ABSTRACT
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
ABSTRACT
Background: Healthcare staff represent a high-risk group for mental health difficulties as a result of their role during the COVID-19 pandemic. A number of wellbeing initiatives have been implemented to support this population, but remain largely untested in terms of their impact on both the recipients and providers of supports. Objective: To examine the experience of staff support providers in delivering psychological initiatives to healthcare staff, as well as obtain feedback on their perceptions of the effectiveness of different forms of support. Method: A mixed methods design employing a quantitative survey and qualitative focus group methodologies. An opportunity sample of 84 psychological therapists providing psychological supports to Northern Ireland healthcare staff participated in an online survey. Fourteen providers took part in two focus groups. Results: The majority of providers rated a number of supports as useful (e.g. staff wellbeing helplines, Hospital In-reach) and found the role motivating and satisfying. Thematic analysis yielded five themes related to provision of support: (1) Learning as we go, applying and altering the response;(2) The ‘call to arms', identity and trauma in the collective response;(3) Finding the value;(4) The experience of the new role;and (5) Moving forward. Conclusions: While delivering supports was generally a positive experience for providers, adaptation to the demands of this role was dependent upon important factors (e.g. clinical experience) that need to be considered in the planning phase. Robust guidance should be developed that incorporates such findings to ensure effective evidence-based psychological supports are available for healthcare staff during and after the pandemic. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
ABSTRACT
Background: Understanding the burden of surgical site infection (SSI) requires comprehensive, reliable and comparable data. However, many hospitals do not routinely collect information on wound healing after the patient leaves hospital. Aim: To evaluate five post-discharge surveillance strategies that collect patient/carer reported outcomes on wound healing following adult and paediatric surgery. Method: Between March 2020 and February 2021, colleagues from five specialist hospitals in England collaborated to collect baseline and compliance data for the different methods of postdischarge surveillance. The five methods included were telephone follow-up;postal questionnaires;postal questionnaires and contacting non-responders by telephone to asking patients to install a postoperative app on their personal smartphone (Medopad, Huma) and using a SSI surveillance text link, which did not need to be installed (Isla, Islacare Ltd). Results: Overall, 1432 patients out of 2116 patients provided information about their wound after discharge. The group of patients who were asked to install an app on their smart device had the lowest return rate for information on their wound, while the system that used a text link and did not need to be installed had one of the highest return rates. Conclusion: Understanding baseline practice and evaluating different methods of discharge surveillance may help to drive improvement in this area. Our early findings suggest that in practice, a SSI surveillance approach using a text link and photos, such as Isla, which is used in hospital before discharge by staff and post-discharge by patients warrants further attention.
ABSTRACT
Introduction: The JDM working party has 140 active members. Since June 2019, they have been represented by a core group of 7 elected members (Chair: Liza McCann, UK;Secretary: Meredyth Wilkinson, UK;Past Chair: Helga Sanner, Norway;Representative for basic science: Judith Wienke, Netherlands;Representative for clinical care/clinical science: Charris Papadopoulou, UK;Representative for education/training (&EMERGE): Raquel Campanilho-Marques, Portugal) and 3 co-opted members (Allied Health Professional Representatives: Sara Röstlund, Sweden and Mette Nørgaard, Denmark;Parent representative, Joanne Swan, Scotland). Objectives: Our aim is to frame our work in line with the PReS pillars-clinical/research, basic science and education/training. We think that part of our role within the PReS Working Group is to help standardise care, facilitate multi-centre research projects and enhance educational opportunities. Methods: The core group meet via teleconference every 2 months with a set agenda incorporating each of the PReS pillars. An update was distributed to all working party members in February 2020, encouraging submission of ideas and/or collaboration on proposed projects. Results: The core group to date has:-Established and completed a survey to define opinion/use in practice of the SHARE JDM consensus guidelines (Enders FB et al, Ann Rheum Dis 2017). Results of this (n=46) submitted in abstract to PReS 2020;manuscript in preparation.-Clarified the role of databases/data sharing in JDM across Europe;PReS JDM Working Party and Euromyositis Position Statement available on PReS website.-Informed members of the EMERGE group of training opportunities/fellowships relating to JDM.-Produced a summary of research projects and educational resources, available on PReS website.-Collaborated with the International Myositis Assessment &Clinical Studies Group (IMACS), promoting shared working. Work currently in progress includes:-Collaborating in the extension of the JDM SHARE consensus for management of JDM in North America (IMACS project).-Research proposal on sleep in JDM-in development.-Training package/educational resource on myositis specific antibodies near completion;will be available in PReS website.-Proposal for a Policy Statement on management of JDM during Covid-19 with a particular focus on transition to adult services.-Survey of practice in JDM proposed;in early stages of development. Conclusion: The JDM PReS working party provides a platform for collaboration in JDM, incorporating clinical and research issues, basic science and education/training. Ideas and collaborations are welcomed and encouraged within an open membership structure. To join the group, e-mail: meredyth.wilkinson.14@ucl.ac.uk.