Change in opioid and analgesic use for headaches after aneurysmal subarachnoid hemorrhage over time

BACKGROUND

Severe headache, a hallmark of aneurysmal subarachnoid hemorrhage (aSAH), affects up to 90% of patients during hospitalization. Opioids remain the guideline recommended mainstay of acute therapy despite their significant side effects and potential for tolerance and addiction. We evaluated time trends in opioid prescriptions, hypothesizing a decline with increasing recognition of the opioid crisis.

METHODS

We performed a retrospective review of patients with aSAH admitted to a single tertiary care center between 2012 and 2019 and included patients with Hunt-Hess-Grade≤3 who were able to verbalize pain scores. Collected variables included mean and maximum daily headache scores, aneurysm treatment modality, and daily analgesic medication doses.

RESULTS

Of 340 patients with aSAH, 114 (86 from 2012-2016 and 28 from 2017-2019) were included. Of the included patients, 86/114 (75.4%) were female. Patients in the 2012-2016 had a median age of 55 compared to 63 in the 2017-2019 group (P=0.02). Otherwise, there was no significant difference in demographic data including time in hospital, treatment option utilized, or aneurysm characteristics. Maximal daily headache score ranged from 6 to 8 for 2012-2016 and 5 to 8 for 2017-2019 cohorts. Average oral morphine equivalents (in mg) administered during hospitalization were similar between groups (2012-2016: 251±345 95% CI [178,323]; 2017-2019: 207±237 95% CI [119,295]; P=0.319). When prescribed, doses of opioids provided at discharge were less in the more recent group (2012-2016: 84.4±78.9 95% CI [57.5, 111]; 2017-2019: 38.1±20.2 95% CI [33.7, 42.5]; P=0.004) CONCLUSION: Despite recognition of important drawbacks of opioid use for headache control, and efforts to reduce opioid use during hospitalization, we found that utilization during hospitalization for SAH did not decrease over time. Maximal headache scores remained similar in the studied time periods, indicative of insufficient pain relief. This points out a pressing need to further investigate alternative opioid and narcotic sparing strategies for patients with SAH.

P–182 The mechanism of mouse embryo hatching and the impact of laser drilling the zona pellucida: an RNA sequencing study

Study question

What is the mechanism of embryo hatching? Will laser-assisted zona pellucida (ZP) drilling alter the embryonic transcriptome?

Summary answer

Hatching is an ATP-dependent process. Hatching is also associated with Rho-mediated signaling. Laser-assisted ZP drilling might cause alternation in embryo metabolism.

What is known already

Embryo hatching is a vital process for early embryo development and implantation. Animal data suggests that hatching is the result of multiple factors, such as mechanical pressure, protease activation, and the regulation of maternal secretions. However, little is known about the regulatory signaling mechanisms and the molecules involved. In addition, despite the extensive use of laser-assisted ZP drilling in the clinic, the safety profile of this technique at molecular level is very sparse. The impact of this technique on the embryonic transcriptome has not been studied systematically.

Study design, size, duration

Eighty mouse embryos were randomly divided into a laser ZP drilling group (n = 40) and an untreated group (n = 40). After treatment, embryos were cultured in vitro for two days. Then, hatching blastocyst (n = 8) and pre-hatching blastocyst (n = 8) from the untreated group, and the hatching blastocyst from the treatment group (n = 8) were processed for RNA sequencing (RNA-seq).

Participants/materials, setting, methods

Cryopreserved 8-cell stage mouse embryos (B6C3F1 × B6D2F1) were thawed, and a laser was used to drill the embryo ZP in the treatment group. Next, the treated and untreated embryos were individually cultured in vitro to the E4.5 blastocyst stage. The resulting blastocysts were lysed individually and used for subsequent cDNA library preparation and RNA-seq. Following data quality control and alignment, the RNA-seq data were processed for differentially expressed gene analysis and downstream functional analysis.

Main results and the role of chance

According to the RNA-seq data, 275 differentially expressed genes (DEGs) (230 up-regulated and 45 down-regulated, adjusted P < 0.05) were identified when comparing hatching and pre-hatching blastocysts in the control groups. Analysis suggested that the trophectoderm is the primary cell type involved in hatching, and revealed the potential molecules causing increased blastocyst hydrostatic pressure (Aqp3 and Cldn4). Functional enrichment analysis suggested that ATP metabolism and protein synthesis were activated in hatching blastocysts. DEGs were found to be significantly enriched in several gene ontology terms, particularly in terms of the organization of the cytoskeleton and actin polymerisation (P < 0.0001). Furthermore, according to QIAGEN ingenuity pathway analysis results, Rho signaling was implicated in blastocyst hatching (Actb, Arpc2, Cfl1, Myl6, Pfn1, Rnd3, Septin9, z-score=2.65, P < 0.0001). Moreover, the potential role of hormones (estrogen (z-score=2.24) and prolactin (z-score=2.4)) and growth factors (AGT (z-score=2.41) and FGF2 (z-score=2.213)) were implicated in the hatching process as indicated by the upstream regulator analysis. By comparing the transcriptome between laser-treated and untreated hatching blastocysts, 47 DEGs were identified (adjusted P < 0.05) following laser-assisted ZP drilling. These genes were enriched in metabolism-related pathways (P < 0.05), including the lipid metabolism pathway (Mvd, Mvk, Aacs, Gsk3a, Pik3c2a, Aldh9a1) and the xenobiotic metabolism pathway (Aldh18a1, Aldh9a1, Keap1, and Pik3c2a).

Limitations, reasons for caution

Findings in mouse embryos may not be fully representative of human embryos. Furthermore, the mechanism of hatching revealed here might only reflect the hatching process of embryos in vitro. Further studies are now necessary to confirm these findings in different conditions and species to determine their clinical significance. Wider implications of the findings: Our study profiled the mouse embryo transcriptome during in vitro hatching, identified potential key genes and mechanisms for future study. In addition, for the first time, we revealed the impact of laser-assisted ZP drilling on the transcriptome, this may help us to assess and improve the existing technique.

Trial registration number

Not applicable

P-798 Fertility preservation in pre-pubertal boys with cancer: A three-dimensional prepubertal testicular organoid for in vitro spermatogonial stem cell propagation and spermatogenesis

Study question

Can a three-dimensional (3D) prepubertal testicular organoid be formed and provide an in vitro microenvironment for spermatogonial stem cells (SSCs) maintenance and future spermatogenesis?

Summary answer

Primary cells extracted from immature testicular tissue (ITT) or SSCs can be grown long-term as 3D organoids, providing the potential for in vitro study.

What is known already

Aggressive cancer treatments, such as chemo- or radiotherapy, can leave young prepubertal boys infertile. Such patients are recommended to undergo the cryopreservation of testicular material to protect future fertility. Within the testes, the specialized 3D structure and direct cell-to-cell interactions play a critical role in the proliferation and development of SSCs. Over recent decades, 3D culture systems and organoids have been used to culture cells in vitro, however, a system that allows investigations into testicular organogenesis in vitro, and its impact on the SSC niche, has yet to be developed.

Study design, size, duration

This study aims to develop a 3D organoid culture system to support the proliferation of SSCs and spermatogenesis. Primary bovine ITT cells and enriched SSCs were isolated and 3D organoids were generated by in vitro culture for up to 40 days. Organoid formation was observed after using different foundation cells seeded at different densities and cultured in medium containing gonadotropic supplements.

Participants/materials, setting, methods

Post-thaw bovine ITTs (2 weeks-of-age) were dissociated using two-step enzymatic digestion. Enriched SSCs were selected by Percoll gradients and differential plating. Viability and apoptosis were evaluated by trypan blue staining and TUNEL assays, respectively. SSCs were evaluated immunocytochemically for germ-cell markers (PGP-9.5, PLZF) and Sertoli cell markers (Vimentin, Sox9). Expression levels of SSCs and spermatogenesis-related genes (Plzf, Gfrα-1, Nanog, Oct4, Stra8, Thy1) were determined by real-time quantitative polymerase chain reaction (RT-qPCR).

Main results and the role of chance

The viability of digested cells from thawed ITTs was 78.667% ± 2.03. Total testicular cells (<10% SSCs) and enriched SSCs(>50% SSCs) were observed to self-assemble into structurally complex organoids recapitulating the cell type compartmentalization of the testis, in a 3D Matrigel-based culture system with 10% knockout serum replacement (KSR) culture medium, but not with 10% fetal bovine serum(FBS) medium. Testicular organoids were found to exhibit either a grape-like structure and a round-shape structure. Cytoplasmic extensions of spermatogonia/Sertoli cells were in contact with each other within a forming colony. Organoids were formed faster and larger when seeded at a final concentration of 1.5 × 106 cells/ml, compared to 5 × 105 cells/ml and 1.5 × 105 cells/ml. Organoids grew to a diameter of 400 μm within 10 - 15 days and were passaged by mechanical disruption at a ratio of 1:3 every 7 - 10 days. Immunocytochemistry results showed that clusters of PGP9.5 and PLZF-positive cells were present within the organoids. The expression of selected germ cell and spermatogenesis markers in the testicular organoids closely resembled that of primary testicular cells for up to 20 days of culture.

Limitations, reasons for caution

We used calves (2 weeks-of-age) as an animal model to study testicular organoids. This tissue may act differently than human tissues and may not fully represent prepuberty. Furthermore, we only evaluated gene expression levels for selected markers that may not represent the full functional capability of germ cells.

Wider implications of the findings

Testicular organoids, as an in vitro bioengineering testicular model, could potentially be used to study testicular tissue development, cellular interactions, endocrinology, and spermatogenesis, in the laboratory but may also be applied for clinical purposes in the future.

Trial registration number

University of Oxford

P–798 Fertility preservation in pre-pubertal boys with cancer: A three-dimensional prepubertal testicular organoid for in vitro spermatogonial stem cell propagation and spermatogenesis

Study question

Can a three-dimensional (3D) prepubertal testicular organoid be formed and provide an in vitro microenvironment for spermatogonial stem cells (SSCs) maintenance and future spermatogenesis?

Summary answer

Primary cells extracted from immature testicular tissue (ITT) or SSCs can be grown long-term as 3D organoids, providing the potential for in vitro study.

What is known already

Aggressive cancer treatments, such as chemo- or radiotherapy, can leave young prepubertal boys infertile. Such patients are recommended to undergo the cryopreservation of testicular material to protect future fertility. Within the testes, the specialized 3D structure and direct cell-to-cell interactions play a critical role in the proliferation and development of SSCs. Over recent decades, 3D culture systems and organoids have been used to culture cells in vitro, however, a system that allows investigations into testicular organogenesis in vitro, and its impact on the SSC niche, has yet to be developed.

Study design, size, duration

This study aims to develop a 3D organoid culture system to support the proliferation of SSCs and spermatogenesis. Primary bovine ITT cells and enriched SSCs were isolated and 3D organoids were generated by in vitro culture for up to 40 days. Organoid formation was observed after using different foundation cells seeded at different densities and cultured in medium containing gonadotropic supplements.

Participants/materials, setting, methods

Post-thaw bovine ITTs (2 weeks-of-age) were dissociated using two-step enzymatic digestion. Enriched SSCs were selected by Percoll gradients and differential plating. Viability and apoptosis were evaluated by trypan blue staining and TUNEL assays, respectively. SSCs were evaluated immunocytochemically for germ-cell markers (PGP–9.5, PLZF) and Sertoli cell markers (Vimentin, Sox9). Expression levels of SSCs and spermatogenesis-related genes (Plzf, Gfrα–1, Nanog, Oct4, Stra8, Thy1) were determined by real-time quantitative polymerase chain reaction (RT-qPCR).

Main results and the role of chance

The viability of digested cells from thawed ITTs was 78.667% ± 2.03. Total testicular cells (<10% SSCs) and enriched SSCs(>50% SSCs) were observed to self-assemble into structurally complex organoids recapitulating the cell type compartmentalization of the testis, in a 3D Matrigel-based culture system with 10% knockout serum replacement (KSR) culture medium, but not with 10% fetal bovine serum(FBS) medium. Testicular organoids were found to exhibit either a grape-like structure and a round-shape structure. Cytoplasmic extensions of spermatogonia/Sertoli cells were in contact with each other within a forming colony. Organoids were formed faster and larger when seeded at a final concentration of 1.5 × 106 cells/ml, compared to 5 × 105 cells/ml and 1.5 × 105 cells/ml. Organoids grew to a diameter of 400 μm within 10 - 15 days and were passaged by mechanical disruption at a ratio of 1:3 every 7 - 10 days. Immunocytochemistry results showed that clusters of PGP9.5 and PLZF-positive cells were present within the organoids. The expression of selected germ cell and spermatogenesis markers in the testicular organoids closely resembled that of primary testicular cells for up to 20 days of culture.

Limitations, reasons for caution

We used calves (2 weeks-of-age) as an animal model to study testicular organoids. This tissue may act differently than human tissues and may not fully represent prepuberty. Furthermore, we only evaluated gene expression levels for selected markers that may not represent the full functional capability of germ cells.

Wider implications of the findings: Testicular organoids, as an in vitro bioengineering testicular model, could potentially be used to study testicular tissue development, cellular interactions, endocrinology, and spermatogenesis, in the laboratory but may also be applied for clinical purposes in the future.

Trial registration number

University of Oxford

P–265 Investigating the nanotoxicity of solid silica nanoparticles in gametes following in vitro exposure

Study question

Do solid silica nanoparticles qualify as a new research tool for the in vitro transfer of compounds into gametes prior to Assisted Reproductive Technology (ART).

Summary answer

Solid silica nanoparticles (SSNPs) could be used as an intra-gamete delivery system to deliver therapeutic biomolecules into gametes prior to ART.

What is known already

Sperm-mediated gene transfer (SMGT) results in the production of transgenic embryos; however, the success rate of this technique is low. Nanoparticles are an efficient intra-cellular delivery system in vitro. Naturally cell-secreted nanoparticles are involved in the development of gametes. Mesoporous silica nanoparticles have been shown to carry large amounts of compounds and to interact with gametes without toxic effects, thus providing an alternative to naturally secreted nanoparticles. However, this technique is associated with some limitations, such as the size of these nanoparticles. SSNPs can be synthesised on a smaller nanoscale, thus providing higher potential to penetrate gametes and delivering biomolecules.

Study design, size, duration

This was an experimental in vitro study that investigated the effects of SSNPs on the motility of boar sperm and the degeneration of hamster oocytes, as determined by ooplasm shrinkage.

Participants/materials, setting, methods

SSNPs (20 nm) were conjugated with fluorescein diacetate–5-maleimide (FDA5M), a fluorescent protein. FDA5M-labelled SSNPS were incubated with boar sperm (N = 3) at 10 and 30µg/ml/107 sperm for four-hours. Motility parameters were assessed by computer-assisted sperm analysis (CASA). Binding potential was evaluated by fluorescent microscopy. Hamster oocytes (7 oocytes/group) were incubated with FDA5M-labelled SSNPs at 100, 150, and 300µg/ml, for two-hours; ooplasm shrinkage was evaluated. Time/matched control sperm was incubated in phosphate-buffered saline and oocytes in KSOM.

Main results and the role of chance

Exposure to FDA5M-labelled SSNPs did not affect total or progressive sperm motility (P = 0.6735 and 0.9606, respectively), average-path velocity or straight-line velocity after 4-hours of incubation (P = 0.7459 and 0.8696, respectively) compared to controls. SSNPs at 10 µg/ml significantly increased sperm curvilinear velocity after 1-hour (P = 0.0495) and linearity and straightness after 4-hours (P = 0.0389 and 0.0312, respectively). SSNPs at 30 µg/ml significantly increased sperm linearity after 3- and 4-hours (P = 0.0384 and 0.005, respectively). The proportion of sperm showing green fluorescence was significantly higher in the 30µg/ml dose of SSNPs than the 10µg/ml dose after 4-hours (P < 0.00001). In oocytes, the zona pellucida remained morphologically intact and the ooplasm exhibited green fluorescence. The ooplasm of 42% of the oocytes at 300µg/ml showed ooplasm shrinkage (a sign of degeneration); no oocytes showed shrinkage at doses of 100 and 150µg/ml of SSNPs. The green fluorescence in the sperm head and the ooplasm indicated the ability of SSNPs to spontaneously interact non-invasively with these gametes either by surface association or by cell-internalisation. This could provide a safe and non-invasive intra-gamete delivery system for research purposes and clinical therapy. This system could be used to deliver specific agents into gametes prior to ART to improve outcomes.

Limitations, reasons for caution

The SSNPs are non-biodegradable; it remains unknown as to how gametes or embryos might react with SSNPs over long time periods. The nanotoxicity of SSNPs has not yet been investigated over the long term. SSNPs have still to be tested with embryos to evaluate their effect on embryonic development.

Wider implications of the findings: SSNPs could be functionalised to target the nucleus of mammalian gametes and embryos to act as a carrier for oligonucleotides and genes to correct chromosomal abnormalities and to provide genetic therapy in these gametes and embryos to treat hereditary diseases before intra-uterine transfer.

Trial registration number

Not applicable

Autism spectrum disorder in females with fragile X syndrome: a systematic review and meta-analysis of prevalence

BACKGROUND

Whilst up to 60% of males with fragile X syndrome (FXS) meet criteria for autism spectrum disorder (ASD), the prevalence and nature of ASD in females with FXS remains unclear.

METHOD

A systematic literature search identified papers reporting ASD prevalence and/or symptomatology in females with FXS.

RESULTS AND CONCLUSION

Meta-analysis suggested that rates of ASD for females with FXS are reliably higher than for females in the general population (a random effects model estimated weighted average prevalence at 14%, 95% CI 13-18%). Whilst papers highlighted a number of social and repetitive difficulties for females with FXS, characteristic profiles of impairment are not clear. Possible associations between ASD traits and IQ, and between ASD and levels of fragile X mental retardation protein, are suggested, but data are equivocal.

Total intravenous anaesthesia

Advances in pharmacokinetic understanding have popularised the safe and effective use of total intravenous anaesthesia delivered by continuous infusion. This article explores why the practical and outcome benefits have made total intravenous anaesthesia an increasingly accepted alternative to use of inhalational agents.

Is there still a role for the oesophageal Doppler in cardiac output monitoring?

The oesophageal Doppler monitor received early endorsement as an effective emerging medical technology, although numerous alternatives have since been widely adopted. This article examines the evidence supporting the continued use of the oesophageal Doppler.

758 Pre-Incisional Infiltration of Local Anaesthetic Is Associated with Reduced Intra-Operative Fentanyl Requirements and Lower Pain Scores in Recovery

Introduction

Effective pain management is a pivotal component of day-surgical pathways. Intra-operative regional infiltration of long-acting local anaesthetic (LA) has been shown to be efficacious in reducing post-operative pain after general anaesthesia, yet few studies have explored the optimal timing of its use.

Method

Patients undergoing day-case breast/general surgical operations under a single consultant surgeon were randomised to receive LA infiltration (Levobupivicaine) before the initial incision, or during wound closure. All patients were given a propofol-based general anaesthetic. Primary outcomes were intra-operative/post-operative fentanyl requirements, and numerical pain scores (at 1 and 3 hours post-operatively). The study ran from October 2019 but was suspended during the COVID-19 pandemic. Non-parametric statistical tests were used.

Results

25 patients were randomised. Those receiving pre-incisional LA had lower fentanyl requirements intra-operatively (mean; 150mcg vs 186mcg, p < 0.05) but similar requirements post-operatively. Mean pain scores were lower in the pre-incisional LA group at 1 hour (1.2 vs 2.3, p < 0.05) and 3 hours post-operatively (0.7 vs 1.3, p > 0.4).

Conclusions

Pre-incisional infiltration of LA led to a significantly reduced requirement for intra-operative fentanyl, and significantly lower pain scores at 1 hour post-operatively. Larger studies should interrogate this effect at individual procedure level and assess for differences in rates of chronic pain.

Immunisation Status of Children with Cerebral Palsy in Rural Bangladesh: Results from the Bangladesh Cerebral Palsy Register (BCPR)

BACKGROUND

Cerebral palsy (CP) is the most common cause of physical disability in childhood, with an estimated 17 million cases worldwide. There is limited data concerning the general health of this population and the immunisation status of children with CP is largely unknown.

OBJECTIVE

We aimed to assess the immunisation status of children with CP in rural Bangladesh and determine the predictors of non-immunisation.

METHODS

This study is part of the Bangladesh CP Register (BCPR) study; a population based CP register commenced in January 2015 in the Shahjadpur sub-district of Bangladesh. As part of BCPR registration, all children with CP in the catchment area were assessed by a paediatrician and their clinical and immunisation history were collected.

RESULTS

Between January and December 2015, 615 children with CP were registered on the BCPR. The median age of the children was 7.5 years, and 38.5% were female. 91.7% of those children had a BCG vaccine scar (as an objective marker for immunisation at birth). However, only 43.2% reported to have received the rubella vaccine during the 2014 national rubella immunisation campaign. Timing of CP diagnosis was found to be an independent predictor for immunisation uptake; those diagnosed before the age of 3 were more likely to have received the rubella vaccine (95% confidence interval [CI] 1.6 - 4.3, odds ratio [OR] 2.6, p <0.0001).

CONCLUSIONS

To the best of our knowledge, this is the first paper to use a formal CP register to examine the relationship between CP and immunisation status in a low or middle income country like Bangladesh. Our data suggest that more than half of children with CP in rural Bangladesh did not receive immunisation during a recent national campaign.

V8 Reporting of governance and ethical considerations in innovative surgical procedures – a systematic review

Introduction

The process of innovation in the field of surgery has largely resulted in improved patient outcomes. However, the uncertainty around the potential benefits and harms of innovative procedures mean that both research governance and ethics are important considerations for those who innovate. Though the need for ethical approval is standardised, other patient safeguards are surgeon and procedure dependent, such as the information provided during the consent procedure. It is currently unknown how ethical considerations in innovative surgery have been reported. This systematic review aims to evaluate the reporting of governance arrangements and ethical safeguards applied to innovative surgical procedures, using a case study of robotic upper gastrointestinal surgery.

Methods

The RoboSurg collaboration is conducting a set of systematic reviews to evaluate reports of innovative robotic surgical procedures including: pancreatectomies, gastrectomies, Roux-en-Y gastric bypasses, oesophagectomies, liver resections, cholecystectomies and anti-reflux operations. Databases were searched in April 2020 using relevant search terms including ‘oesophagectomy’ and ‘robotics’. Data extracted include details of approvals from Institutional Review Boards, ethics committees and clinical effectiveness groups, a priori study registration, and patient consent.

Results

Interim results for the reporting of governance arrangements and ethical safeguards from studies detailing robotic oesophagectomies will be presented. The search yielded 1908 abstracts for screening, of which 101 were included. The proportion of studies reporting on each ethical safeguard for patients undergoing this innovative procedure will be described and summarised.

Conclusion

This review will evaluate how governance and ethical safeguards in studies of innovative surgical procedures have been reported.

P12 A systematic review of the reporting of surgical quality assurance and learning curve in robotic oesophagectomy

Introduction

There is an increasing trend in novel robotic-assisted oesophagectomy in place of standard techniques, potentially due to its perceived technical benefits and improved post-operative outcomes. However, safety and efficacy remain uncertain and little is known about surgeons’ expertise in this complex procedure. This review aims to summarise the reporting of surgeons’ expertise in studies evaluating robotic oesophagectomy.

Method

Systematic searches of OvidSP, MEDLINE and Cochrane Library were conducted using key words for robotic surgery and oesophageal cancer. Searches were limited to human studies published up to February 2020. Studies reporting any type of outcome for robotic oesophagectomy were included. Data on quality assurance measures (e.g. type of centre, surgeons’ experience, study entry criteria) and learning curve assessments were recorded.

Results

Of 954 abstracts screened, 226 full texts were reviewed and 103 included. Two studies were clinical trials. There were 85 (82.5%) single and 6 (5.8%) multi-centred institutions. Forty-four (43%) stated the type centre(s) involved: general (n = 1), specialist (n = 41) or mixed (n = 2). Thirteen (13%) reported centres’ caseload of robotic and non-robotic oesophagectomies within a defined period. Seven described surgeons’ prior experience in robotic oesophagectomy, and 5 described experience in open/laparoscopic surgery. Two stipulated entry criteria for surgeons (training qualification and number of robotic oesophagectomies performed). Eighteen (17%) assessed the learning curve through changes in operating time, complications and conversion rates.

Discussion

There is currently inadequate reporting on surgeons’ expertise in robotic oesophagectomy, making comparisons with standard techniques challenging. This highlights the need for better transparency when reporting surgical innovation, as outlined by the IDEAL framework.

P125 The effect of wellbeing mobile-applications on the Mental and Physical Health of Healthcare workers: A Systematic Review

Introduction

The growing pressure on Healthcare workers (HCWs) can lead to worsening physical and mental wellbeing. Use of traditional support systems is limited and whilst there are a significant number of mental health platforms, few are targeted towards HCWs.

Objective

This review aimed to assess the available literature and platforms focused on supporting HCWs mental health and wellbeing.

Methods

A systematic search, following PRISMA guidelines was conducted. Abstracts were included if they targeted HCWs and used smartphone apps to support wellbeing. A further comprehensive application search of IOS and Android stores was performed to identify HCW wellbeing applications.

Results

In total 725 abstracts were identified. 10 publications, with a total of 683 participants, relating to wellbeing applications in HCWs met the inclusion criteria. 87% of the HCWs included in the studies were female. The majority (9/10) of the studies reported improved wellbeing of HCWs following the use of app-based interventions. A total of 1656 mobile applications were identified and met the inclusion criteria if they focused on HCWs wellbeing. The majority of the studies and apps focused on increasing mindfulness practices and yielded statistically significant results compared to traditional interventions.

Conclusion

Wellbeing programmes delivered through an app provide convenience and can improve the mental and physical wellbeing HCW’s. This is particularly key during challenging times. Given the limited number of published studies on smartphone apps and the limited number of apps for HCWs, it is clear that there is a deficit that requires urgent addressing despite two promising candidates.

P102 Reporting of innovations in surgery: a systematic review of robotic liver resections

Introduction

Liver resections are most commonly performed for either primary or secondary cancers. Consensus guidelines recommend that minor liver resections should be attempted laparoscopically, however this technique has limitations. These include difficulties with surgical access, ergonomics and visualization. Consequently, there has been increasing interest in innovative solutions such as robotic surgery. The IDEAL Collaboration has provided guidance for the reporting of surgical innovations, but it is not known how robotic liver resections have been reported. The aim of this study is to summarize technique descriptions and governance procedures, and understand which clinical outcomes have been reported.

Methods

A systematic review is being conducted in accordance with the PRISMA guideline. A search of Embase, Ovid Medline, the Cochrane Library and Web of Science was performed, using search concepts of “robotic” and “liver resection”. Articles will be screened to select primary research reporting outcomes of robotic liver resections. Data will be extracted on the reporting of study characteristics, governance and ethical arrangements, mitigations of harm, techniques and modifications, and outcomes. A descriptive summary of the data will be produced. The results will be critiqued in relation to guidance from the IDEAL Collaboration.

Results

The search returned 3063 articles, with 2385 remaining after de-duplication. An interim descriptive analysis of the data will be presented, summarizing how robotic liver resections have been reported. A critique of the available results in the context of IDEAL guidance will be provided.

Conclusion

This systematic review will describe how robotic liver resections have been reported as surgical innovations.

Aquatic contaminants in Solomon Islands and Vanuatu: Evidence from passive samplers and Microtox toxicity assessment

Water Quality issues in many Pacific countries are rising, with the increase in coastal populations and associated urban runoff but management requires contamination issues in the aquatic environment to be identified and prioritised. In Vanuatu and Solomon Islands there are few laboratories and resources to assess for the presence or impact of complex chemical contaminants. The extent and impact of chemical contamination of the marine and coastal environment is poorly described. Passive chemical samplers were used to measure a range of aquatic pollutants around the capital cities, Honiara (Solomon Islands) and Port Vila (Vanuatu). We detected a range of chemicals indicative of agricultural and industrial contamination and a few sites had concerning concentrations of specific hydrocarbons and pesticides. The rapid ecotoxicology test, Microtox, indicated toxic impacts in rivers, coastal sites and urban drains This work provides new data on chemical contamination and possible impacts of that contamination for both countries. The techniques could be applied widely across the region to generate critical data for environmental management, guide monitoring efforts and measure the impact of policy or land-use changes.

Multiple pipeline embolization devices improves aneurysm occlusion without increasing morbidity: A single center experience of 140 cases

INTRODUCTION

Rates of aneurysm occlusion with the pipeline embolization device (PED) has varied widely in the literature from 55.7% to 93.3% at 6 months, which may reflect a difference in technique including sizing and number of devices used.

METHODS

140 cases at our institution were retrospectively reviewed, and aneurysms treated with a single PED vs. multiple were compared.

RESULTS

Complete aneurysm occlusion was achieved in 86.9% at 6 months, 91.8% at 1 year, and 97.6% at longest follow-up. Retreatment with an additional device was required in 7 (5.1%). Major and minor complication rate within 30 days was 1.4% and 5.0%, and at greater than 30 days was 0.8% and 3.1%. Patients treated with multiple PEDs had significantly higher rates of aneurysm occlusion at 6 months (92.9% vs. 75.6%, p = 0.017) and 12 months (98.4% vs. 81.1%, p = 0.014), with no difference in complications. The two groups were similar aside from a higher number of ophthalmic and paraophthalmic aneurysms treated with multiple PEDs (23.4% vs. 6.5%, p = 0.004; and 35.1% vs. 17.4%, p = 0.020), and more posterior communicating artery and recurrent aneurysms treated with a single PED (28.3% vs. 3.2%, p = 0.001; 23.9% vs. 8.5%, p = 0.031). The use of multiple PEDs was found to be an independent predictor of aneurysm occlusion in a multivariate analysis (p = 0.015).

CONCLUSIONS

The use of multiple PEDs for intracranial aneurysms leads to significantly higher occlusion rates without added morbidity. This benefit is particularly appropriate for ophthalmic segment aneurysms, while more distal segments with eloquent perforating branches should be managed with caution.

76 This is (Probably) Not the Frailty Solution You are Looking For: Utilisation of A Novel Stand-Alone Community-Based Ambulatory Care Unit

Introduction/Aim

Our organisation wished to expand its “Care Closer To Home” capability, especially for older and/or frail patients. Our novel Ambulatory Care Unit (ACU) in a community hospital, staffed by GPs & nurses, opened a year ago. The ACU has some Point of Care (POCT) diagnostics, access to plain-film radiography and OT/physio. During the planning of the unit,” acute frailty” was anticipated to be core business. We wished to determine whether this turned out to be the case.

Method

Interrogation of the ACU patient log (spreadsheet collated from Data Collection Forms) Dec 2018-Nov 2019.

Results

Conclusion/Discussion

Recording of CFS by ACU staff was poor, limiting the validity of our results. Nevertheless, it is obvious that most patients seen in our ACU are not frail, and do not require therapies input. Those that are frail, however, have an acceptable conversion-to-admission rate of 8.6%, comfortably below the national target (20%).

Barriers to greater utilisation of our service for frail patients may include lack of urgent but non-emergency transport options for the less mobile, lack of access to certain commonly-used tests (e.g. CT, troponin) and referrer anticipation of difficulty discharging the frail patient in crisis without a new or boosted care package and/or access to respite beds. These aspects of service planning need to be addressed if the potential utility of community-based units like ours for frail patients is to be maximised.

AAPS Perspective on the EURL Recommendation on the use of Non-Animal-Derived Antibodies

In May 2020, the EU Reference Laboratory for alternatives to animal testing (EURL ECVAM) published a recommendation report entitled "Recommendation on nonanimal-derived antibodies". In this report, the EURL ECVAM specifically states: "Therefore, taking into consideration the ESAC Opinion on the scientific validity of replacements for animal-derived antibodies, EURL ECVAM recommends that animals should no longer be used for the development and production of antibodies for research, regulatory, diagnostic and therapeutic applications. The provisions of Directive 2010/63/EU should be respected, and EU countries should no longer authorise the development and production of antibodies through animal immunisation, where robust, legitimate scientific justification is lacking." (1). Here, we are providing the American Association of Pharmaceutical Scientists (AAPS) opinion on the EURL ECVAM recommendation report. In brief, there has been a clear and strong progress in reduction of animal use in the drug discovery and development process, including significant reduction of animal use in production of antibody reagents. Yet, it is proposed that more data need to be generated, shared and discussed within the scientific community before a decision to implement the change to non-animal derived antibodies is made.

Healthcare staff perceptions and misconceptions regarding antibody testing in the United Kingdom: implications for the next steps for antibody screening

BACKGROUND

Healthcare workers have been at increased risk of exposure, infection and serious complications from COVID-19. Antibody testing has been used to identify staff members who have been previously infected by SARS-CoV-2, and has been rolled out rapidly in the United Kingdom. A number of comment and editorial articles have been published that raise concerns about antibody testing in this context. We present perceptions of National Health Service (NHS) healthcare workers in relation to SARS-CoV-2 antibody testing.

METHODS

An electronic survey regarding perceptions towards SARS-CoV-2 antibody testing was distributed to all healthcare workers at a major NHS tertiary hospital following implementation of antibody testing.

RESULTS

In total, 560 healthcare workers completed the survey (80% female; 25% of Black and Minority Ethnic background; 58% from frontline clinical staff). Exploring whether they previously had COVID-19 was the primary reported reason for choosing to undergo antibody testing (85.2%). In case of a positive antibody test, 72% reported that they would feel relieved, whilst 48% felt that they would be happier to work in a patient-facing area. Moreover, 12% responded that a positive test would mean "social distancing is less important", with 34% of the responders indicating that in this case they would be both less likely to catch COVID-19 and happier to visit friends/relatives.

CONCLUSIONS

NHS staff members primarily seek out SARS-CoV-2 antibody testing for an appropriate reason. Based on our findings and given the lack of definite data regarding the extent of immunity protection from a positive SARS-CoV-2 antibody test, significant concerns may be raised regarding the reported interpretation by healthcare workers of positive antibody test results. This needs to be further explored and addressed to protect NHS staff and patients.

Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research

Objective: To discuss and develop a statement on the current state of the evidence and opinion in Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide recommendations. Background: A group met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were agreed as the focus of the meeting. Methods: 12 internationally acknowledged experts, in this or a closely related area (e.g. PTSD) met to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity. Keys points: Work focussed on tokophobia is recent and there remains a wide range of issues, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding, which creates challenge for robust assessment and the identification of risk factors. An improved aetiological and developmental understanding of the tokophobia is required to underpin appropriate, effective and evidence-based interventions. Evaluation of pathways of care and relevant interventions, should be a focus of future research. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research is necessary.