Rethinking the Work of Theologians in the Pandemic's Wake

This article focuses on what the pandemic reveals about theological work in the academy and imagines a way forward. Too often, theologians are ground down, isolated workers, overworked, and strapped for time. They constantly must choose between progress in the guild and their familial and communal relationships. This false choice starves theologians of meaning and purpose, and, in such scarcity, inflames pursuit of status. However, a communal conception of theological academic work could mitigate some of these frictions. To imagine this possibility, we draw upon our collective experiences of working in Benedictine institutions that also argue for communal approaches to living, learning, and experiencing God. We draw ideas from the Rule of Benedict as a model for life-giving community that we think can be resituated in academic life.

Early infection risk in patients with systemic lupus erythematosus treated with rituximab or belimumab from the British Isles Lupus Assessment Group Biologics Register (BILAG-BR): a prospective longitudinal study

Background: Patients with systemic lupus erythematosus (SLE) are at an increased risk of infection relative to the general population. We aimed to describe the frequency and risk factors for serious infections in patients with moderate-to-severe SLE treated with rituximab, belimumab, and standard of care therapies in a large national observational cohort. Method(s): The British Isles Lupus Assessment Group Biologics Register (BILAG-BR) is a UK-based prospective register of patients with SLE. Patients were recruited by their treating physician as part of their scheduled care from 64 centres across the UK by use of a standardised case report form. Inclusion criteria for the BILAG-BR included age older than 5 years, ability to provide informed consent, a diagnosis of SLE, and starting a new biological therapy within the last 12 months or a new standard of care drug within the last month. The primary outcome for this study was the rate of serious infections within the first 12 months of therapy. Serious infections were defined as those requiring intravenous antibiotic treatment, hospital admission, or resulting in morbidity or death. Infection and mortality data were collected from study centres and further mortality data were collected from the UK Office for National Statistics. The relationship between serious infection and drug type was analysed using a multiple-failure Cox proportional hazards model. Finding(s): Between July 1, 2010, and Feb 23, 2021, 1383 individuals were recruited to the BILAG-BR. 335 patients were excluded from this analysis. The remaining 1048 participants contributed 1002.7 person-years of follow-up and included 746 (71%) participants on rituximab, 119 (11%) participants on belimumab, and 183 (17%) participants on standard of care. The median age of the cohort was 39 years (IQR 30-50), 942 (90%) of 1048 patients were women and 106 (10%) were men. Of the patients with available ethnicity data, 514 (56%) of 911 were White, 169 (19%) were Asian, 161 (18%) were Black, and 67 (7%) were of multiple-mixed or other ethnic backgrounds. 118 serious infections occurred in 76 individuals during the 12-month study period, which included 92 serious infections in 58 individuals on rituximab, eight serious infections in five individuals receiving belimumab, and 18 serious infections in 13 individuals on standard of care. The overall crude incidence rate of serious infection was 117.7 (95% CI 98.3-141.0) per 1000 person-years. Compared with standard of care, the serious infection risk was similar in the rituximab (adjusted hazard ratio [HR] 1.68 [0.60-4.68]) and belimumab groups (1.01 [0.21-4.80]). Across the whole cohort in multivariate analysis, serious infection risk was associated with prednisolone dose (>10 mg;2.38 [95%CI 1.47-3.84]), hypogammaglobulinaemia (<6 g/L;2.16 [1.38-3.37]), and multimorbidity (1.45 [1.17-1.80]). Additional concomitant immunosuppressive use appeared to be associated with a reduced risk (0.60 [0.41-0.90]). We found no significant safety signals regarding atypical infections. Six infection-related deaths occurred at a median of 121 days (IQR 60-151) days from cohort entry. Interpretation(s): In patients with moderate-to-severe SLE, rituximab, belimumab, and standard immunosuppressive therapy have similar serious infection risks. Key risk factors for serious infections included multimorbidity, hypogammaglobulinaemia, and increased glucocorticoid doses. When considering the risk of serious infection, we propose that immunosupppressives, rituximab, and belimumab should be prioritised as mainstay therapies to optimise SLE management and support proactive minimisation of glucocorticoid use. Funding(s): None.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Resilience as a predictor for why some marital relationships flourished and others struggled during the initial months of COVID-19

Using the theory of resilience and relational load, this study examined how married individuals' baseline communal orientation (CO) and relational load (RL) at the beginning of the pandemic predicted their stress, conflict, mental health, and flourishing during quarantine. Using a Qualtrics Panel, married individuals (N = 3,601) completed four online surveys from April to June 2020. Results revealed the initial levels of CO brought to quarantine predicted less stress and conflict, and better mental health and flourishing at baseline, and these outcomes remained relatively stable across the next 3 months. RL at baseline did the exact opposite for these outcomes, making coping more difficult. We also hypothesized CO and RL moderate the impact of stress (T1) on mental health 3 months later by reducing conflict. Rather than serving as buffers, CO and RL at baseline directly affected conflict (T2/T3) and mental health (T4) throughout quarantine.

Telerehabilitation Implementation: Perspectives from Physiotherapists Working in Complex Care

Purpose:The COVID-19 pandemic resulted in a rapid change in ways clinicians deliver physiotherapy services, leading to an important uprise in telerehabilitation implementation. Sharing the experiences of physiotherapists in clinically adopting this technology during this initial wave of the pandemic can influence future implementation. This mixed-method study aimed to identify the barriers and new facilitators of telerehabilitation clinical implementation. Methods:Canadian physiotherapists with and without telerehabilitation experience, working in various clinical settings, were recruited during the first wave of the COVID-19 pandemic. Participants completed the Assessing Determinants of Prospective Uptake of Virtual Reality instrument (ADOPT-VR) adapted for telerehabilitation and participated in online focus groups to explore their experiences with telerehabilitation implementation. Demographic data and ADOPT-VR responses were analyzed descriptively. Qualitative data were analyzed using content analysis. Results:Sixteen physiotherapists completed the study. Scores on the Likert scale showed that physiotherapists enjoyed telerehabilitation (7.5/10) and perceived it as being useful (7.3/10). Physiotherapists disagreed with the necessity to use only minimal mental efforts (4.4/10) and feeling familiar with the evidence (4.7/10). Limited access to telerehabilitation implementation evidence, a reduced hands-on approach, and a lack of validated remote assessments were reported as barriers. Discussion:Clinical practice guidelines, validated remote neurological assessments, changes in physiotherapy curriculum and policymaking are critical to improving telerehabilitation implementation within physiotherapy practices. Conclusion:Participants positively experienced the quick use of telerehabilitation from the beginning of the COVID-19 pandemic, but some important barriers remain.

Politicising pandemics: Evidence from US media coverage of the World Health Organisation

During the COVID-19 pandemic, the World Health Organisation (WHO) was politicised in the United States (US) by Donald Trump in an effort to deflect blame as the virus spread. In this paper, we empirically investigate media coverage of the WHO in the US to better understand how negative evaluations of international organisations (IOs) spread. To do so, we perform quantitative text analysis on an original corpus of over 11,000 news articles on the WHO from the New York Times and the Washington Post between 1980 and 2020. Our text-as-data analyses yield several noteworthy findings. First, we show that media coverage of the WHO in the US has become more negative over time. Second, we show that negativity increases during global health crises. Third, we provide evidence that explicit criticisms also increase during crises. Fourth, we show that "blame-shifting” by Trump and allies was clearly observable in the US news media. Finally, we show that negative stories about the WHO are shared more than positive ones on social media. Our results provide unique evidence, suggesting that the WHO has become more politicised in the US, which we argue creates opportunities for politicians seeking to blame IOs during crises. © 2023 The Authors. Global Policy published by Durham University and John Wiley & Sons Ltd.

Prospective cohort study of adults hospitalised with acute COPD exacerbations: SARS-CoV-2-associated patient characteristics and clinical outcomes

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common and associated with respiratory function decline, increased morbidity and mortality. It is unclear how COVID19 has impacted AECOPD phenotype and if it is associated with worse outcomes compared to other infections in COPD patients. Aim(s): To explore changes in AECOPD clinical characteristics and outcomes during the COVID-19 pandemic. Method(s): A prospective cohort study of all adults >=18y admitted to either acute care hospital in Bristol UK, Aug 20- Jul 21. Patients presenting with signs/symptoms or a clinical/radiological diagnosis of acute respiratory disease were included. Result(s): 2557 hospitalisations with AECOPD were recorded (incidence 361 per 100000);13% had SARS-CoV-2 identified, 69% had another pathogen and 18% had no infectious aetiology identified. Patient characteristics and clinical features were similar for patients with and without COVID19. ICU admissions were more common with SARS-CoV-2 than other infections (4% v 1%, P<0.001). SARS-CoV-2 associated AECOPD had greater inpatient (25% v 9%, P<0.001) and 30-day mortality (25% v 12%, P<0.001) than AECOPD associated with other infections. Among all AECOPD patients who had received >=1 dose of any COVID vaccination, ICU admission rates were lower than for unvaccinated persons (4% v 0%, P<0.01). Discussion(s): SARS-CoV-2 infection was associated with worse outcomes among persons hospitalized with AECOPD. SARS-CoV-2 vaccination was effective in reducing disease severity and ICU admission. More data are needed about the effectiveness of COVID19 vaccines for modifying disease severity in COPD patients.

S38 Omicron (B.1.1.529) SARS-CoV-2 infection results in less severe disease than infection with Delta (B.1.1.617.2) variant among hospitalised adults: a prospective cohort study

S38 Figure 1ConclusionsOmicron infection was associated with less severe illness compared to Delta infection across three separate measures of severity. COVID-19 vaccination was independently associated with lower in-hospital disease severity, regardless of variant. Lower severity of Omicron combined with the ability of vaccine to further reduce severity may result in reduced pressure on healthcare services;however, the increased transmissibility of Omicron and potential for higher numbers of infections, particularly in elderly patients, may mitigate these benefits.Please refer to page A208 for declarations of interest related to this .

S41 Incidence of SARS-CoV-2 and non-SARS-CoV-2-associated community acquired lower respiratory tract infections in Bristol, UK: a prospective cohort study

S41 Figure 1ConclusionsWhile SARS-CoV-2 infection was a large component of hospitalised aLRTD, non-SARS-CoV-2 infection caused 56% of respiratory infection hospitalisations overall. Measured incidences of non-SARS-CoV-2 pneumonia and NP-LRTI were higher than pre-pandemic UK estimates. Given public health interventions to reduce all infective aLRTD implemented during this year, these higher estimates likely reflect highly comprehensive surveillance although there may have been a true higher non-SARS-CoV-2 disease incidence. These results demonstrate the significant burden of acute respiratory infection on healthcare systems. Broader efforts to prevent and manage all forms of adult aLRTD should be prioritized in addition to current COVID-19 prevention efforts.Please refer to page A209 for declarations of interest related to this .

Acute Lower Respiratory Tract Disease (aLRTD)is a complex clinical syndrome causing significant disease burden in a prospective cohort study

Background: Acute Lower Respiratory Tract Disease (aLRTD) includes pneumonia, non-pneumonic lower respiratory tract infection (NP-LRTI), heart failure (HF) and chronic respiratory disease exacerbation (CRDE). COVID19 has affected aLRTD disease burden. Few studies estimate total aLRTD burden, and subgroup distribution may have changed. Aim(s): To describe the frequency of individual aLRTD components and determine the impact of COVID19 on aLRTD disease. Method(s): A prospective cohort study of all adults >=18y admitted to either acute care hospital in Bristol, UK, from Aug 20-Jul 21. Patients were included if presenting with signs/symptoms or a clinical/radiological diagnosis of aLRTD. Result(s): 9243 aLRTD hospitalisations occurred: 5161 pneumonia, 2636 NP-LRTI, 1990 HF, 4144 CRDE, and 198 undifferentiated aLRTD cases. Overlap was common (Fig1): 31% HF and 83% CRDE events occurred in association with pneumonia or NP-LRTI. Hospitalisation rates corresponded with COVID-19 incidence over time. 41% hospitalisations were associated with positive SARS-CoV-2 test. Non-COVID19 aLRTD hospitalisations showed less variation over time. Discussion(s): aLRTD is a complex matrix with significant overlap between CRDE, HF and pneumonia/NP-LRTI. COVID19 disease in hospitalised adults was a large component of total aLRTD during this pandemic year;however, non-COVID19 aLRTD caused considerable disease burden.

Imprinted repertoire restriction in immunodeficiency

Background: Impaired generation of antibody responses define 'predominantly antibody immuno-deficiencies' (PAD) with reduced IgG and impaired vaccination responses. However, the antibody repertoire defects underpinning PAD are unknown. Here, we examine the antibody repertoire using mass spectrometry-based proteomics (MS-proteomics) in PAD and healthy controls (HC). Method(s): Following SARS-CoV-2 vaccination, anti -S1 ELISA, and live-virus neutralisation assays were assessed. Purified anti-S1 IgG and IgM was sequenced by MS-Proteomics to define immunoglobulin heavy chain variable region subfamily (IGHVsf) usage and somatic hypermutation (SHM). Result(s): 12 vaccine responsive PAD subjects were included, matched to 11 HC. Neutralisation and anti-S1 titres were reduced in PAD. Strikingly, all PAD subjects demonstrated restricted IgG IGHVsf utilisation, [median 3, (range 2-4), vs 6 (5-11) in HC, p<0.001], irrespective neutralisation or total antibody response. IgG SHM and IgM repertoire did not differ but IgG IGHV 3-7 utilisation was less frequent in PAD. Conclusion(s): MS proteomics uncovers stereotyped anti-S1 IgG IGHVsf restriction in PAD subjects following vaccination. Our results suggest that a relatively pauci-clonal antibody repertoire can produce a functional immune response, otherwise masked by traditional serology measures. Further studies to uncover the determinants of antibody repertoire breadth and elaborate on this novel approach to assessing serological responses are required. Copyright © 2022

Communicating About Mental Health During a Pandemic: An Examination of Active and Aware Publics on Twitter

With the arrival of COVID-19, several U.S. states enacted stay-at-home orders to mitigate spread, but the isolation of quarantine and the uncertainty surrounding the virus were likely to have a detrimental influence on mental health. This study investigates how people discussed COVID-19 in relation to mental health on Twitter. Using Crimson Hexagon, this research examines tweets (N = 2,199,625) for three months following the first confirmed case of COVID-19 in the United States and includes a quantitative analysis of the public's concern about the disease as well as a qualitative thematic analysis of conversations on the topic (n = 800). Results indicate that those who discuss mental health online behave as an active and aware public that recognizes how mental health can be affected during a health crisis. The quantitative analysis shows that when cases of the disease increased, mentions of depression, post-traumatic stress disorder, and psychologists also increased. Additionally, as deaths related to the disease increased, so did mentions of psychologists. Qualitative statistics indicate that this public makes a concerted effort to provide social support and solidarity for others. © 2023 (Jesse King, Audrey Halversen, Olivia Morrow, Whitney Westhoff, and Pamela Brubaker). Licensed under the Creative Commons Attribution Non-commercial No Derivatives (by-nc-nd). Available at http://ijoc.org.

Usage of Regular Safety Surveys to Assess and Improve Safety Culture in the Radiation Treatment Department

Aim: The Radiation Treatment Quality Assurance Committee (RTQAC) is a multidisciplinary committee within the Radiation Treatment department. As a newly established committee in 2013, the RTQAC had a desire to obtain feedback from staff and to evaluate the existing safety culture. Safety culture surveys have been continued with the aim to assess and improve the safety culture within our department. Process: The RTQAC has since completed six safety culture surveys. The surveys have ranged from 9-15 questions in length with the most recent one sent in 2021. Some questions were edited or modified with each survey as the committee saw fit. The surveys were sent to all current staff across various disciplines in the Radiation Treatment department. Themes have emerged over the years as with some general categories, including: Reporting Program, Barriers to Reporting, Communication and Discussion of Incidents and Suggestions for Improving Quality and Safety. Results are collected and analyzed in comparison with previous results and are shared with the department in a summarizing report. Benefits/Challenges: Regular collection of safety culture survey results have highlighted successes within the department and the RTQAC. It has provided staff an opportunity to talk openly and anonymously about safety concerns. Themes emerging from results have provided content for group discussion and review of potential areas of improvement. Opportunities for education in the department have been highlighted. The results have also allowed the RTQAC to reflect on the scope of the committee tasks. One consistent challenge faced has been the low number of respondents, which limits creation of conclusions and potential suggestions or recommendations. There can also be a great deal of time associated with reviewing a large number of comments. The committee takes all comments seriously and some negative comments can be difficult to read. Impact/Outcomes: The implementation of safety culture surveys in our department has proven invaluable. It has allowed the committee to obtain current opinions about safety culture and incident learning processes given that these are dynamic and changing over time. Trends, both positive and negative, have been observed over the last 8 years. Safety culture is something that has to be constantly evolving as it can change with various staff and external challenges such as COVID-19. Copyright © 2022

Unravelling psychiatric heterogeneity and predicting suicide attempts in women with trauma-related dissociation using artificial intelligence

Background: Suicide is a leading cause of death, and rates of attempted suicide have increased during the COVID-19 pandemic. The under-diagnosed psychiatric phenotype of dissociation is associated with elevated suicidal self-injury;however, it has largely been left out of attempts to predict and prevent suicide. Objective: We designed an artificial intelligence approach to identify dissociative patients and predict prior suicide attempts in an unbiased, data-driven manner. Method: Participants were 30 controls and 93 treatment-seeking female patients with posttraumatic stress disorder (PTSD) and various levels of dissociation, including some with the PTSD dissociative subtype and some with dissociative identity disorder (DID). Results: Unsupervised learning models identified patients along a spectrum of dissociation. Moreover, supervised learning models accurately predicted prior suicide attempts with an score up to 0.83. DID had the highest risk of prior suicide attempts, and distinct subtypes of dissociation predicted suicide attempts in PTSD and DID. Conclusions: These findings expand our understanding of the dissociative phenotype and underscore the urgent need to assess for dissociation to identify individuals at high-risk of suicidal self-injury.

Usage of Regular Safety Surveys to Evaluate and Strengthen Safety Culture in the Radiation Treatment Department

Purpose: The Radiation Treatment Quality Assurance Committee (RTQAC) is a multidisciplinary committee within the Radiation Treatment department. As a newly established committee in 2013, the RTQAC had a desire to obtain feedback from staff and to evaluate the existing safety culture. This practice has continued in subsequent years, with six surveys conducted over an 8-year period. The purpose of the safety culture surveys is to measure staff comfort with reporting incidents and the informationgathering process which follow an incident, to gather staff feedback on ways to improve the quality of treatment delivery, to measure and assess the current state of the safety culture in the department, and to identify themes from the results to drive quality improvement initiatives. Material(s) and Method(s): The safety culture surveys are developed in an electronic format and have been sent to all staff across various disciplines in the Radiation Treatment department, including radiation oncologists, medical physicists, physics associates, electronics engineers, radiation therapists, nurses, and clerical staff. The most recent survey was conducted in 2021. The surveys have ranged from nine to fifteen questions in length. Many of the questions have remained the same across the years, while some have been modified with each survey as seen fit by the committee. Responses are collected in both a multiple-choice format as well as written responses. Responses collected from each survey are analyzed, and when possible, compared against similar questions asked in previous years. The results are compiled into a report which is shared with the department. Result(s): Safety culture is something that is dynamic, as it can change with the implementation of new procedures, updates to incident reporting systems, changes in staffing, and external challenges such as COVID-19. Regular collection of safety culture survey results have highlighted both successes and areas of improvement within the department and the RTQAC. While in many areas, trends are positive, those areas which illustrate progressively negative responses have identified common issues which can be addressed. Feedback that has been collected has subsequently helped guide quality improvement initiatives. Conclusion(s): The implementation of safety culture surveys in our department has proven invaluable. It has provided staff an opportunity to talk openly and anonymously about safety concerns. Through assessment of responses, quality improvement strategies can be undertaken, which in turn can advance the culture of safety in the program. Copyright © 2022 Elsevier Ireland Ltd. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Assessing research collaboration networks and social media use among venous thromboembolism researchers during the COVID-19 pandemic

Background: The ways in which research collaborations are formed and strengthened have evolved during the COVID-19 pandemic due to restrictions limiting in-person meetings. Given the need to rapidly adapt to online communication, and to accelerate COVID-19 venous thromboembolism (VTE) research, social media has played an important role in all aspects of these interactions. Aim(s): (1) Assess the size and geographic breadth of VTE researchers' project collaborations before and during the early stages of the COVID-19 pandemic;(2) Characterize how social media platforms are used by VTE researchers. Method(s): An online survey about research collaborations and social media use was distributed in June 2020 to VTE researchers via Twitter, CanVECTOR (n = 59) and INVENT (n = 389) research network websites and email lists. Research collaboration data were analyzed using ego-centred social network analytic techniques to assess the size and composition of researchers' VTE-and COVID-related collaboration networks. Result(s): Over half of respondents (23/45, 51%) reported leading at least one collaborative VTE research project in the past 2 years, with 16 (36%) currently leading COVID-related VTE research. Eighteen (78%) respondents who led VTE research projects also contributed as a collaborator to VTE research projects over the past 2 years, with 17 (74%) contributing to COVID-related VTE research. Research in the VTE field is inter-institutional and international, but early COVID-related collaborations tended to be more local (Table 1). Social media platforms were used primarily by VTE researchers to collect and disseminate COVID-19 VTE research information. Conclusion(s): Research in the VTE field is inter-institutional and international, but early COVID-related VTE research collaborations tended to be more local. Social media platforms may be useful in strengthening international collaborations between VTE researchers with similar interests. (Table Presented).

Emergency Department Visit Rates by Selected Characteristics: United States, 2020.

In 2020, an estimated 131 million emergency department (ED) visits occurred in the United States, with 19.0% of adults reporting a visit and 4.7% of children reporting two or more visits in the past 12 months (1-3). In that time, over 20 million cases of COVID-19 caused a disruption in access to and use of care (4). This report presents characteristics of ED visits, including those with mentions of COVID-19, by age group, sex, race and ethnicity, and primary expected source of payment, using data from the 2020 National Hospital Ambulatory Medical Care Survey (NHAMCS)(5).

Contrapower harassment in paramedicine: Experiences of academic staff in Australian universities

Background: Although bullying and harassment among academic staff has been well researched, research on students bullying and harassing academic teaching staff (ie, contrapower harassment) is less common. Contrapower harassment has been on the rise in academia over the last decade, partly attributable to changes in the student– faculty staff relationship. This study aimed to understand better the extent and impact of students’ contrapower harassment on paramedic academic teaching staff within Australian universities, as well as actions and interventions to address it. Methods: This study used a two-phase mixed methods design. In phase 1, a convenience sample of paramedic teaching academics from 12 universities in Australia participated in an online questionnaire. In phase 2, an in-depth interview was conducted with nine participants from phase 1. Results: Seventy-six academic teaching staff participated in the study. Survey results showed that most academics surveyed had experienced harassment from paramedic students, with the highest incidence of harassment occurring during student assessment periods. Alarmingly, over 30% of the academics surveyed had been ‘stalked’ by a student and over 50% had felt powerless and helpless when students had attacked them on social media. Problematic students were identified as those who presented with an over-inflated sense of entitlement or with psychological states and traits that find it challenging to accept feedback and failure, and look to externalise their failures. Reasons for increases in contrapower harassment included a complex mix of consumer and demand-driven education, ondemand (and demanding) instant gratification and degree self-entitlement, and an increase in social media and online learning (particularly during the COVID-19 pandemic of 2020). Conclusion: Although most of the academics in this study experienced contrapower harassment by students, they also report that most students are level-headed and supportive, and do not carry out this type of harassment. Promoting student professionalism and reassessing student evaluations are starting points for addressing this type of harassment. Further research on the broader systemic issues that influence the contributors to contrapower harassment is needed.

Use of Dose-dense EC Chemotherapy in Early Breast Cancer – Experience from Two London Hospitals

Purpose: Dose-dense (dd) chemotherapy regimens reduce breast cancer recurrence and mortality with no significant increase in non-cancer related mortality [1]. However, uptake is poor, probably due to concerns regarding toxicity. We aimed to quantify rates of toxicity and dose reduction in patients receiving dd epirubicin and cyclophosphamide (EC), and to identify any associated patient factors. Methods: This was a retrospective and prospective study. Patients receiving neoadjuvant or adjuvant dd EC (epirubicin 90 mg/m2 and cyclophosphamide 600 mg/m2 2-weekly) between 2018 and 2021 at two London hospitals were identified from electronic records. Baseline ECOG performance status (PS), incidence of dose delay, dose reduction and hospital admission were identified from electronic records. Results: 108 patients received dd EC, 49 (45%) in the neoadjuvant and 59 (55%) in the adjuvant setting, receiving a total of 422 cycles. Median age was 47 years (25–69 years). 105 patients (95%) had a baseline PS of 0;the other 6 (5%) a PS of 1. 99 patients (92%) received 4 cycles of dd EC as planned, of which 84 (78%) had no dose reductions. 3 patients were converted to the standard regimen due to toxicity. 5 patients had cycles omitted due to toxicity (n = 2) or other causes. One patient died due to COVID-19. 16 patients (15%) had a dose reduction. Treatment was delayed by at least 1 week in 18 patients (17%). The most common reasons for this were haematological toxicity (n = 6) and infection (n = 4). 6 patients (6%) had both delays and dose reductions. 8 patients (7%) were admitted to hospital during treatment, 4 of whom had febrile neutropenia. Conclusion: This real world data demonstrate that dd chemotherapy can be delivered in routine practice. The rates of dose reduction and delay were comparable to those found in standard regimes [1]. Patient selection by oncologists is an important factor. Reference [1] Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials. Lancet 2019;393(10179):1440–52.