pediatric Mentoring Circles (PMC) to trainees considered underrepresented in medicine and students from backgrounds considered disadvantaged. Methods: Student recruitment was conducted through T4D social media channels (Twitter, Instagram). This targeted premedical students from high school through postbaccalaureate level. Faculty included six pediatrician mentors from T4D, representing various training levels from residency to junior faculty with different specialty backgrounds. Monthly sessions were conducted from September-December 2020. Grant funding was obtained through the American Association of Pediatrics “Pediatric Pipeline Innovation Program” mechanism. Results: Fifty-five students were selected and divided into groups with the six T4D faculty mentors. Students represented 16 states with >90% representing underrepresented racial/ ethnic backgrounds. Importantly, 42% of students never previously attended a pipeline program, 65% are first generation college students, 75% will be the first healthcare worker in their family, and 100% would be the first physician in their family. Five topic areas were addressed (applying to medical school, goal setting and network development, pediatrics career opportunities, pediatrics leadership, and the impact of racism on child and adolescent health) through workshops utilizing different learning modalities. Students were provided pre and post workshop learning articles and tools for further developing their professional identity formation, through goal setting, network mapping, and personal reflections. Conclusion: T4D PMC increased exposure to pediatrics through a unique virtual model with scaffolded sessions based on the students' education level and a supportive environment to foster professional identity formation through pediatric-focused mentorship. Additionally, PMC provided introductory knowledge and skills for students regarding the medical school/ residency application process. Students appreciated the virtual model as it gave them a national tiered network of peers and mentors. Mentors empowered students to continue their journeys to pediatrics by embracing shared experiences through stories about successes and hardships. Next steps include long-term evaluation of student outcomes and partnering with organizations such as Association of Pediatric Program Directors as the next planned cohort targets medical students from diverse backgrounds.

Improving access to cancer clinical trials for patients from CALD backgrounds whose preferred language is not English - Results of a National Survey in Australia (Current Resources)

INTRODUCTION AND OBJECTIVES: Despite Australia having an extremely diverse population, research demonstrates that cancer patients from culturally and linguistically diverse ('CALD') communities are underrepresented in clinical trials. To inform future policy and strategy to address this inequity, we completed a national survey of the Australian clinical trials workforce evaluating current resources to address this issue, identified barriers and preferred solutions. This reports current resources in place. METHODS: An online survey was created using Redcap comprising a mix of 15 closed and open-ended items with an estimated completion time of 20 minutes. The survey was emailed to members of two peak bodies for oncology clinicians in Australia, the Clinical Oncology Society of Australia (COSA) and the Medical Oncology Group of Australia (MOGA) and all major cancer cooperative trial groups (12) in Australia. The survey was also promoted by the study team to relevant individuals and online via Twitter. Quantitative analysis was performed using Microsoft Excel and qualitative analysis of free text entries was performed using NVivo. RESULTS: 91 respondents completed the questionnaire, with representatives from each state - the majority of respondents were from NSW (53%) and Victoria (31%). 68% were clinicians and 16% were clinical trial coordinators. 55% of respondents reported that their trial catchment was comprised of over 20% patients from a CALD background - however, 62% reported that less than 20% of their trials had included CALD participants in the previous 12 months. 74% of respondents reported that their units do not routinely collect data on preferred language or ethnic background of trial patients. Qualitative analysis showed that the only resource routinely available to sites are in person interpreters used in standard of care, which additionally, have been difficult to access during the COVID pandemic leading to only phone interpreters. CONCLUSIONS: This representative survey of the Australian cancer clinical trials workforce confirms an ongoing inequity with disproportionately lower numbers of CALD patients on enrolled in cancer clinical trials compared to the catchments served. Most respondents stated that CALD data is not routinely collected, which inhibits ongoing monitoring of this issue. We did not find evidence of existing specific resources in place to support recruitment of CALD populations, apart from standard of care interpreters.

Gender, ethnic and regional bias in Endourology during the annual BAUS meeting: An independent 12 years review and analysis

Introduction & Objectives: There is increasing realisation of the bias that exists in the female and gender representation worldwide in annual meetings and conferences. British Association of Urological Surgeons (BAUS) understands and recognizes the importance of equality, diversity and inclusivity (EQI) as an essential tool to deliver the highest standard of care for patients. A 10-point plan was laid recently to implement inclusion of people from diverse background. EQI has a positive effect on innovation, well-being of workforce and quality of care. We looked at the ethnic, gender and regional distribution of speakers represented at the annual BAUS Endourology sub-section meetings and whether it meets the BAUS statement of equality. Materials & Methods: BAUS annual programmes were reviewed from 2009 to 2020 (12 years) and all Endourology speakers were identified by 2 independent reviewers for ethnicity, gender and regional representation. We also looked at the gender and ethnicity of the chairpersons involved with the meeting. Results: A total of 193 speakers (range 6-47 speakers/year) took part in the BAUS annual meeting (Endourology subsection) (Fig 1). Of the total 164 speakers were from the UK, of which 26 (15.8%) were of ethnic origin and of those only 2 (1.2%) were females. For 6 years there has been no ethnic representation among the UK speakers and there were only 20 (12.!%) female speakers. The gap was reduced in the post-Covid pandemic period. Of the 50 chairpersons during this time, 40 (80%) were of white ethnicity and 10 (20%) were of diverse ethnic background. Only 3 (7%) were females and all of white ethnicity. Of the UK speakers 57 (35%) were from London, 103 (63%) were from the rest of England with only 3,1 and 0 from Scotland, Wales and Northern Ireland respectively.

CHAGAS SCREENING PROGRAM IN A PUBLIC SAFETY NET HOSPITAL IN QUEENS: CHALLENGES AND SUCCESSES

STATEMENT OF PROBLEM/QUESTION: Chagas disease (CD) is a lifelong protozoan parasitic infection that if left untreated can result in cardiomyopathy in a third of cases;a screening program can identify individuals with chronic asymptomatic disease. DESCRIPTION OF PROGRAM/INTERVENTION: Elmhurst Hospital is a public safety net hospital in Queens serving a diverse community with many immigrants from Mexico, Central and South America. An estimated 8 million people in Latin America and 300,000 in the US are living with CD. We implemented a Chagas screening program in the Elmhurst adult primary care clinic. Our electronic health record (EHR), Epic, captures patient diversity by including 200 ethnic background options;we used this field to identify at-risk patients. Patients waiting for their appointment were brought into a private area and educated about CD by a Spanish-speaking volunteer. They were asked their country of origin, their ability to recognize the Reduviid bug, and the type of house they grew up in. Written educational materials about CD in Spanish provided by CDC website were given to patients. Once a patient accepted screening the provider received a secure chat in the EHR instructing them to order the Chagas serology. All patients have been kept on a secure list, and all are called for follow-up regardless of their results. Patients who test positive receive a follow-up plan that includes cardiac testing and referral to the Infectious Diseases (ID) clinic. Education about immigrant health and CD was provided to faculty, nurses and residents by ID specialists. MEASURES OF SUCCESS: The number of patients accepted and screened for CD. FINDINGS TO DATE: From June to November 2021, 340 patients in the Elmhurst medicine clinic were approached about their risk for CD. Of these migrants 36% were from Mexico, 51% were from S. America and 13% were from Central America. 23% of these patients grew up in an adobe house and 26% recognized the reduviid bug from a picture. Of 324 at-risk individuals asked about previous Chagas knowledge, only 7% were familiar with CD. 203 patients were tested with final results, 18 refused testing, 37 tests are pending for the next visit, and 82 were not ordered. 2 were positive on the screening ELISA with confirmation pending;CDC has suspended testing during the COVID-19 pandemic. Family members will be screened if confirmatory testing is positive. KEY LESSONS FOR DISSEMINATION: For practices serving large atrisk populations, a Chagas screening program can help to address a healthcare disparity. Partnership with ID specialists is essential for this process to succeed. Having an EHR that captures diverse demographic information identifies atrisk patients and is critical to the success of such a program. Challenges include having to obtain confirmatory testing at CDC which involves a patient returning for a follow-up visit and another blood draw. PCP champions can be a useful resource to sustain CD screening in the future. Low awareness of CD in our patient population suggests that community outreach to at-risk individuals is needed to increase awareness.

EVALUATING THE MANAGEMENT OF SYPHILIS AT THE CARDIFF ROYAL INFIRMARY (CRI) DURING THE COVID- 19 PANDEMIC

Introduction Recent surveillance reports a 22% increase in syphilis diagnoses in Wales. This audit evaluates the standard of care given to patients with new diagnoses of syphilis during the COVID-19 pandemic. Methods The electronic patient record database was used to retrospectively identify those who had a positive diagnosis of primary, secondary or early latent syphilis between 01/03/2020 to 30/09/2021 and case notes were audited against the 2015 BASHH Syphilis guidelines. Results 78 records were identified with 9 incorrectly coded as syphilis. 69 patients received care for early syphilis during the period. 91% were men who have sex with men (MSM). 28% co-infected with HIV. 62% were white-British, 7% were of another ethnic background. 51% presented with symptoms, 46% were asymptomatic and 2% diagnosed elsewhere. 74% were diagnosed at face-toface clinical services and 17% through online testing. All patients had pre-treatment RPRs 72% had them on day of treatment. 100% had partner notification discussed. 100% were offered pre-exposure prophylaxis for HIV (PrEP). 99% received recommended treatments (BASHH standard 97%). Interestingly, despite coding and documentation stating early syphilis, 26% of patients had late syphilis treatment regimes. At the time of audit, 48 patients were 6 months post-treatment - 40% had RPR documented (BASHH standard 60%), 29% not documented, 19% lost to follow-up and 8% care transferred care. Conclusion The service saw more new early syphilis diagnoses during the pandemic than the 18 months prior (previously 56 cases). BASHH standards were almost met despite virtually all nurses being re- deployed to COVID wards.

Recruiting and retaining plasma donors in a voluntary non-remunerated context: Experiences from the Dutch 'Powerbank'

Background: Sanquin-the Dutch blood organization-collects both whole blood (WB) and plasma in a voluntary non-remunerated context. Increasing demand for plasma and a desire to depend less on foreign plasma made Sanquin step up their plasma collection game. Traditionally, Sanquin collects plasma in mixed whole blood and plasma centers. To increase efficiency, Sanquin opened a plasma-only center in the summer of 2020: the Powerbank. The Powerbank aims for high recruitment and retention rates by offering donors costefficient processes, high service levels, and a loyalty program. Aims: The aim of our study was to understand what kind of donors the Powerbank attracts and how they experience the Powerbank. Methods: To get a complete image of Powerbank donors and their experiences, we used a mixed methods approach combining a quantitative survey about characteristics of the plasma donor population with qualitative focus groups to provide more insight into donors' experiences. For the survey, we invited 4784 plasma donors from the Powerbank and a nearby mixed donation center, to examine potential differences between the two populations. We collected demographic information, that is, gender, age, education, ethnic background and working status. During six focus group discussions, we talked to 32 donors who had transferred from a mixed donation center to the Powerbank to reflect on their experiences. Topics included general impressions of the Powerbank, service level, perceptions of the loyalty program, and differences with the mixed center. Results: 646 Powerbank donors participated in the survey, as well as 780 donors from the mixed center. We found no differences between the two populations in terms of gender, education, household composition, or ethnic background. However, we did find that-compared to the mixed center-Powerbank donors were significantly younger, had made fewer prior donations, and were less often students or retirees. Donors in the focus group discussions were generally positive about the Powerbank. Positive points included the less clinical atmosphere, efficiency (specifically less waiting), the freedom of choice in the loyalty program, the service level, and the food. Donors had mixed feelings about the haemoglobin measurement (post donation) and the location (hard to find at first, but visible for passersby in the mall). Summary/Conclusions: Even though the COVID-19 pandemic had considerable impact on (plans for) recruitment and retention of donors at the Powerbank, we saw that donors were generally quite positive about the Powerbank. The somewhat younger, working donor population at the Powerbank and experiences of transferred donors seem to suggest that a new generation of donors could benefit from a visible location with a less clinical atmosphere where they are offered an efficient donation process and high service levels.

NEWER CONTINUOUS GLUCOSE MONITORING SYSTEMS

“Newer Continuous Glucose Monitoring Systems” Satish K. Garg, MD Professor of Medicine and Pediatrics, Director of adult Diabetes program, University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, Colorado. Over the past decade there have been many advances in diabetes technologies, such as Continuous Glucose Monitoring devices/systems (CGMs), insulin-delivery devices, and hybrid closed-loop systems. There have been significant advances in CGMs in the past decade. In fact, ten years ago very few people use to believe in the use of CGMs, even though they had been available for the past two decades. Many providers used to question who, why, and when will patients ever use CGMs similar to the questions asked about Self-Monitoring of Blood Glucose (SMBG) about four decades ago. At the time of this writing, more than five million people world-wide are using a CGM for their diabetes management, especially those who require insulin (all patients with Type 1 diabetes (T1D) and about 20% of patients with Type 2 diabetes (T2D)). Total sales of all CGMs now exceeds more than $7 billion and the use of SMBG is going down every day. Most of the CGMs have improved their accuracy significantly in the past two decades. I still remember doing studies on the GlucoWatch and earlier versions of Dexcom STS where mean absolute relative difference (MARD) used to be in the range of 15-26%. Now most of the CGMs (Guardian by Medtronic, G6 by Dexcom, and Libre 2 by Abbott) have single-digit MARD. In addition, the majority of the new CGMs do not require calibrations and the newer CGMs last for 10-14 days. An implantable CGM by Senseonics (Eversense®) is approved in the USA for 3 months and a different version is approved in Europe for 6 months. FDA has still not approved the 6-month version of Eversense® implantable sensor in the USA, which also has single-digit accuracy. The newer CGMs that are likely to be launched in the next 3-6 months;hopefully around the ATTD Conference, include 10.5-day Dexcom G7 (60% smaller than the existing G6), 7-day Medtronic Guardian 4, 14-day Libre 3, and 6-month Eversense®. Most of the newer CGM data can be viewed on Android or iOS/iPhone smart devices, and in many instances they have several features like predictive alarms and alerts, easy insertion, automatic initialization (in some instances down to 27 mins, Dexcom G7) with single-digit MARDs. It has also been noticed that arm insertion site might have better accuracy than abdomen or other sites like the buttock for kids. Lag time between YSI and different sensors have been reported differently, sometimes it's down to 2-3 mins;however, in many instances, it's still 15-20 mins. Diabetes effects communities of color disproportionately higher. For example, the highest prevalence of diabetes in the USA is amongst Native Americans (14.7%), which is nearly two times higher than Caucasians. African Americans and Hispanics also have higher prevalence of diabetes in the USA. It's also known that LatinX, African Americans, and Native Americans are much less likely to be offered new technologies like continuous subcutaneous insulin infusion (CSII/insulin pumps) and CGMs. Use of technology, especially CGMs, is expected to remove many of the social barriers and disparities in care for people with diabetes. A large database during the COVID-19 pandemic recently reported better Time-in-Range (TIR) in patients with diabetes irrespective of their ethnic background. However, the baseline TIR was significantly lower for minorities as compared to Caucasians. I believe the future will bring a larger increase in the use of CGMs for people with insulin-requiring diabetes (estimated at more than 100 million people globally) and those with T2D on non-insulin therapies (estimated at more than 400 million people globally). I also envision an increase in the number of pre-diabetes patients (estimated at more than 200 million people globally) using CGMs so that early medical intervention for diabetes management can be entertained. The intermittent or continuou use of CGM would depend upon the clinical needs. Needless to say, healthy individuals without diabetes (who can afford CGMs) might even use these technologies for self-evaluation of their glucose profiles after meals.

Diabetic ketoacidosis presentation during the early part of the covid-19 pandemic: What was different?

Background and Aim: Covid-19 has been associated with erratic glycaemic control, sometimes leading to diabetic emergencies, including diabetic ketoacidosis (DKA). We reviewed DKA admissions to the Sandwell and West Birmingham Hospitals to assess whether being admitted with DKA during the early phase of the covid-19 pandemic affected the clinical presentation and outcomes of DKA locally. Methods: This retrospective study included all patients with DKA in the pre-covid period (31 patients): 16th January-15th March 2020, versus those with DKA in the initial covid period (29 patients): 16th March-15th May 2020. Data collected included demographics, comorbidities, length of hospital stay (LOS), and diabetes-specific parameters, including type and duration of diabetes, last HbA1c, diabetes medications, DKA parameters leading to Critical Care admission, and time to DKA resolution. Results: Those presenting with DKA during the covid period were more likely to be male, of ethnic background, had longer duration of diabetes, better-controlled diabetes, and there were three times more patients with type 2 diabetes. Prescription of long-acting insulin alongside DKA protocol was significantly better during the covid period. Mean time to DKA resolution was significantly longer and mean LOS was 24 hours longer in the covid period. Conclusions: Diagnosis and management of DKA was objectively much better during the covid period but DKA occurred in more unexpected groups and recovery time was longer. Further study of larger samples with a multi-centred approach to see how DKA presentation has evolved during the pandemic would benefit our understanding of the impact of covid-19 on diabetes.

Harnessing Telemedicine to Improve Access to Care During the COVID-19 Pandemic

Objective: Before COVID-19, telemedicine had gained traction as a clinical tool, which was reflected by the adoption of new billing codes. Here we report outcomes in our Endocrine practice, which rapidly switched to exclusively tele-health in March 2020 with no pre-existing systems or protocols for this transition. We hypothesized that barriers to care, including patients’ health literacy, access to technology/internet, and access to remote monitoring tools such as blood pressure cuffs and weight scales, would make the transition to tele-health less successful in a low-income urban setting than in the suburbs. Methods: We measured show rates at Temple Endocrinology outpatient clinic sites using the CPT coding system to compare all scheduled appointments with all completed visits. We selected periods from April 1st to July 31st of 2019 and the same dates in 2020, because outpatient visits were exclusively in-person (2019) or exclusively tele-health (2020). Appointments included both faculty and fellow clinics. Data were stratified by service location amongst four major clinic sites that serve patients of different socioeconomic and ethnic backgrounds – namely, Temple University Hospital (TUH) in North Philadelphia, an urban federally designated medically underserved area, Temple Fort Washington (FW) serving a high-income suburban area, Temple Center City (CC) serving a high-income urban area, and Temple Jeanes, serving a middle-income suburban area. Results: Surprisingly, the proportion of completed outpatient visits at TUH increased from 68.2% (n = 2,965/4,346) in 2019 to 72.9% (n = 2,997/4,109) in 2020 (p = 0.00001), with an absolute increase of 1.01% in our completed encounters. In contrast, at FW, the proportion of completed outpatient visits decreased from 89.8% (n = 378/421) in 2019 to 79.3% (n =211/266) in 2020 (p = 0.00014). At CC, 90.2% (n = 342/379) visits were completed in 2019 and 89.5% (n = 366/409) in 2020 (p = 0.73). At Jeanes, rates were 75.8% (n = 485/640) in 2019 and 76.7% (n = 615/802) in 2020 (p = 0.69). Discussion/Conclusion: Despite the speed with which we transitioned to an entirely tele-health-based practice at the start of the pandemic, we found that we were equally – if not more able – to complete clinical Endocrinology visits with our population of underserved patients in North Philadelphia. In contrast, at our suburban FW campus, the show rates fell. We are currently examining disease acuity, transportation issues related to in-person visits, and internet access through smartphones in the populations served by TUH and FW. Overall, our data suggest that tele-health can be a successful option for Endocrine practice in an underserved urban area.