Randomized controlled trial of a book-sharing intervention in a deprived South African community: effects on carer-infant interactions, and their relation to infant cognitive and socio-emotional outcome

Background: Consistent with evidence from high income countries, we previously showed that, in an informal peri-urban settlement in a low-middle income country, training parents in book-sharing with their infants benefitted infant language and attention (Vally et al., 2015). Here, we investigated whether these benefits were explained by improvements in carer-infant interactions in both book-sharing and non-book-sharing contexts. We also explored whether infant socio-emotional development benefitted from book-sharing. Methods: We conducted a randomized controlled trial in Khayelitsha, South Africa. Carers of 14-16 month-old infants were randomized to 8 weeks’ training in book-sharing (n = 49) or a wait list control group (n = 42). In addition to the cognitive measures reported previously, independent assessments were made at base line and follow-up of carer-infant interactions during book-sharing and toy play. Assessments were also made, at follow-up only, of infant pro-social behaviour in a ‘help task’, and of infant imitation of doll characters’ non-social actions and an interpersonal interaction. Eighty-two carer-infant pairs (90%) were assessed at follow-up. (Trial registration ISRCTN39953901). Results: Carers who received the training showed significant improvements in book-sharing interactions (sensitivity, elaborations, reciprocity), and, to a smaller extent, in toy-play interactions (sensitivity). Infants in the intervention group showed a significantly higher rate of pro-social behaviour, and tended to show more frequent imitation of the interpersonal interaction. Improvements in carer behaviour during book-sharing, but not during toy play, mediated intervention effects on all infant cognitive outcomes, and tended to mediate intervention effects on infant interpersonal imitation. Conclusions: Training in book sharing, a simple, inexpensive intervention that has been shown to benefit infant cognitive development in a low-middle income country, also shows promise for improving infant socio-emotional outcomes in this context. Benefits are mediated by improvements in carer-infant interactions, particularly in book-sharing contexts

Ultrastructure of Larval Trematodes from Snails Collected from Lake Winnibigoshish

Trematodes are a class of parasitic flatworm that are internal parasites of both mollusks and vertebrate hosts. Most trematodes have a complex life cycle that includes at least two hosts: one where sexual reproduction occurs (definitive host) and one where asexual reproduction occurs (intermediate host). Identification of both larval and adult stages is critical for determining the species of trematode in question as well as the mechanisms that allow that parasites to reside within their intermediate host. The current investigation was started to elucidate the mechanisms that allow for parasite attachment within intermediate hosts. Snails were collected from Lake Winnibigoshish in northern Minnesota, an area known for harboring trematode diversity within both definitive and intermediate hosts. During this study, two different larval forms (rediae and tetracotyle) were dissected from snail hosts and prepared for scanning electron microscopy (SEM). Examination of the presence or absence of structures used for the attachment to host tissues will be performed. These findings will help better understand the interaction that occurs between the intermediate snail host and the parasitic worm

171 Developing & Centralising a Nurse-Led Local Anaesthetic (La) Transperineal (Tp) Biopsy Service During Covid: A Success Story

INTRODUCTION: During the first COVID-19 wave, the BAUS Section of Oncology issued guidance to minimise risks of sepsis and general anaesthesia at prostate biopsy. Consequently, and as a result of diminished diagnostics capacity on Trust acute sites, we implemented a centralised network-wide nurse-led LA TP biopsy service on a COVID-secure “green” site and abandoned trans-rectal biopsies. We evaluated the impact of this service improvement on patient waiting times before and after national lockdown in March 2020. METHOD: Classic Quality Improvement (QI) methodology was used with continuous data collection and waiting list management by clinical staff with standard admin support. Balancing measurements were collected. Run charts were used to confirm whether a change led to a real and sustainable improvement. RESULTS: The number of days waiting, from time of request to date of biopsy, is presented in the following run chart. The mean waiting time for those pre lockdown was 145 days (SD 57) whereas post lockdown was 23 days (SD 20). This identified that there was a significant difference between the average waiting time pre and post lockdown (U = 55.5, p = <0.001) There were also reductions in waiting time when subcategorised into planned Active Surveillance cases, target cases and delayed cases. CONCLUSIONS: Centralising the TP biopsy service and converting to a nurse led LA service has led to reductions in waiting lists and was safely expedited and resilient even in the COVID-19 pandemic. Allowing a second advanced TP practitioner to be fully trained, during COVID. The service was highly valued by patients and staff

Developing and centralising a nurse‐led local anaesthetic transperineal biopsy service during COVID

Abstract Introduction Transperineal (TP) biopsy has recently replaced the transrectal ultrasound (TRUS) approach as the ideal method of biopsy in the United Kingdom with growing trends to adopt. To minimise transmission of COVID‐19 during the first wave of the pandemic, the British Association of Urological Surgeons Section of Oncology issued guidelines reducing general anaesthesia (GA) procedures and initiate COVID‐secure ‘green’ site diagnostics. As a result of these guidelines and reduction in clinical diagnostics trust‐wide, we ceased all TRUS diagnostics and implemented a centralised, nurse‐led LA TP biopsy service. Materials and methods A waiting list was developed for those awaiting prostate cancer diagnostics across the network. A COVID‐secure ‘green’ site was quickly identified with TP biopsies starting soon after. Quality improvement methodology was utilised and a run chart was used to show if changes were sustainable. Results Successful implementation and centralisation of a TP biopsy service occurred with TRUS guided biopsies ceasing across all sites on 12 May 2020. The procedures were carried out by urology advanced nurse practitioners under local anaesthesia with a select few occurring under GA. Centralising the service in a COVID‐secure manner freed up dedicated theatre sessions and personal leading to increased efficiency elsewhere. The service was robust and was maintained upon lifting of COVID restrictions. Conclusions A centralised, nurse led LA TP biopsy service in a procedural unit was implemented successfully. The service has remained resilient upon lifting of restrictions and return to business as usual. This led to improved performance across trust by freeing up valuable resources and staff to undertake more duties. The service remains highly valued trust‐wide