WONCA 2022 Congress Highlights

RSV has been broadly studied as a major pathogen in infants. However, its burden in older populations is sometimes less well-known. Dr Stefania Maggi described how important it is to pay attention to the elderly population, and the burden that RSV has in these patients².

During ageing, the immune system enters senescence, being less capable of fighting pathogens that otherwise do not pose an important threat. This is the case with RSV, a pathogen that can reinfect subjects from childhood to old age.

The clinical profile of this virus is typical for a respiratory pathogen – including cough, wheezing, sore throat and fever. When RSV appears in older adults, it can include other symptoms, such as hypoxia, tachycardia/tachypnoea, delirium and fatigue and is a major cause of hospital admissions.

Classic, umbrella and platform clinical trial designs

Dr Saville, an expert biostatistician, explained the differences between the known ‘classic’, traditional trial model, where there is one question to resolve in a homogeneous population (eg, is there any benefit of using treatment A instead of treatment B?) and the ‘umbrella’ trial model that considers multiple treatments and multiple populations (eg, same disease, multiple biomarkers that determine different population groups)¹¹. This last option is planned and executed in a way that allows access to more detailed information about the relationships between different treatments and different populations all together as part of the same ‘umbrella’.

Umbrella trials were the first step into designing clinical trials for a constantly evolving clinical reality where more potentially relevant symptoms and biomarkers with treatment implications are constantly being found. Another step towards this aim are ‘platform’ trials.

Remote consultations can improve waiting times and improve accessibility and convenience, but need to be done properly to avoid discrimination based on access to technologies and understanding of the available tools

A study presented by Dr Ana Luisa Neves raised the issues of reduced access to technology by those patients with poor digital literacy, care delays, misuse and a sense of clinical uncertainty¹⁹. She indicated that some strategies to implement in order to solve these obstacles would include training for patients and the creation of resources to improve health literacy, preparation of guidelines for remote care and improved remote triage.

Considerations regarding ethics were raised by Dr Tania Moerenhout, who discussed the challenges that are faced when moving towards virtual consultations²⁰. According to her study, there is a risk of compromising continuity of care as well as equity, but she also emphasized the increase in accessibility and convenience, recommending a proactive and comprehensive approach towards increased virtual consultations to ensure appropriate service.

Dr Catherine Clifford’s clinic based in Ireland identified that foreigners had a harder time understanding medical alerts due to COVID-19²¹. Her group came up with a way to support these patients. During the pandemic, a volunteer network of international healthcare workers created video messages in more than thirty languages explaining the COVID-19 pandemic, the steps to follow and the vaccination programmes. This interesting initiative survived beyond the COVID-19 crisis and, since then, new multilingual videos have been produced on other health topics of interest including instructions to access healthcare in Ireland, screening services and antenatal care.