Aim Determine levels of depression, anxiety and stress symptoms and factors associated with psychological burden amongst critical care health care workers in the early stages of the coronavirus disease (2019) (COVID-19) pandemic. Methods Anonymous web-based survey distributed in April 2020. All health care workers employed in a critical care setting were eligible to participate. Invitations to the survey were distributed through Australian and New Zealand critical care societies and social media platforms. The primary outcome was the proportion of health care workers that reported moderate to extremely severe scores on the Depression Anxiety Stress Scale-21 (DASS-21) Results Of the 3770 complete responses, 3039 (80.6%) were from Australia. A total of 2871 respondents (76.2%) were female; median age was 41 years old. Nurses made up 2269 (60.2%) of respondents with most [2029 (53.8%)] working in Intensive Care Units.Overall, 813 (21.6%) respondents reported moderate to extremely severe depression, 1078 (28.6%) reported moderate to extremely severe anxiety and 1057 (28.0%) moderate to extremely severe stress scores. Mean ± standard deviation DASS-21 depression, anxiety and stress scores amongst woman vs men were: 8.0 ± 8.2 vs 7.1 ± 8.2 (p=0.003); 7.2 ± 7.5 vs 5.0 ± 6.7 (p<0.001); and 14.4 ± 9.6 vs 12.5 ± 9.4 (p<0.001) respectively.After adjusting for significant confounders, clinical concerns associated with higher DASS-21 scores included; not being clinically prepared (β 4.2, p<0.001), an inadequate workforce (β 2.4, p=0.001), having to triage patients due to lack of beds and or equipment (β 2.6, p=0.001), virus transmission to friends and family (β 2.1, p=0.009), contracting COVID-19 (β 2.8, p=0.011), being responsible for other staff (β 3.1, p<0.001), and being asked to work in an area that was not in the respondents expertise (β 5.7, p<0.001). Conclusion In this survey of critical care health care workers, between 22 and 29% of respondents reported moderate to extremely severe depression, anxiety and stress symptoms with females reporting higher scores compared to men. Although female gender appears to play a role, modifiable factors also contribute to psychological burden and should be studied further.

Application of sub-stage-specific PET in stage 3 melanoma enables asymptomatic detection of most recurrences, has high NPVs that may provide patient reassurance, and is associated with a high rate of detection of resectable and potentially curable disease at relapse.

9563 Background: With the evolving treatment landscape in metastatic melanoma, approaches to disease surveillance post resection in stage 3 disease requires reconsideration. We previously reported the outcomes of sub-stage-specific schedules of combined fluorodeoxyglucose-positron emission and computerized tomography (PET/CT) surveillance at high risk of relapse following surgery. The aim of this study was to provide an update on our surveillance protocol with an extended sample size and longer duration of follow-up. Methods: From 2009, patients with AJCC stage 3 melanoma underwent PET/CT scans according to pre-specified schedules based on Bayesian probabilities of sub-stage-specific relapse. Schedules were stage 3A: 6, 18 mo; stage 3B: 6, 12, 18, 24, 36, 48, 60 months; stage 3C: 6, 12, 18, 24, 36 months. Contingency tables were used to evaluate the sensitivity, specificity and predictive values of these schedules. Results: In total, 171 patients (3A: 34; 3B: 93; 3C:44) underwent 553 PET/CT scans with a median follow up of 47 months. Relapses were identified in 65 (38%) patients of which (72%) were asymptomatic at the time of radiologically documented relapse. False positive results occurred in 8%. The positive predictive value (PPV) of an individual scan for diagnosing true recurrence was 77% (64-87%). Negative scans at 6 months had negative predictive values (NPV) between 57% in Stage 3A to 69% in Stage 3B for relapse. Sensitivity and specificity of the overall approach of sub-stage-specific PET/CT surveillance for detecting disease relapse were 70% and 89%, respectively. Evaluable predictive values for detecting disease relapse were: stage 3A: PPV:56%, NPV:76%; 3B: PPV 83%, NPV 86%; stage 3C: PPV 84%, NPV 84%. 32 of 65 patients (49%; 3A: 1; 3B: 7; 3C: 2) underwent resection of relapsed disease and 10 of these patients remained free of disease with a median follow-up of 24 months. Conclusions: Sub-stage-specific PET/CT is effective in detecting asymptomatic recurrence in stage 3 melanoma, and is associated with a high rate of disease resection at relapse.