CLADIN- CLADribine and INnate immune response in multiple sclerosis - A phase IV prospective study.

Cladribine (Mavenclad®) is an oral treatment for relapsing remitting MS (RRMS), but its mechanism of action and its effects on innate immune responses in unknown. This study is a prospective Phase IV study of 41 patients with RRMS, and aims to investigate the mechanism of action of cladribine on peripheral monocytes, and its impact on the P2X7 receptor. There was a significant reduction in monocyte count in vivo at week 1 post cladribine administration, and the subset of cells being most impacted were the CD14lo CD16+ 'non-classical' monocytes. Of the 14 cytokines measured in serum, CCL2 levels increased at week 1. In vitro, cladrabine induced a reduction in P2X7R pore as well as channel activity. This study demonstrates a novel mechanism of action for cladribine. It calls for studying potential benefits of cladribine in progressive forms of MS and other neurodegenerative diseases where innate immune related inflammation is implicated in disease pathogenesis.

Improved photocatalytic oxidation of micropollutant in wastewater by solar light: assisted palladium-doped graphitic carbon nitride.

The escalating global industrial expansion has led to the extensive release of organic compounds into water bodies, resulting in substantial pollution and posing severe threats to both human health and the ecosystem. Among common micropollutants, bisphenol A (MP-BA) has emerged as a significant endocrine-disrupting chemical with potential adverse effects on human health and the environment. This study aims to develop an efficient photocatalyst, specifically by incorporating palladium-doped graphitic carbon nitride (Pd@GCN), to eliminate MP-BA pollutants present in industrial wastewater. The examination of optical properties and photoluminescence indicates that incorporating Pd into GCN enhances the visible light absorption spectra, which extends beyond 570 nm, and accelerates the separation rate of electron-hole pairs. The photocatalytic degradation efficiency of MP-BA increases from 81.7 to 98.8% as the solution pH rises from 5.0 to 9.0. Moreover, Pd@GCN significantly improves the removal rate of MP-BA in wastewater samples, reaching an impressive 92.8% after 60 min of exposure to solar light. Furthermore, the Pd@GCN photocatalyst exhibits notable reusability over six cycles of MP-BA degradation, indicating its promising potential for the treatment of organic pollutants in wastewater under solar light conditions.

Oxidation of antibiotic micropollutants in various water resources through integration of Bi2WO6 and g-C3N4.

Recently, the hazardous effects of antibiotic micropollutants on the environment and human health have become a major concern. To address this challenge, semiconductor-based photocatalysis has emerged as a promising solution for environmental remediation. Our study has developed Bi2WO6/g-C3N4 (BWCN) photocatalyst with unique characteristics such as reactive surface sites, enhanced charge transfer efficiency, and accelerated separation of photogenerated electron-hole pairs. BWCN was utilized for the oxidation of tetracycline antibiotic (TCA) in different water sources. It displayed remarkable TCA removal efficiencies in the following order: surface water (99.8%) > sewage water (88.2%) > hospital water (80.7%). Further, reusability tests demonstrated sustained performance of BWCN after three cycles with removal efficiencies of 87.3, 71.2 and 65.9% in surface water, sewage, and hospital water, respectively. A proposed photocatalytic mechanism was delineated, focusing on the interaction between reactive radicals and TCA molecules. Besides, the transformation products generated during the photodegradation of TCA were determined, along with the discussion on the potential risk assessment of antibiotic pollutants. This study introduces an approach for utilizing BWCN photocatalyst, with promising applications in the treatment of TCA from various wastewater sources.

Exploring the potential of CoMoO4-modified graphitic carbon nitride to boost oxidation of amoxicillin micropollutants in hospital wastewater.

This study investigates the removal of amoxicillin micropollutants (AM) from hospital wastewater using CoMoO4-modified graphitic carbon nitride (CMO/gCN). Consequently, CMO/gCN exhibits notable improvements in visible light absorption and electron-hole separation rates compared to unmodified gCN. Besides, CMO/gCN significantly enhances the removal efficiency of AM, attaining an impressive 96.5%, far surpassing the performance of gCN at 48.6%. Moreover, CMO/gCN showcases outstanding reusability, with AM degradation performance exceeding 70% even after undergoing six cycles of reuse. The removal mechanism of AM employing CMO/gCN involves various photoreactions of radicals (•OH, •O2-) and amoxicillin molecules under light assistance. Furthermore, CMO/gCN demonstrates a noteworthy photodegradation efficiency of AM from hospital wastewater, reaching 92.8%, with a near-complete reduction in total organic carbon levels. Detailed discussions on the practical applications of the CMO/gCN photocatalyst for removal of micropollutants from hospital wastewater are provided. These findings underline the considerable potential of CMO/gCN for effectively removing various pollutants in environmental remediation strategies.

Natural Cellulose Fiber-Derived Photothermal Aerogel for Efficient and Sustainable Solar Desalination.

Aerogels are becoming a promising platform to fabricate photothermal materials for use in solar steam generation (SSG), which have remarkable application potential in solar desalination, due to their excellent thermal management, salt resistance, and considerable water evaporation rate. In this work, a novel photothermal material is fabricated by forming a suspension between sugarcane bagasse fibers (SBF) and poly(vinyl alcohol), tannic acid (TA), and Fe3+ solutions via hydrogen bonds of hydroxyl groups. After freeze drying, the fabricated SBF aerogel-based photothermal (SBFAP) material possesses a 3D interconnected porous microstructure, which could enhance water transportation ability, reduce thermal conductivity, and quickly dissolve salt crystals on the SBFAP surface. Thanks to the formation of micro/nanosized complexes between TA and Fe3+ ions on the SBFAP material, the SBFAP exhibits high light capture and water evaporation rate (2.28 kg m-2 h-1). In particular, due to strong hydrogen bonding and the SBF, the SBFAP material is reinforced, thereby exhibiting excellent structural stability in seawater. Moreover, the high salt tolerance of SBFAP favors its high desalination performance for at least 76 days of continuous evaporation under actual conditions. This research paves the way for the fabrication of natural cellulose fiber-based photothermal materials for application in solar desalination.

Improved Cr (VI) adsorption performance in wastewater and groundwater by synthesized magnetic adsorbent derived from Fe3O4 loaded corn straw biochar.

This work developed an easy method to utilize corn straw (CS) waste for sustainable development and reduce the volume of waste volume as well as bring value-added. The magnetic adsorbent was prepared by loading Fe3O4 onto biochar derived from corn straw (Fe@CSBC), then used for capturing Cr (VI) in groundwater and wastewater samples. The characterization of adsorbents showed that Fe3O4 was successfully loaded on corn straw biochar (CSBC) and contributed to the improvement of the surface area, and surface functional groups like Fe-O, Fe-OOH, CO, and O-H. The presence of iron oxide was further confirmed by XPS and XRD analysis and a magnetization value of 35.6 emu/g was obtained for Fe@CSBC. The highest uptake capacity of Cr (VI) onto Fe@CSBC and CSBC by monolayer were 138.8 and 90.6 mg/g, respectively. By applying magnetic adsorbent Fe@CSBC for the treatment of groundwater and wastewater samples, the chromium could be removed up to 90.3 and 72.6%, respectively. The remaining efficiency of Cr (VI) was found to be 84.5% after four times reused Fe@CSBC, demonstrating the great recyclable ability of the adsorbent. In addition, several interactions between Cr (VI) and Fe@CSBC like ion exchange, complexation, and reduction reaction were discussed in the proposed adsorption mechanism. This study brings an efficient method to turn corn straw biomass into an effective magnetic adsorbent with high adsorption performance and good reusability of Cr (VI) in groundwater as well as in wastewater.

Parental Preference for Treatment Location and Inclusion in Decision Making in Painful Pediatric Procedures: Towards an Evidence-Based Clinical Guideline.

PURPOSE: To determine parental preference for treatment location of painful procedures for pediatric patients, and the involvement of parents in decision-making about procedure location. DESIGN AND METHOD: A descriptive survey design was applied. Parents of hospitalized children were asked what procedures their child had undergone, where the procedures were performed, who decided on the location, what their preference was, and why. Data was collected over a twelve-day period in seven wards of a tertiary pediatric hospital. RESULTS: Of 312 different procedures, 244 (78%) were performed in the patient's room. The treatment room was reserved for complex procedures such as lumbar punctures. Seventy-three percent of parents surveyed indicated a strong preference for procedures to be performed in the patient's room, with the most common reason being 'comfortability'. Parents were only involved in procedure location decision-making in 50% of the reported cases. CONCLUSIONS: For parents, the patient's room is the preferred location for many procedures. The opinion of parents was not always taken into consideration by health care professionals, in contrary to the principles of patient-centered care. These findings are important for health care professionals in pediatric settings to reconsider the location of procedures and how parents are involved in decision making.

Iron-impregnated granular activated carbon for arsenic removal: Application to practical column filters.

Arsenic is a major drinking water contaminant in many countries causing serious health hazards, and therefore, attempts are being made to remove it so that people have safe drinking water supplies. The effectiveness of arsenic removal from As(V) solutions using granular activated carbon (GAC) (zero point of charge (ZPC) pH 3.2) and iron incorporated GAC (GAC-Fe) (ZPC pH 8.0) was studied at 25 ±â€¯1 °C. The batch study confirmed that GAC-Fe had higher Langmuir adsorption capacity at pH 6 (1.43 mg As/g) than GAC (1.01 mg As/g). Adsorption data of GAC-Fe fitted the Freundlich model better than the Langmuir model, thus indicating the presence of heterogeneous adsorption sites. Weber and Morris plots of the kinetic adsorption data suggested intra-particle diffusion into meso and micro pores in GAC. The column adsorption study revealed that 2-4 times larger water volumes can be treated by GAC-Fe than GAC, reducing the arsenic concentration from 100 µg/L to the WHO guideline of 10 µg/L. The volume of water treated increased with a decrease in flow velocity and influent arsenic concentration. The study indicates the high potential of GAC-Fe to remove arsenic from contaminated drinking waters in practical column filters.

Psychological distress, well-being, resilience, posttraumatic growth, and turnover intention of mental health nurses during COVID-19: A cross-sectional study.

Mental health nurses (MHNs) experience a range of stressors as part of their work, which can impact their well-being and turnover intention. There is no prior evidence, however, on MHNs' mental health, well-being, resilience, and turnover intention during the COVID-19 pandemic. The aims of this online survey-based cross-sectional study, conducted during the pandemic, were to explore the psychological distress, well-being, emotional intelligence, coping self-efficacy, resilience, posttraumatic growth, sense of workplace belonging, and turnover intention of n = 144 Australian mental health registered and enrolled nurses; and explore relationships between these variables, in particular, psychological distress, well-being, and turnover intention. There was a higher percentage of MHNs with high (27.78%) and very high psychological distress (9.72%) compared to population norms as measured by the K10. Emotional intelligence behaviours were significantly lower than the population mean (GENOS-EI Short). Coping self-efficacy was mid-range (CSES-Short). Resilience was moderate overall (Brief Resilience Scale), and posttraumatic growth was mid-range (Posttraumatic Growth Inventory; PTGI). Sense of workplace belonging was moderate, and turnover intention was low. Higher levels of psychological distress were associated with higher turnover intention, and lower workplace belonging, coping self-efficacy, well-being, resilience, and emotional intelligence behaviours. Despite the levels of psychological distress, nearly half the sample (n = 71) was 'flourishing' in terms of well-being (Mental Health Continuum Short-Form). To help prevent staff distress in the post-pandemic period, organisations need to proactively offer support and professional development to strengthen staff's psychological well-being, emotional intelligence, and resilience skills. These strategies and group clinical supervision may also support lower turnover.

Promoting resilience in mental health nurses: A partially clustered randomised controlled trial.

BACKGROUND: There is a critical global shortage of nurses in mental health, with workforce attrition due in large part to workplace stressors. Proactive strengths-based interventions to strengthen nurses' capacity to manage stress and improve mental health, wellbeing and resilience may also support workforce retention. OBJECTIVE: To determine the effects of a resilience-building programme on mental health nurses' coping self-efficacy (primary outcome), and psychological distress, wellbeing, resilience, posttraumatic growth, emotional intelligence behaviours, workplace belonging, and turnover intention (secondary outcomes). DESIGN: Partially clustered randomised controlled trial. SETTING: Large tertiary metropolitan mental health service in Australia. PARTICIPANTS: A total of 144 registered and enrolled nurses working clinically ≥0.6 full-time equivalent (73/intervention, 71/control), with 122 completing 3-month follow-up. METHODS: The Promoting Resilience in Nurses programme is an evidence-based workplace intervention delivered by trained facilitators across two workshops. Surveys were administered online upon registration and prior to randomisation (Time 1) into Intervention or Control (no intervention) arms, and immediately after the final workshop (Time 2), and at three months follow-up (Time 3). Linear mixed models for outcome measures were fitted to Time 2 and 3 responses. RESULTS: There were seven intervention groups, with seven to 13 participants per group. Coping self-efficacy improved at Time 2 (estimated intervention effect 21.2 units, 95 % Confidence Intervals: 13.3 to 29.0) and Time 3 (12.1 units, 4.7 to 19.6), as well as wellbeing (Time 2: 9.2 units, 5.0 to 13.4), resilience (Time 2: 0.24 units, 0.01 to 0.46) and posttraumatic growth (Time 2: 16.1 units, 7.0 to 25.3). Psychological distress reduced (Time 2: -3.7 units, -6.2 to -1.31). All were sustained at three months. Emotional intelligence behaviours were improved (Time 2: 3.5 units, 0.6 to 6.5) but not sustained. Workplace belonging improved at Time 3 (0.34 units, 0.02 to 0.65) only. No statistically significant effects for turnover intention. CONCLUSIONS: Despite major contextual challenges, the Promoting Resilience in Nurses programme achieved the aims of promoting nurses' efficacy to cope with stress and regulate their emotions and improving mental health and wellbeing. The findings support the programme as a feasible and successful intervention for nurses across other settings and contexts. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12620001052921). Registered 15/10/2020. First recruitment 04/02/2021. TWEETABLE ABSTRACT: Promoting Resilience in Nurses intervention improved coping self-efficacy, wellbeing, resilience, posttraumatic growth, emotional intelligence and psychological distress.

Resilience and mental health nursing: An integrative review of updated evidence.

Mental health nursing work is challenging, and workplace stress can have negative impacts on nurses' well-being and practice. Resilience is a dynamic process of positive adaptation and recovery from adversity. The aims of this integrative review were to examine and update understandings and perspectives on resilience in mental health nursing research, and to explore and synthesize the state of empirical knowledge on mental health nurse resilience. This is an update of evidence from a previous review published in 2019. Using integrative review methodology, 15 articles were identified from a systematic search (July 2018-June 2022). Data were extracted, analysed with constant comparison method, synthesized narratively and then compared with the findings from the original review. As an update of evidence, mental health nurse resilience was moderate to high across studies, was positively associated with psychological well-being, post-traumatic growth, compassion satisfaction and negatively associated with burnout, mental distress and emotional labour. Lack of support and resources from organizations could negatively impact nurses' ability to maintain resilience and manage workplace challenges through internal self-regulatory processes. A resilience programme improved mental health nurses' awareness of personal resilience levels, self-confidence, capacity to develop coping skills and professional relationships. Some studies continue to lack contemporary conceptualizations of resilience, and methodological quality varied from high to low. Further qualitative and interventional research is needed to investigate the role of resilience in mental health nursing practice, personal well-being, workforce sustainability and the ongoing impacts of the COVID-19 pandemic.

Mental health nurses' experience of resilience during COVID-19: A qualitative inquiry.

The COVID-19 pandemic created unprecedented demands and additional stress for nurses in mental health settings. There is no prior evidence on nurses' experience of building and maintaining resilience in the context of work during COVID-19. The aim of this study was to explore the experience and impacts of the COVID-19 pandemic on the resilience of nurses in mental health settings. Data from semi-structured interviews with 20 nurses from an Australian mental health service were analysed using reflexive thematic analysis. Four main themes were generated: experiencing significant disruptions; making sense of shared chaos; having professional commitment; and growing through the challenges. Nurses' practice and teamwork were disrupted by COVID-19 related changes to care models and infection prevention policies. They successfully adjusted by having awareness of self and others' emotions, using mental and emotional self-regulatory strategies, engaging in self-care, using 'bricolage' to create different ways to provide care, and having mutually supportive relationships. Nurses connected to their sense of purpose and professional commitment to fuel their therapeutic work and sustain care delivery. They experienced personal and professional growth with an increased understanding of their strengths and resilience. In the post-pandemic period, although the challenges presented by the pandemic have lessened, there are ongoing negative impacts on nurses' wellbeing. To maintain and strengthen their wellbeing and practice, the findings indicate the importance of professional development in emotional regulation skills, and strategies to strengthen self-care and build collegial relationships in teams. Resilience education can be implemented to support nurses' resilient practice skills.

Targeted system approach to ethylene biosynthesis and signaling of a heat tolerant tomato cultivar; the impact of growing season on fruit ripening.

Growing tomato in hot weather conditions is challenging for fruit production and yield. Tomato cv. Savior is a heat-tolerant cultivar which can be grown during both the Vietnamese winter (mild condition) and summer (hot condition) season. Understanding the mechanisms of ethylene biosynthesis and signaling are important for agriculture, as manipulation of these pathways can lead to improvements in crop yield, stress tolerance, and fruit ripening. The objective of this study was to investigate an overview of ethylene biosynthesis and signaling from target genes to proteins and metabolites and the impact of growing season on a heat tolerant tomato cultivar throughout fruit ripening and postharvest storage. This work also showed the feasibility of absolute protein quantification of ethylene biosynthesis enzymes. Summer fruit showed the delayed peak of ethylene production until the red ripe stage. The difference in postharvest ethylene production between winter and summer fruit appears to be regulated by the difference in accumulation of 1-aminocyclopropane-1-carboxylic acid (ACC) which depends on the putative up-regulation of SAM levels. The lack of differences in protein concentrations between winter and summer fruit indicate that heat stress did not alter the ethylene biosynthesis-related protein abundance in heat tolerant cultivar. The analysis results of enzymatic activity and proteomics showed that in both winter and summer fruit, the majority of ACO activity could be mainly contributed to the abundance of ACO5 and ACO6 isoforms, rather than ACO1. Likewise, ethylene signal transduction was largely controlled by the abundance of ethylene receptors ETR1, ETR3, ETR6, and ETR7 together with the constitute triple response regulator CTR1 for both winter and summer grown tomatoes. Altogether our results indicate that in the heat tolerant tomato cv. Savior, growing season mainly affects the ethylene biosynthesis pathway and leaves the signaling pathway relatively unaffected.

Risk assessment of microplastic exposure: A case study near a refinery factory at the central coast of Vietnam.

The goal of this study was to identify the presence of microplastics on the beach near a refinery in the central coast of Vietnam. In this study, 11 sampling sites were selected within a length of 300 m of the beach. The results showed that microplastics were presented in all collected samples with an average concentration of 1582 ± 660 MPs/kg. Fibers were the predominant shape of microplastics found in the samples, which accounted for 57.11 %, while the rest were classified as fragments. The average size of microplastics varied greatly around 83.1 ± 74.3 µm with the vast majority having a size smaller than 50 µm (41.84 %). A total of 11 polymers of microplastics were detected from collected samples, Polyethylene Terephthalate was the main polymer with 46.43 %. The pollution load index of microplastics was 3.15 showing that refinery activities could expose microplastic to the environment.

Protocol for a mixed methods process evaluation of the Promoting Resilience in Nurses (PRiN) trial.

Mental health nurses are exposed frequently to occupational stress and can experience a range of negative impacts on their well-being and intention to stay in the nursing workforce. Promoting Resilience in Nurses (PRiN) is a strength-based resilience education programme that incorporates evidence-based cognitive behavioural and interpersonal approaches with post-traumatic growth theory. A partially clustered randomized controlled trial at a large public mental health service will be used to examine the effects of PRiN on mental health nurses' coping self-efficacy, resilience, well-being, mental health, emotional regulation, post-traumatic growth, workplace belonging, and turnover intention as compared to controls. Process evaluations are increasingly used to help understand and interpret trial results for complex interventions. This paper describes the protocol for an embedded mixed methods process evaluation that aims to evaluate the PRiN programme implementation and identify factors that may explain variation in participant outcomes in the trial. Data collection includes a programme participant satisfaction survey; a follow-up semi-structured interview with selected programme participants; a unit/team manager survey on barriers and facilitators to staff recruitment and programme participation; and a fidelity checklist completed by programme facilitators. Normalisation Process Theory will be used to inform data analysis and integration. The findings will provide insights into factors that affect programme implementation, particularly in the context of the COVID-19 pandemic and may help explain differences in participant outcomes. Findings will also inform post-trial programme sustainability as well as potential future upscale and adaptation for implementation across healthcare settings.

Alginate-modified biochar derived from rice husk waste for improvement uptake performance of lead in wastewater.

In this work, alginate-modified biochar derived from rice husk waste was synthesized using a simple process. The modified biochar (MBC) and rice husk biochar (RhBC) were investigated for removing Pb (II) ions in wastewater. The BET result displayed significantly improved specific surface area of MBC up to 120 m2/g along with a total pore volume of 0.653 cm3/g. FTIR spectrums presented the higher oxygen-contained functional groups of MBC as compared to RhBC, resulting in increasing adsorption capacity of Pb (II). MBC had higher adsorption capacity (112.3 mg/g) and faster removal rate (0.0081 g mg-1 min-1) than those of RhBC (41.2 mg/g and 0.00025 g mg-1 min-1). Modified RhBC can remove more than 99% of Pb (II) from wastewater and it could be utilized for three cycles with a removal performance of over 90%. In addition, the Pb adsorption mechanism by using MBC was proposed and the practical application of MBC for the treatment of wastewater in Vietnam was discussed.

Photodegradation of ciprofloxacin antibiotic in water by using ZnO-doped g-C3N4 photocatalyst.

Ciprofloxacin antibiotic (CIP) is one of the antibiotics with the highest rate of antibiotic resistance, if used and managed improperly, can have a negative impact on the ecosystem. In this research, ZnO modified g-C3N4 photocatalyst was prepared and applied for the decomposition of CIP antibiotic compounds in water. The removal performance of CIP by using ZnO/g-C3N4 reached 93.8% under pH 8.0 and an increasing amount of catalyst could improve the degradation performance of the pollutant. The modified ZnO/g-C3N4 completely oxidized CIP at a low concentration of 1 mg L-1 and the CIP removal efficiency slightly decreases (around 13%) at a high level of pollutant (20 mg L-1). The degradation rate of CIP by doped sample ZnO/g-C3N4 was 4.9 times faster than that of undoped g-C3N4. The doped catalyst ZnO/g-C3N4 also displayed high reusability for decomposition of CIP with 89.8% efficiency remaining after 3 cycles. The radical species including ·OH, ·O2- and h+ are important in the CIP degradation process. In addition, the proposed mechanism for CIP degradation by visible light-assisted ZnO/g-C3N4 was claimed.

Flexible, affordable and environmentally sustainable solar vapor generation based on ferric tannate/bacterial cellulose composite for efficient desalination solutions.

Desalination by solar steam generation (SSG) system is a green technology to produce pure water, which can address the issue of water scarcity. A novel photothermal material for the SSG system was fabricated by immersing bacterial cellulose (BC) sequentially into tannic acid (TA) and iron(iii) (Fe3+) solutions. Surface analysis of the resulting BC-TA-Fe3+ (BTF) material showed that coordination nanocomplexes between Fe3+ and hydroxyl groups of TA were formed on the surface of cellulose nanofibers. BTF material exhibited high sunlight absorption (∼95%), hydrophilic, self-cleaning properties, and excellent structural stability. SSG systems based on BTF had an evaporation efficiency of 91% and an evaporation rate of 1.56 kg m-2 h-1 under 1 sun illumination. Then, an efficient desalination device based on the larger-scale BTF material was fabricated to produce freshwater, the amount of freshwater per day was 5.6 kg m-2 on a sunny day. BTF material, thus, showed great potential in seawater desalination applications along with simple, versatile, scalable, and affordable fabrication methods.

Patient Preferences for Time and Location of Infusible Therapies in Multiple Sclerosis and Neuroimmunologic Disorders.

BACKGROUND: People with multiple sclerosis and neuroimmunologic disorders (herein referred to as patients) are increasingly treated with infusible monoclonal antibodies. This rise in demand has placed increased loads on current infusion services and mandates careful strategic planning. This study examined patient preferences for the timing and location of infusions and their association with demographic and disease variables to facilitate patient-focused strategic planning. METHODS: Ninety-one patients receiving an infusible therapy at an infusion service during March 2019 were asked to complete a questionnaire exploring eight domains, including preferences for time of infusions and location of infusion centers. Potential access to home-based treatment was included as an option. Unstructured (free-text) feedback on current service was also obtained. RESULTS: Eighty-three patients completed the survey (mean age, 42 years; 75% women). Infusions were predominantly natalizumab (66%) and ocrelizumab (25%). Of these patients, 71% were engaged in some form of work or study, and 83% of this group had to arrange time off from work or study to attend treatment. Seventy percent of patients would prefer their infusion before noon, and 60% would consider home-based infusions. Most used a car as their transport to the infusion service. CONCLUSIONS: These results suggest that patients are more likely to prefer infusible treatment in the morning and are open to home-based infusions. This study provides information for health services to target service delivery at peak preference times and consider alternate ways of delivering infusible treatments.

Fast and safe: Optimising multiple sclerosis infusions during COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic challenges multiple sclerosis services to be innovative in delivering infusible therapies. To reduce time in clinical settings, and potential staff or space losses, we implemented rapid infusion protocols for selected patients. OBJECTIVE: To analyse the rate of infusion related reactions and patient experience of rapid infusions of natalizumab and ocrelizumab. To document time reduction patients spent in clinical settings during the COVID-19 pandemic. METHODS: Patients with prior exposure to at least three natalizumab or two 300mg ocrelizumab infusions were approved for rapid protocols. A retrospective audit and survey were completed. RESULTS: We analysed 269 rapid natalizumab infusions and 100 rapid ocrelizumab infusions. Infusion related reactions during the natalizumab or ocrelizumab infusions occurred in two patients (1.52%) and eight patients (8%), respectively. All infusion related reactions were mild to moderate and did not require infusion discontinuation. No infusion reactions occurred during the post-infusion observation. Patient experience was positive. CONCLUSION: Frequency or severity of infusion related reactions in rapid infusions were no different compared to published data. In the setting of COVID-19, pandemic rapid infusion protocols could potentially save hospital resources and limit patient exposure to a high-risk clinical setting while still maintaining ongoing treatment of multiple sclerosis.