#59: Launching a Network-based Platform for Clinical Case Discussions of Infections in Immunocompromised Pediatric Patients Worldwide
Authors: Gutierrez Tobar I , Vázquez M , Happ B , Kopsidas I , Tinoco Martín I , Homsi M R , Caniza M A 
Published: June 2021

Abstract

Background
Infectious in pediatric patients with cancer are common and can be life-threatening. Understanding risks for infections, mechanisms of progression, and diagnostic and therapeutic interventions is essential for quality care. Clinical guidance emerges frequently from high-income countries and dissemination of information using traditional methods takes time to reach resource-limited settings. By using case-based learning (CBL) strategies, we sought to expedite this process to improve practices worldwide. We report the implementation of a network-based platform for discussion of infections in the immunocompromised child in resource-limited settings and the potential for dynamic sharing of best care practices.

Methods
Using a virtual meeting platform, we established a weekly appointment and invited members of our regional networks, mainly comprising pediatricians with training / interest in infection care and prevention who care for children with cancer. We solicited cases for discussion by providing an electronic case submission form, a presentation template, a presentation checklist, and a protected health information reminder sheet. Materials were prepared in Spanish and English, launching initially in Spanish (October 2019), then expanding to English (September 2020) alternating between Spanish and English-led discussions. Based on the case of the week, a panel of experts, worldwide infectious disease experts, provided recommendations for care based on published evidence, standardized guidelines, and best practices. Detailed written summaries were captured and shared with case submitters. We recorded attendance and evaluated participant satisfaction and the use of discussed information. Additional CBL materials were developed post-launch to support and expand CBL beyond the live meeting sessions.

Results
From October 2019 to December 2020, we hosted 45 online meetings with clinical cases presented from 15 countries and 23 institutions across the globe. We have had a total of 1054 attendees, with an average of 28 participants per live meeting. Discussions included complications grouped by viral, fungal, and mycobacterial infection. A quarterly survey revealed that participants found the case discussions most beneficial for reviewing recent literature and learning practices from invited guest experts. Most respondents have very often or always adopted the recommendations discussed during online meetings for the management of patients locally. Additional materials include: a protected virtual community space for storing all CBL materials and promoting continued participant engagement; a growing index of infections with prepared PubMed searches for quick and easy navigation to peer-reviewed literature (n=9); and, written case summary reports, indexed by infection, made available to all audience members for reference (5=in draft, 12=published). During the first part of the COVID-19 pandemic, we incorporated a journal club structure to discuss emerging literature on the virus, and specifically the implications for children with / without cancer. Participants indicated that COVID-19 activities were extremely useful for discussing and digesting the rapidly evolving scientific literature for SARS-CoV-2 and being able to apply lessons learned in real-time.

Conclusions
A virtual platform for CBL provides a critical resource that expedites information-sharing and can potentially improve patient care by expanding access to expertise and experience for best care practices beyond geographic boundaries.