When life imitates art: Watchlist and the impossible pandemic

Oscar Wilde (1891/1909) declared that it is not Art that imitates Life but Life that imitates Art. What happens when an artistic work, pitched as "soft sci-fi”, predicts something both decidedly unpleasurable and, later, alarmingly prophetic? Such is the case with Watchlist (2020), a new Australian theatrical work written prior to COVID-19, which warns of impending environmental catastrophe and ends with the release of a zoonotic pathogen. The debut production in 2021 was performed amid the global reality of the continuing pandemic which rendered the play a prescient cultural artefact and complicated the audience reception of the work. This study expands from Wilde's concept of counter-mimesis into the theoretical frameworks of Hans Robert Jauss (1982) and Susan Bennett (1997), who provide an alternative to author-centric, practice-led research while laying the blueprint for a dialectical exchange between Life and Art. The dialectical exchange is then explored in the genre of science fiction more broadly, including both literature and franchise filmmaking. Through this analysis, the authors break down the binary of Life and Art, building from Jauss and Bennett, to demonstrate the advantages of this alternative critical vocabulary. © 2023, Australasian Association of Writing Programs. All rights reserved.

Clinical epidemiology of COVID-19 in Black people with HIV in south London, UK

Background: The COVID-19 pandemic disproportionally affected Black communities who were at greater risk of SARS-CoV-2 acquisition, morbidity, and mortality than those of White ethnicity. We describe the clinical epidemiology of COVID-19 in the GEN-AFRICA cohort of Black people with HIV in two South London clinics. Method(s): First reported episodes of COVID-19 up to 12/2021 were ascertained by direct questioning and/or medical records review. The cumulative incidence of COVID-19 and vaccination was determined by Nelson- Aalen methods. Pre-pandemic immunovirological and comorbidity status obtained prior to 01/2020 was used to identify risk factors for COVID-19 using Cox regression. We compared characteristics of participants with mild/ moderate (not requiring hospitalization) and severe (requiring hospitalization or resulting in death) COVID-19. Result(s): COVID-19 status was available for 1184 (95%) of 1289 GEN-AFRICA participants (mean age 49.1 years;55% female;median CD4 565;93% HIV RNA <200), and SARS-CoV-2 vaccination status for 1160;998 (86%) had received at least one vaccine dose (administered to 50% by 16/02/2021). A total of 310 participants (26.2%) reported a first episode of COVID-19 (any severity), with a cumulative incidence of 6%, 14%, 15% and 22% following the initial, alpha, delta, and omicron waves. Women, people of East African ancestry, and those with detectable HIV RNA were more likely to report COVID-19 (Table). CD4 (current/nadir), class of antiretroviral therapy (ART), and comorbidity status were not associated with COVID-19. Findings were similar when restricted to episodes in 2020 (prior to vaccine availability) or testconfirmed COVID-19. Severe COVID-19 cases (N=34) were more often male (p=0.002), of West-African ancestry (p=0.01), with lower CD4 cell counts (p=0.002), and they more often had a history of AIDS, diabetes mellitus, cardiovascular disease, and chronic kidney disease (all p=0.001) compared to mild/moderate cases;they were also more likely to be on protease inhibitor (PI)- containing ART (p=0.01). Conclusion(s): By the end of the second year of the pandemic, 22% of black people with HIV in South London had experienced COVID-19. Immune and comorbidity status were not associated with COVID-19 when all cases were considered but strongly associated with severe COVID-19 disease, as were West-African ancestry and being on a PI. (Table Presented).

HIV care during the SARS-COV-2 pandemic for Black people with HIV in the UK

Background: The COVID-19 pandemic disproportionally affected black communities but the impact on HIV care in this group remains poorly understood. We evaluated measures of HIV care during the COVID-19 pandemic in the GEN-AFRICA cohort of black people with HIV living in the U.K. Method(s): We evaluated interruptions to HIV care during the COVID-19 pandemic (01/2020-09/2022) in the GENAFRICA cohort at nine UK clinics who provided HIV outcomes for >80% of their participants. We ascertained death, transfers of care, loss to follow up for >12 months, the highest HIV viral load and interruptions to antiretroviral therapy (ART). We evaluated factors associated with the composite outcome of HIV viraemia (viral load >200 c/mL) and/or an ART interruption using logistic regression analysis;factors associated (P<0.1) in univariable analysis were included in the multivariable model. We also summarized reasons for ART interruptions where recorded. Result(s): 2321 participants (mean age 51.3 years;55.8% women;pre-pandemic current/nadir CD4 of 500/204 cells/mm3 and HIV RNA <200 c/mL in 92.3%) were in care on 01/01/2020. Thirty (1.3%) subsequently died, 24 (1.0%) transferred care and 48 (2.1%) became lost to follow up. 523 (22.7%) reported an episode of COVID-19 and 1771 (87.1%) having been vaccinated against SARSCoV- 2. The composite outcome could be evaluated in 2130 (91.8%);259 (11.2%) had a documented HIV VL >200 c/mL, 228 (9.8%) an ART interruption and 325 (14%) had HIV viraemia/ART interruption. In multivariable analysis, older age, a pre-pandemic HIV RNA <200 c/mL and being vaccinated against SARS-CoV-2 were associated with reduced odds of HIV viraemia/ART interruption (Table) while sex, CD4 (current/nadir), comorbid status and having had COVID-19 were not associated. Reasons for ART interruption were available for 52 participants;38% cited domestic logistic reasons, 27% issues related to foreign travel, 19% psychological reasons, 12% lockdown or changes to the daily routine and 4% personal choice. Conclusion(s): During the COVID-19 pandemic, one in seven black people with HIV experienced an ART interruption and/or HIV viraemia. Pre-pandemic measures of suboptimal engagement in care, pandemic restrictions, and wider health beliefs as reflected by COVID-vaccination, contributed to these undesirable HIV outcomes. (Table Presented).

Factors associated with severe SARSCOV- 2 infection in people of Black ethnicities living with HIV in the UK

Background: The COVID-19 pandemic has disproportionally affected people of black ethnicities, who have been at greater risk of SARS-CoV-2 acquisition, morbidity and mortality than those of white ethnicity. We describe factors associated with severe COVID-19 infection in the GEN-AFRICA cohort of people of black ethnicities living with HIV in the U.K. Method(s): First reported episodes of COVID-19 up to October 2022 were ascertained by direct questioning and/or medical records review. Pre-pandemic immune-virological and comorbidity status was based on measurements obtained prior to 01/2020 and used to identify risk factors for severe (requiring hospitalisation or resulting in death) COVID-19, using logistic regression Results: COVID-19 status was available for 1806 (72%) of 2503 GEN-AFRICA participants (mean age 49.2 [SD 10.2] years;56% female;80% sub-Saharan African and 14% Caribbean ancestry, median CD4 count 555 [IQR 400-733] cells/mm3;93% undetectable HIV RNA [<200 copies/ mL]);573 (32%) reported a clinical illness consistent with COVID-19;63 (3.5%) experienced severe COVID-19 (hospitalisation 59;death 4). Those who experienced severe COVID-19 were older, more often male, had lower CD4 counts and fewer had undetectable HIV RNA;they more often had prior AIDS, hypertension, diabetes mellitus and chronic kidney disease. Region of ancestry, nadir CD4 count, and obesity were not associated with severe COVID-19. In multivariable analysis, CD4 count <350 cells/mm3, diabetes mellitus and chronic kidney disease were associated with increased odds of severe COVID-19 (Table). Sex and a pre-pandemic HIV RNA were associated with severe disease although this did not reach statistical significance. By October 2022, 1534 (88%) of this sample had received >=1 dose of SARS-CoV-2 vaccine;those who experienced severe COVID-19 were less likely to report vaccination (77% vs. 89%, p=0.01). Conclusion(s): By the end of October 2022, nearly onethird of people of Black ethnicities with HIV in this sample had experienced COVID-19;3.5% had developed severe COVID-19 disease. Pre-pandemic immunovirological and comorbidity status were associated with severe COVID-19. Black populations with less favourable HIV control than observed for GEN-AFRICA participants may have suffered greater COVID-19 morbidity and mortality. (Table Presented).

HIV CARE DURING THE SARS-CoV-2 PANDEMIC IN BLACK PEOPLE WITH HIV IN THE UK

Background: The COVID-19 pandemic disproportionally affected black communities but the impact on HIV care in this group remains poorly understood. We evaluated measures of HIV care during the COVID-19 pandemic in the GEN-AFRICA cohort of black people with HIV living in the United Kingdom. Method(s): We evaluated interruptions to HIV care during the COVID-19 pandemic (01/2020-09/2022) in the GEN-AFRICA cohort at nine UK clinics who provided HIV outcomes for >80% of their participants. We ascertained death, transfers of care, loss to follow up for >12 months, the highest HIV virus load, and interruptions to antiretroviral therapy (ART). We evaluated factors associated with the composite outcome of HIV viraemia (virus load >200 c/mL) and/or an ART interruption using logistic regression analysis;factors associated (P< 0.1) in univariable analysis were included in the multivariable model. We also summarized reasons for ART interruptions where recorded. Result(s): On 01/01/2020, 2321 GEN-AFRICA study participants (mean age 51.3 years;55.8% women;pre-pandemic current/nadir CD4 of 500/204 cells/mm3 and HIV RNA < 200 c/mL in 92.3%) were under active HIV follow up. Thirty (1.3%) subsequently died, 24 (1.0%) transferred care, and 48 (2.1%) became lost to follow up;523 (22.7%) reported an episode of COVID-19 and 1771 (87.1%) having been vaccinated against SARS-CoV-2. The composite outcome could be evaluated in 2130 (91.8%);259 (11.2%) had a documented HIV VL >200 c/mL, 228 (9.8%) an ART interruption, and 325 (14%) had HIV viraemia/ ART interruption. In multivariable analysis, older age, a pre-pandemic HIV RNA < 200 c/mL and being vaccinated against SARS-CoV-2 were associated with reduced odds of HIV viraemia/ART interruption (Table) while sex, CD4 (current/nadir), comorbid status and having had COVID-19 were not or no longer associated. Reasons for ART interruption were available for 52 participants;38% cited domestic logistic reasons, 27% issues related to foreign travel, 19% psychological reasons, 12% lockdown or changes to the daily routine, and 4% personal choice. Conclusion(s): During the COVID-19 pandemic, one in seven black individuals with HIV experienced an ART interruption and/or HIV viraemia. Pre-pandemic measures of suboptimal engagement in care, pandemic restrictions, and wider health beliefs as reflected by SARS-CoV-2 vaccination status, contributed to these undesirable HIV outcomes.

Not by trees alone: centering community in urban forestry

Urban forestry and urban greening efforts are blossoming as cities and towns work to enhance their open spaces as green infrastructure that provides multiple benefits. This work has reached new urgency given the need for both high-performance landscapes that can mitigate the effects of climate change and accessible, safe greenspaces that can support community well-being during the COVID-19 pandemic. At the same time, activists, practitioners, scholars, and decision-makers--particularly those within Black, Indigenous, People of Color, and frontline communities who bear the brunt of negative impacts--are calling for the need to attend to environmental justice implications of greening efforts. Following a review of the literature, we draw upon our observations as researchers embedded in the field of urban and community forestry to offer three themes and related guiding questions that can help advance that work: (1) supporting human capacity and care (investments in people and organizations);(2) community organizing beyond the green silo (intersectional and cross-sectoral approaches);and (3) re-envisioning the functions of the urban forest (productive systems and biocultural approaches). Our perspective is inspired by the work of residents, practitioners, and decision-makers who are engaging in reflection and innovation in pursuit of "just cities" that can enhance diversity, equity, and inclusion as critical to and inseparable from sustainability and resilience. We suggest that the field of urban forestry draw upon a community forestry ethos as we center the needs, capacities, and priorities of historically marginalized communities at the heart of the work of creating more just, sustainable cities.

Virtual Care in Child and Adolescent Mental Health Services: Considerations for Shared Decision Making and System Improvement

Objectives: While promoted as a means of improving access to services, virtual mental health care prior to the pandemic was not widely perceived to be user-friendly or of the quality afforded by face-to-face care. Most clinicians had previously delivered care in person and reported advantages and limitations to virtual care. This underscored the need to understand why virtual care appeared to offer benefits for some patients, families or caregivers, and clinicians, but not all of them. Method(s): We employed an iterative, pragmatic multimethods approach, incorporating routinely collected administrative health data, system metrics, and key informant interviews to identify barriers and facilitators to the readiness and uptake of virtual care among children, adolescents, families, clinicians, and staff using virtual care in pediatric community and hospital-based mental health services. We built upon existing continuous quality improvement activities, adding qualitative methods to promote data richness and allow for methodological triangulation. Interviews were coded to identify themes and patterns of similarity or divergence across the data sources, respondent type, or other relevant characteristics. Result(s): Participants (n = 48) in semi-structured interviews included 9 youth, 10 parents/caregivers, 21 clinicians, and 8 administrative staff. Five themes emerged regarding drivers of virtual mental health care: the pandemic wave, patient characteristics, clinician characteristics, type of appointment (first or follow-up), and organizational policies and resources. Shared decisions regarding modality considered appointment complexity and risk, therapeutic alliance, and convenience. The choice of modality was influenced by patient/caregiver preference during lower COVID-19 activity and required greater clinical justification at peaks. Conclusion(s): A hybrid model of in-person and virtual mental health services is supported moving forward. Overall perceptions of virtual care were that it is useful as a supplementary tool to in-person services. Decision making about treatment modality needs to be a shared decision with clinicians and patients;understanding what works for whom, and when, is important for ensuring accessible, safe, and high-quality mental health care. TREAT, MDM, DAM Copyright © 2022

Evaluation of a complex home ventilation population before and after the advent of COVID-19 in the UK

P75 Figure 1Home ventilation delivery and dependence[Figure omitted. See PDF]ConclusionsThe apparent association between home non-invasive ventilator dependence and increased mortality in the second year of COVID-19 in the UK warrants investigation of unmet need in this patient group, compared with the invasively ventilated. Targeted review is planned in the local setting, facilitated by utilisation of home ventilation registry as a method of population surveillance.ReferencesLloyd-Owen SJ, et al. Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey. ERJ 2005;25: 1025–1031.Allen M. Respiratory Medicine: GIRFT Programme National Specialty Report. London: GIRFT, 2021.

Facilitator reflections on online delivery of simulation-based mental health education during COVID-19

Purpose During COVID-19, Maudsley Simulation successfully pivoted to fully online delivery of simulation-based education (SBE) in mental health. In migrating digitally, the simulation faculty experienced a range of new phenomena and challenges. The authors' experiences may be transferable to other specialities and for other educator groups. By sharing the authors' experiences, this study aims to support others adapt to online SBE. Design/methodology/approach This piece represents the authors' collective reflections on the challenges of adapting their facilitation skills to the online environment. It also offers various suggestions on how to improve the learner experience in view of these challenges. Findings Beyond merely platform orientation and operating procedure familiarisation, the team gained insights into ensuring optimal learning, engagement and participant experience during online deliveries. Delivery of online SBE brings several potential barriers to psychological safety and these warrant careful consideration by experienced simulationists. Practical implications Optimising participant engagement and psychological safety remain key considerations despite this novel medium. Facilitators must be willing to adapt accordingly to begin delivering high-quality online SBE. Originality/value From their experience, facilitators must reframe their debriefing expectations and adjust how they engage participants and manage group dynamics given the inherently different nature of this new learning environment.

University Students' Engagement with Devices and Technology

In this paper, through the replication of a pre-COVID-19 research project, we seek to test and compare first-year Australian university students' study and private uses of technology;compare the desires and capacities of different cohorts (Law and Justice vs Engineering) for technology use;and identify any impacts arising from COVID-19 to their learning experiences. Quantitative and qualitative data, collected by an online questionnaire, identified that, while some participants had more experience with different technologies, there were limited differences between the cohorts' willingness to use, and their use of, technology for study purposes. Concerns expressed by participants related to where, when, and for what purpose technology was used. Participants all had access to a smart phone, and almost all used a laptop for study purposes. The results suggest the combination of online or pre-recorded lectures and synchronous (either face-to-face or online) tutorials was the most favoured option. While participants were comfortable with the use of technology in teaching and learning, they were wary about using such tools for private communications;however, Zoom and Microsoft Teams, appeared to be in common use. The results confirm the need for a broader and more in-depth understanding of students' technology uses, needs, and desires. © 2022.

Practitioner Attitudes towards an Early Warning System : From Professional Distraction to Relational Support

As the general population ages and life expectancy increases in the United States, demand for virtual health care is on the rise. Undoubtedly, the next several decades will see increases in automated patient care and use of data-driven warning systems, trends which have already accelerated in the wake of Covid-19. Thus, understanding how traditionally trained healthcare practitioners respond to predictive analytics, like early warning systems, is vital for their successful implementation in the future. © 2021 IEEE.

Comparison of baseline characteristics, treatment and clinical outcomes of critically ill COVID-19 patients admitted in the first and second waves in Australia

Objective: To report longitudinal differences in baseline characteristics, treatment, and outcomes in patients with coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) between the first and second waves of COVID-19 in Australia. Design, setting and participants: SPRINT-SARI Australia is a multicentre, inception cohort study enrolling adult patients with COVID-19 admitted to participating ICUs. The first wave of COVID-19 was from 27 February to 30 June 2020, and the second wave was from 1 July to 22 October 2020. Results: A total of 461 patients were recruited in 53 ICUs across Australia;a higher number were admitted to the ICU during the second wave compared with the first: 255 (55.3%) versus 206 (44.7%). Patients admitted to the ICU in the second wave were younger (58.0 v 64.0 years;P = 0.001) and less commonly male (68.9% v 60.0%;P = 0.045), although Acute Physiology and Chronic Health Evaluation (APACHE) II scores were similar (14 v 14;P = 0.998). High flow oxygen use (75.2% v 43.4%;P < 0.001) and non-invasive ventilation (16.5% v 7.1%;P = 0.002) were more common in the second wave, as was steroid use (95.0% v 30.3%;P < 0.001). ICU length of stay was shorter (6.0 v 8.4 days;P = 0.003). In-hospital mortality was similar (12.2% v 14.6%;P = 0.452), but observed mortality decreased over time and patients were more likely to be discharged alive earlier in their ICU admission (hazard ratio, 1.43;95% CI, 1.13–1.79;P = 0.002). Conclusion: During the second wave of COVID-19 in Australia, ICU length of stay and observed mortality decreased over time. Multiple factors were associated with this, including changes in clinical management, the adoption of new evidence-based treatments, and changes in patient demographic characteristics but not illness severity. © 2021, College of Intensive Care Medicine. All rights reserved.

Building Adaptive Capacity Through Civic Environmental Stewardship: Responding to COVID-19 Alongside Compounding and Concurrent Crises

A growing body of community resilience literature emphasizes the importance of social resources in preparing for and responding to disturbances. In particular, scholars have noted that community based organizations and strong social networks positively contribute to adaptive capacity, or the ability to adjust and respond to change while enhancing the conditions necessary to withstand future events. While it is well established that strong civic engagement and social networks contribute to enhanced adaptive capacity in times of change, there is more to learn about how adaptive capacity at the civic group and network level is impacted temporally by multiple and compounding crises. Research has shown that the ability for communities to adapt and respond to crisis is closely tied to longer term recovery. In the midst of the COVID-19 pandemic, which has overlapped and intersected with multiple additional climate crises as well as a reigniting of the ongoing American reckoning with racial injustice, the ability for communities to adapt and respond to compounding crises seems more crucial than ever. This paper uses qualitative data from semi-structured interviews with 34 civic environmental stewardship groups in New York City to explore their role in building adaptive capacity. In order to better understand how past crises have impacted stewardship groups' response to COVID-19, we focus on how groups have demonstrated flexibility and learning at an organizational scale. We look at two other crises, both acute (Superstorm Sandy, which hit the East Coast in 2012) and chronic (systemic racism) to identify instances of learning that lead to organizational transformation. We further aim to understand how group professionalization, measured by budget and staff size, and network connectivity impact their actions. By comparing the groups' experiences and responses to each event, we uncover strategies learned from past events (e.g., sharing contact lists, holding internal dialogues, leveraging new funding sources) that enable stewardship groups to respond to disaster in a way that builds their organizational adaptive capacity as well as contributes to the long-term resilience of their communities.

A pilot trial applying 18-sessions of repetitive transcranial magnetic stimulation to the dorsolateral prefrontal cortex of participants undergoing acute medically-managed withdrawal from opioids over three-days

Opioid Use Disorder (OUD) is an impactful condition with only moderately effective treatments available and relapse especially common early in treatment. This project determined the feasibility of delivering an accelerated course of repetitive transcranial magnetic stimulation (rTMS) to participants with OUD during medically managed withdrawal. If feasible, delivering rTMS at this early stage of treatment may improve outcomes. Participants included those with moderate or severe OUD who were undergoing medically-managed withdrawal using either buprenorphine or methadone. During the taper, eighteen-sessions of rTMS were applied over three days (6-sessions/day separated by 30-minutes, 10Hz, figure-of-eight-coil, EEG coordinate F3, 3000 pulses each, 120% rMT, delivered during opioid image presentation). The first participant underwent open-label study-treatment, while the final six were treated in a double-blind sham-controlled fashion. The primary outcome measures included provoked craving following a standardized cue paradigm, as well as subjective pain measures. Four participants received active stimulation, three of which (27F, 27M, 31F) completed treatment at 120%rMT, and one (27M) withdrew due to symptoms of opioid withdrawal. Three participants received sham stimulation (30F, 27M, 51M) two of which completed treatment at 120%rMT and one other completing treatment at 100% rMT. The blind was effective and only one headache occurred as an adverse event. No statistics were run due to the small sample size, however the participants who received active stimulation reported that composite craving (want, resist, crave opioids) dropped numerically more in the active-group (mean decrease 10.3±8.1) then in the sham-group (mean decrease 7.0±4.6) following a standard opioid cue paradigm. Clinical pain was low at baseline and changed minimally following the intervention. No firm conclusions can be drawn from this pilot trial, which was stopped early due to the COVID19 pandemic, however accelerated treatment with rTMS appears to be well tolerated by those undergoing medically managed withdrawal. Keywords: opioid, craving, clinical trial, rTMS

O18.5 Comparison of Intimate Partner Violence prior to and during the COVID-19 pandemic: Findings from the I-SHARE cross-sectional multi-country study

BackgroundShelter-in-place and related COVID-19 physical distancing measures may influence the risk of intimate partner violence (IPV). The current study aims to (1) describe perceived changes in IPV experienced during and prior to the COVID-19 outbreak, (2) identify social correlates of IPV.MethodsThe International Sexual Health and REproductive Health (I-SHARE) study collected data on sexual and reproductive health during the COVID-19 pandemic (10,717 respondents in 16 countries between July 26thand December 1st 2020). The sample comprises participants in 7 HICs, 5 UMICs, 2 LMICs, and 2 LICs: 6,643 (62.3%) participants identified as women, 3,650 (34.2%) as men, and 178 (1.7%) as another gender. The median age was 30 (IQR 24;39). Adults (≥18yrs) were recruited online (social media, panel, or population-representative). IPV was a primary outcome measured using an adapted six-item version of the WHO IPV scale. Mixed effects modelling was used to assess participants’ experience of IPV in the three months prior to, and during, the COVID-19 physical distancing measures;participants were also asked about informal and formal reporting of IPV.ResultsPreliminary analysis indicated that 1,864 (17.4%) of the 10,717 participants reported experiencing at least one form of IPV before the introduction of COVID-19 control measures;1,346 (12.6%) participants reported IPV during COVID-19 physical distancing measures. Among participants experiencing IPV when physical distancing measures were in place, 691 (37.1%) told either a friend, the police, social services or other organization. Participants with a reduction in household income during the COVID-19 measures (aOR 1.48, 95% CI 1.29–1.69) and increased consumption of alcohol during COVID-19 (aOR 1.51, 95% CI 1.26–1.81) had higher odds of experiencing IPV.ConclusionIPV may have decreased during COVID-19 measures, but remained common overall. Structural interventions are necessary to mitigate the impact of IPV.

COVID-19 pandemic: Architecture librarians respond

Librarianship is a resourceful profession, but COVID-19 created new challenges for everyone, especially those working in public service with architecture students and faculty. Unlike in STEM disciplines, many architectural materials remain print-based, which impacted the quick change faculty needed to make to online teaching and classroom instruction. It impeded timely reference by even seasoned librarians and student access to necessary resources to complete their assignments. With libraries closed, librarians innovated and soldiered on, ordering new and different resources, applying new methods, learning new tools, and taking advantage of new vendor access models. This article documents the initial impact of COVID-19 on architecture libraries and librarians, supplemented by survey input from architecture librarians and faculty, and suggests strategies for navigating an uncertain future. © 2021 by The Art Libraries Society of North America. All rights reserved.

The impact of a bedside medication scanning deviceon administration errors in the hospital setting: AProspective observational study

Introduction: The medication administration process iscomplex and influenced by interruptions, multi-tasking andresponding to patient's needs and is consequently prone toerrors.1 Over half (54.4%) of the 237 million medicationerrors estimated to have occurred in England each year werefound to have taken place at the administration stage and7.6% were associated with moderate or severe harm. The implementation of a Closed Loop Medication Administrationsolution aims to reduce medication administration errorsand prevent patient harm.Aim: We conducted the first evaluation to assess the impact of a novel optical medication scanning device, MedEye,on the rate of medication administration errors in solid oraldosage forms.Methods: We performed a before and after study on oneward at a tertiary-care teaching hospital that used a commercial electronic prescribing and medication administrationsystem and was implementing MedEye (a bedside tool forstopping and preventing medication administration errors).Pre-MedEye data collection occurred between Aug-Nov2019 and post-MedEye data collection occurred betweenFeb-Mar 2020. We conducted direct observations of nursingdrug administration rounds before and after the MedEyeimplementation. Observers recorded what they observedbeing administered (e.g., drug name, form, strength andquantity) and compared this to what was prescribed. Errorswere classified as either a 'timing' error, 'omission' error or'other' error. We calculated the rate and type of medicationadministration errors (MAEs) before and after the MedEyeimplementation. A sample size calculation suggested thatapproximately 10,000 medication administrations wereneeded. Data collection was reduced due to the COVID 19pandemic and implementation delays.Results: Trained pharmacists or nurses observed a total of1,069 administrations of solid oral dosage forms before and432 after the MedEye intervention was implemented. Thepercentage of MAEs pre-MedEye (69.1%) and post-MedEye(69.9%) remained almost the same. Non-timing errors(combination of 'omission' + 'other' errors) reduced from 51(4.77%) to 11 (2.55%), which had borderline significance(p=0.05) however after adjusting for confounders, significance was lost. We also saw a non-significant reduction in'other' error types (e.g., dose and documentation errors) following the implementation of MedEye from 34 (3.2%) to 7(1.62%). An observer witnessed a nurse dispense the wrongmedication (prednisolone) instead of the intended medication(furosemide) in the post-MedEye period. After receiving a notification from MedEye that an unexpected medication hadbeen dispensed, the nurse corrected the dose thus preventingan error. We also identified one instance where the nurse correctly dispensed a prescribed medication (amlodipine) butthis was mistakenly identified by the MedEye scanner as another prescribed medication (metoclopramide).Conclusions: This is the first evaluation of a novel opticalmedication scanning device, MedEye on the rate of MAEs inone of the largest NHS trusts in England. We found a nonstatistically significant reduction in non-timing error rates.This was notable because incidents within this category e.g.,dose errors, are more likely to be associated with harm compared to timing errors.2 However, further research is neededto investigate the impact of MedEye on a larger sample sizeand range of medications.

The OARSI “joint effort initiative” repository of online osteoarthritis management programmes: an implementation rapid response during covid-19

Purpose: 1) To collate into a repository, best-evidence online osteoarthritis management programmes (OAMPS), and 2) facilitate their implementation, in the context of the COVID-19 pandemic.The Osteoarthritis Research Society International Joint Effort Initiative (OARSI JEI) is a collaboration between international researchers, clinicians and knowledge brokers with an interest in the implementation of OAMPS. OAMPs are defined by the OARSI JEI as “models of evidence-based, non-surgical care that have been implemented in a real world setting and include the following four components: personalised OA care;delivered as a package of care with longitudinal reassessment and progression;comprising two or more elements of the core non-surgical, non-pharmacological interventions (education, exercise and weight loss);with optional adjunct treatments as required (e.g. assistive devices and psychosocial support)”. In 2020, COVID-19 presented a major barrier to the clinical delivery of traditional “in-person” OAMPS. In response, the OARSI JEI implementation group sought to create a repository resource for healthcare professionals (HCPs) seeking to access and signpost patients with OA to online, high-quality OAMPS. The resource also provided access to online HCP training. Methods: An existing community of practice (OARSI JEI implementation group) with access to patient and public involvement, was utilised to create and share an evidence-informed online OAMP repository via social media and OARSI networks. The project involved 5 key stages. Online OAMPS resource investigation: International research, implementation and HCP experts from the JEI implementation group (n=32) were invited to send all online OAMP resources that they were aware of to the reviewers (LS, JQ). These were captured in a spreadsheet with data extracted on programme name;country of origin;whether the resource targeted patients or HCPs;access details relating to required technology, sign in and any access costs;weblink;brief programme content summary;OARSI expert advocating for the programme quality (including whether the content is evidence informed). Screening for repository inclusion: Two reviewers (JQ, LS) screened the resources received against inclusion criteria (matching the OAMP definition, remotely deliverable via the internet, OARSI expert endorsed). Disagreements were resolved through discussion. Creating the online OA repository resource: Academics (JQ, LS, KD) provided content and feedback for a knowledge broker (LC) to create a pdf repository containing included online OAMP information, weblinks and summary information in the form of an infographic. Rapid social media knowledge mobilisation: The repository resource was initially hosted on the Keele Impact Accelerator Unit website and shared on completion with existing OARSI member JEI networks via social media (Twitter)(LC). Owners of online OAMPS also promoted their own programmes via social media. Reflection and learning: Project method strengths and limitations were discussed, critiqued and captured during an OARSI JEI community of practice meeting. Results: The final OARSI online repository included 7 OAMPS and linked training resources. The online repository is available at: with ongoing plans for hosting on the OARSI website. Fig. 1 illustrates the repository cover and Fig. 2 is the infographic repository summary. A relative dearth of online OAMPS meeting our prespecified criteria were identified which included: ESCAPE pain;The Joint Academy;JIGSAW-E (for pharmacists and physiotherapists);PEAK: Join2Move;Osteoarthritis Management Healthy Weight for life. Only JIGSAW-E, PEAK and the Join2Move app were widely available free resources for HCPs at the early stage of the COVID-19 pandemic. All online OAMPs were in English except the Join2Move app which is in Dutch. Content details of the included online OAMPs and online OAMP HCP training packages are summarised in Table 1. The initial Twitter launch tweet sharing the repository infographic and repository link has had 5,679 impre sions and 334 engagements to date and has been shared globally. Reflections and limitations: There is an urgent requirement for more high-quality OAMPs to be freely available for remote delivery and in a wider range of languages. This has relevance both during the COVID pandemic and more generally for rural, geographically isolated populations and low- and middle-income countries. In reacting to an emergency, rapidly evolving, time-pressured clinical pandemic context, there was a tension in matching the highest quality methods for searching, evaluating and synthesising online OAMPs in the shortest possible time. For example, full systematic review methods were deemed inappropriate and the project was not explicitly informed a-priori by a protocol or knowledge mobilisation theory, however, members of the team had knowledge mobilisation expertise. It is possible that we did not identify all online OAMPs. For example, no online OAMPS from South America, Africa or Asia were identified which may, in part, be explained by the geographical representation within the community of practice, with participants mostly from Europe, North America and Australasia. It is acknowledged that the pragmatic and rapid OAMP resource identification, screening and knowledge mobilisation from this project does not guarantee implementation into clinical practice. The existence of the OARSI JEI implementation group facilitated the timely execution of this project whilst the use of social media allowed the repository to be shared rapidly with many stakeholders. Future plans include the hosting of the repository and future JEI work on the OARSI website (to increase resource access);the formal synthesis of knowledge mobilisation metrics relating to the online repository and included OAMPS, and;the ongoing review of repository content in the light of new OAMPS. Conclusions: The OARSI-endorsed JEI implementation group facilitated the creation of an online OAMP repository in response to the COVID-19 pandemic and need for remotely delivered care. There is a dearth of widely available and remotely deliverable OAMPs internationally. This is likely to present a significant barrier to the delivery of best OA care, especially during COVID-19. OARSI can have a key role in supporting the implementation of best OA care. There is a need to actively broaden the diversity and national representation within the JEI implementation group and increase patient and public involvement to best serve the international OA populations, particularly from low- and middle-income countries, it seeks to inform. [Formula presented] [Formula presented] [Formula presented]