TALKING ABOUT LONELINESS: QUALITATIVE INSIGHTS FROM OLDER ADULTS: IMPLICATIONS FOR RESEARCH, POLICY, AND SERVICES

The very personal and complex nature of loneliness is too rarely articulated in research papers. Each presenter in this interdisciplinary and international symposium presents insights into loneliness and /or social isolation that can help bridge this gap. Victor (Social Gerontology) using open ended responses from the 2018 BBC Loneliness Experiment, presents how 1480 older people describe loneliness and highlights the need to give more attention to existential loneliness. O'Sullivan (Public Health) presents the results of 18 life story interviews with older adults attending a mental health service. The analysis identified three different typologies of loneliness with specific recommendations for training and services. Phone-based support programs are increasingly being used as a solution for those experiencing loneliness. However, less is known about what aspects are most helpful. Perissinotto (Geriatrics and Palliative care) presents results from 38 qualitative interviews with a focus on barriers and facilitators to implementing a phone-based support intervention, particularly for older adults experiencing loneliness. Cudjoe (Medicine) presents qualitative data from older adults (English, Spanish and Mandarin speaking), living in non-profit affordable housing in 22 different states. Drawing on experiences of their social connections during the COVID-19 pandemic, the paper gives voice to the implications of the loss of common facilities, and opportunities to socialize with other residents, and the increased role technology plays in staying connected. Our discussant, Prof Leavey, a leader in the field of mental health, will reflect on the major themes emerging from these multidisciplinary perspectives, especially what they mean for public health and services.

Role strain and COVID-era burden among South Asian caregivers of individuals with brain health conditions and disabilities

Background: The COVID-19 pandemic has renewed attention to the conflicting demands placed on caregivers worldwide. Nowhere is this more evident than in South Asia, where cultural norms and a scarcity of long-term care facilities have made the home the locus of caregiving for individuals with brain health conditions and disabilities. A hidden cost of this informal arrangement is the burden experienced by the primary caregiver. This may be exacerbated when traditional caregiving expectations clash with personal aspirations outside the family. Method(s): The COVID-19 pandemic has renewed attention to the conflicting demands placed on caregivers worldwide. Nowhere is this more evident than in South Asia, where cultural norms and a scarcity of long-term care facilities have made the home the locus of caregiving for individuals with brain health conditions and disabilities. A hidden cost of this informal arrangement is the burden experienced by the primary caregiver. This may be exacerbated when traditional caregiving expectations clash with personal aspirations outside the family. Result(s): The COVID-19 pandemic has renewed attention to the conflicting demands placed on caregivers worldwide. Nowhere is this more evident than in South Asia, where cultural norms and a scarcity of long-term care facilities have made the home the locus of caregiving for individuals with brain health conditions and disabilities. A hidden cost of this informal arrangement is the burden experienced by the primary caregiver. This may be exacerbated when traditional caregiving expectations clash with personal aspirations outside the family. Conclusion(s): Role strain may be a significant driver of burden when the caretaker's educational and professional potential collide with traditional South Asian family obligations. The burden reported by our respondents suggests that role strain may elevate stress among young, educated caregivers. Our results, therefore, provide indirect evidence concerning the changing economic and socio-cultural context of caregiving in South Asian households. Copyright © 2022 the Alzheimer's Association.

COVID-19-related loneliness, social isolation and burden in informal caregivers worldwide

Background: Informal caregivers may experience high levels burden. Prior to COVID-19, loneliness and social isolation, and especially the discordance between them, were recognized for rapid aging-related cognitive decline. The COVID-19 has significantly increased social isolation and loneliness in caregivers. Thus, we aimed to explore the variables that were associated with higher care burden among all caregivers and only among caregivers for people living with dementia, and whether the increased burden could be associated with a discrepancy between loneliness and social isolation. Method(s): 'Comparing Loneliness and Isolation in COVID-19' was an online global survey of over 20,000 respondents, including 5243 caregivers across 50 countries with enduring brain or/and physical health conditions. We first used a multilevel modelling to identify risk factors associated with higher burden. Then, we defined profiles of discrepancy between loneliness and social isolation, based on the differences between standardized score on a scale of loneliness and of social connectedness and estimated the association between the discrepancy and higher burden. Result(s): In our sample, 74% of caregivers were female, 44% were caring for people with dementia, and 22% for people with multiple conditions, including dementia. The most prevalent age group was 60-69 years old. Factors significantly associated with higher care burden were being female, having poorer financial situation, worse mental health during the pandemic, caring for people with dementia or intellectual disabilities, caring in the same home, being diagnosed with COVID, and changes of care abilities. 40% of caregivers consistently reported high level of loneliness and social isolation, 38% reported consistent lower levels of both, and two groups reported discordance (low levels of loneliness and high social isolation in 13%;high levels of loneliness and mild social isolation in 12%). The latter group was at the highest risk of self-reported increased and intense care burden. Conclusion(s): This represents the largest, most widespread survey on the impact of the COVID-19 pandemic on caregivers of people with long-term conditions to date and reflects the importance of capturing the nuances in the relationship between loneliness and social isolation in caregivers. It will be an important resource for support agencies and to inform policy. Copyright © 2022 the Alzheimer's Association.

Risk factors for loneliness in family caregivers of people with dementia and enduring mental health conditions during the COVID-19 pandemic in Latin America

Background: During the COVID-19 pandemic, loneliness has increased in the general population due to government measures to contain the spread of the disease. In Latin America (LA), caregiving is most often delivered informally by family members Family caregivers often face mental health challenges linked to their caregiving role and their social context. Pandemic-related social restrictions have been especially detrimental for older people with dementia or other brain health challenges, as well as their family caregivers. We aimed to investigate the associations of loneliness, social isolation and care burden in these family caregivers. Method(s): We undertook a cross-sectional survey of over 300 informal caregivers of people with dementia or enduring mental health problems living in 4 Latin American countries, Mexico, Brazil, Chile, and Peru. We categorized loneliness into 3 groups 'low', 'moderate' and 'severe loneliness'. Here, we analyzed factors related to changes in the prevalence of moderate and severe loneliness before and during the pandemic using a longitudinal multinomial logistic regression model. Result(s): During the pandemic, there was a significant increase in loneliness prevalence (p<.001) among caregivers in Latin America, with more people having moderate (6.25% pre-pandemic;17.67% mid-pandemic) and severe loneliness (2.78% pre-pandemic;15.19% mid-pandemic). Gender differences in the prevalence of loneliness or higher levels of loneliness among dementia caregivers compared to caregivers of other conditions were not seen. The regression model revealed that the increment in risk for moderate loneliness during the pandemic was related to caregivers' age, level of education, and social contact/isolation. Increased risk for severe loneliness was related to caregivers' social contact during the pandemic and perceived mental health. Conclusion(s): Public health interventions regarding COVID-19 pandemic should consider increased loneliness in Latin-American caregivers. This population will need both, short and long-term mental health and practical support. Next steps include gathering more evidence on specific risk factors for loneliness and its impact on caregivers' physical and mental health. Copyright © 2022 the Alzheimer's Association.

Developing an Online Practicum in Professional Education: A Case Study from UK Teacher Education

A ‘practicum’, ‘clinical experience’ or ‘internship’ is an established component of professional preparation in education, health, social work, law, accountancy and engineering. Across diverse occupational fields, employability and work readiness are gaining prominence in college marketing strategies. The disruption to work placements during the Covid-19 pandemic in programmes linked to licensure rapidly increased the pace and scale of virtualisation and the need for systematic evaluation of curriculum re-design. This chapter presents a case study of the transition to a fully online practicum for UK university students training to be teachers during 2020/21. Drawing on interviews with students, university tutors and school partners, the chapter outlines key learning about partnership formation and innovation. The evaluation suggests that online supervision requires participants to work harder to establish a positive working alliance and sense of belonging across time–space-digital media. The study highlights the importance of iterative review to promote reciprocity, transparency and voice. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

AN EXPLORATION OF RHEUMATOLOGY PATIENTS' PERCEPTIONS AND KNOWLEDGE ABOUT SICK DAY RULES WHILE USING STEROIDS FOR IMMUNOSUPPRESSION

Background/Aims Steroids are commonly used for immunosuppression in the majority of rheumatology conditions. Patients on long-term steroids are vulnerable to adrenal insufficiency during acute illness or if steroids are stopped or weaned down abruptly. During the COVID-19 pandemic, this risk has further multiplied due to change in practice with inclusion of telephone consultations and less frequent hospital visits. Although our patients were routinely provided with steroid alert cards by pharmacy, we aim to ascertain the knowledge and understanding of sick day rules in patient who are on steroids for immunosuppression. Methods We designed a novel questionnaire consisting of 10 questions, designed to determine patients' knowledge about steroid sick day rules. All questions were close-ended, either single best answer or yes/ no except question about primary rheumatological condition and type of steroids. A total of 100 patients (including new and follow-ups) attending rheumatology clinics between January and June 2020 were screened and selected randomly. Questionnaires and consent forms were sent by post as agreed with clinical effectiveness team with return envelopes. Results 29 completely filled questionnaires were received back. The majority of patients (96.5%;n=28) were on prednisolone and only 3.44% (n=1) were on hydrocortisone. The majority of the patients (95.6.6%;n=29) were on steroids for duration between 1-6 months. Answering the question on steroid dose during an acute illness,10.3% (n=3) patients had knowledge to take double dose of steroids, 55.1% (n=16) responded to take regular dose, 3.44 (n=1) answered by lowering dose to half, and strikingly 10.3% (n=3) answered to stop steroids. For further question on when to seek medical advice during an acute illness while on steroids, 31.0% (n=9) responded by answering correctly, 37.9% (n=11) were unsure when to take medical attention, and 3.44% (n=1) responded to wrong option. Despite providing steroids alert cards to everyone, only 65.5% (n=19) answered yes on asking about carrying alert card with them. Conclusion Despite providing steroid alert card and verbal information, these data highlight a significant dearth of knowledge and understanding about sick day rules among rheumatology patients on steroids for immunosuppression. This knowledge gap increases the risk of potentially lifethreatening emergency of adrenal crisis among this patient group. To bridge this knowledge gap, we started to provide steroid sick day rules written information leaflet to all new and old rheumatology patients on steroids to reduce risk of future adrenal crisis. We are aiming to re audit this after 1 year to check improvement in patient knowledge and understanding of sick day rules with this change in practice.

Bringing our heeadsss together-prioritising the voices of children and young people Collaborators

Background Children and young people (CYP) are increasingly attending acute paediatric services due to mental health difficulties. 50% of all mental health problems are established by 14 years of age and 75% by 24 years. Underinvestment in mental health has been a longstanding concern, amplified by the COVID-19 pandemic through extra stress caused by prolonged school closures, social isolation and a lack of access to usual support services. In 2020, the Royal College of Paediatrics and Child Health highlighted that suicide is now the leading cause of death in England and Wales for children aged 5-19 years, emphasising the need to prioritise and improve mental health. Paediatricians must develop the knowledge and skills to identify, support and make appropriate referrals for common mental health problems. HEEADSSS is a well-known psychosocial screening tool with eight domains, used to identify potential or actual harm. Objectives Establish whether CYP within the West Midlands, UK are receiving adequate psychosocial assessments on hospital admission and whether healthcare professionals are signposting to relevant services. The primary outcome was the percentage of CYP with documented evidence of being offered a HEEADSSS assessment. Methods A regional prospective audit across nine hospitals was performed for three days per week from 4st -31st January 2021. A standardised proforma was used to gather information from medical records of all CYP aged >12 years admitted to paediatric wards. Pooled data were analysed using Microsoft Excel. Results 231 patients were included. The median age was 14 years old (range 12-17 years). 163(71%) were female. 202 (87%) had no known communication difficulties. 53(23%) were known to CAMHS and 43(19%) to social care. 78/231 (34%) were admitted with mental health as the presenting complaint. 35/231(15%) were documented to be given the opportunity to be spoken to alone;29(82%) accepted. No department had a psychosocial screening tool embedded in the admission document. 158/231(69%) had less than half of the eight domains completed. The median was 1.5 (range 0-8). Home and education/ employment were most frequently asked (37-42%). Eating/exercise, drugs, safety, sexual activity and other activities were the least frequently asked (14-27%). The proportion of those with a concern identified when asked ranged from 18%-39%. However, in self-harm, depression and suicide, only 85/231 (37%) were asked, with concern identified in 87%. 78 patients were admitted for mental health;28(39%) had less than half the domains completed (median 5, range 0-8). Drug use 46/78(59%), safety and sexual activity (both 38/78 (49%)) were inconsistently documented in this group, with concerns identified in 20-26% of those asked. 90/231(39%) were referred to CAMHS, social care, counselling, online or other support services. 16/77(21%) patients with a concern documented in at least one domain were not referred onwards. Conclusions This study demonstrates poor implementation of the HEEADSSS tool on admission, across a wide geographical area. Increased utilisation of a psychosocial screening tool would provide more opportunities to CYP to discuss their psychosocial health and receive appropriate support, in line with national guidance standards. Further work is underway addressing barriers to using HEEADSSS, considering electronic or embedded tools and signposting to relevant services.

BRONCHOSCOPY TRAINING USING ALFIE (AIRWAY LOW FIDELITY INCLUDING ENDOBRONCHIAL ULTRASOUND BIO-SIMULATOR) AND SINGLE USE FLEXIBLE BRONCHOSCOPY

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: The covid-19 pandemic has resulted in us having to re-consider our traditional teaching modalities and develop newer, dynamic methods of furthering medics' education. Both high and low fidelity simulators in bronchoscopy including endobronchial guided transbronchial needle aspiration (EBUS-TBNA) are costly.We therefore investigated a combination of a low-cost bio-simulator made of recyclable materials found in any house or hardware store (ALFIE: Airway Low Fidelity including EBUS) and single use flexible bronchoscopy (SUFB) have the capability of differentiating novices from experts and the ability to train novices in bronchoscopy? METHODS: Residents and fellows were invited to training on ALFIE simulator using a commercially available SUFB. Trainees were evaluated individually before and after training using a modified validated Bronchoscopy Skills and Tasks Assessment Tool (B-STAT) including the scope handling, endobronchial biopsy and brushing. RESULTS: 18 trainees were included (14 residents and 4 fellows). Pre-training assessment of scope handling differentiated novices from experienced bronchoscopists ((p=0.0025 (95% confidence intervals (CI) 3.12-12.17). Training of novices was associated with an improvement in scope handling and sampling (p=0.0001 (95% CI 4.73-10.27)). CONCLUSIONS: ALFIETM-SUFB combination differentiated novices from those with more experience and training on ALFIETM-SUFB was associated with a significant improvement in performance on a modified BSTAT assessment. CLINICAL IMPLICATIONS: ALFIE and SUFB combination has the potential to create a low-cost platform for remote training in bronchoscopy. Even beyond the COVID-19 pandemic with a combination of virtual teaching software, this potentially provides a convenient training platform to train junior doctors' remotely. DISCLOSURES: No relevant relationships by Kevin Deasy, source=Web Response No relevant relationships by Marcus Kennedy, source=Web Response No relevant relationships by barry O'Reilly, source=Web Response No relevant relationships by Ray O'Sullivan, source=Web Response No relevant relationships by Anne-Marie Sweeney, source=Web Response

ALFIE: AIRWAY LOW FIDELITY INCLUDING ENDOBRONCHIAL ULTRASOUND BIO-SIMULATOR

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: The COVID pandemic has prioritised the role of simulation-based training. Both high and low fidelity simulators in bronchoscopy including endobronchial guided transbronchial needle aspiration (EBUS-TBNA) are costly.To develop a low fidelity bio-simulator from predominately recyclable household materials or materials available in a hardware store, and, to demonstrate its utility in EBUS-TBNA skills training. METHODS: ALFIE (Airway Low Fidelity Including EBUS) bio-simulator was developed and various organic materials were tested as pseudo-peri-bronchial lymph nodes. Residents (novices) and fellows (advanced trainees) were tested using a modified validated EBUS-TBNA scoring tool before and after training on ALFIE bio-simulator. RESULTS: 19 trainees were includes (11 residents and 8 fellows). Pre-training assessment of scope handling differentiated novices from experienced bronchoscopists ((p=0.0004 (95% confidence intervals 1.09-3.11). Training of novices was associated with an improvement in scope handling (p=0.0352 (95% confidence intervals 0.07-1.75)). Significant improvements in EBUS-TBNA performance were identified in fellows after ALFIE Bio-simulator training (p=0.0472 (95% confidence intervals 0.03-1.4.65)). CONCLUSIONS: Assessment of scope handling on ALFIE, a cheap home-made bio-simulator differentiated novices form more experienced trainees and all trainees bronchoscopy skills improved with training on ALFIE bio-simulator. CLINICAL IMPLICATIONS: ALFIE is a cheap bio-simulator that can be positioned in trainees office allowing continuous bronchoscopy including EBUS-TBNA training. There is no Intellectual Property Patent and ALFIE assembly instructions will be sent to any physician or surgeon who seeks a cheap low fideliity bronchoscopy including EBUS-TBNA bio-simulator. DISCLOSURES: No relevant relationships by Kevin Deasy, source=Web Response No relevant relationships by Marcus Kennedy, source=Web Response No relevant relationships by barry O'Reilly, source=Web Response No relevant relationships by Ray O'Sullivan, source=Web Response No relevant relationships by Anne-Marie Sweeney, source=Web Response no disclosure on file for helen whelton;

Quantitative sars-cov-2 alpha variant b.1.1.7 tracking in wastewater by allele-specific rt-qpcr

The critical need for surveillance of SARS-CoV-2 variants of concern has prompted the development of methods that can track variants in wastewater. Here, we develop and present an open-source method based on allele-specific RT-qPCR (AS RT-qPCR) that detects and quantifies the B.1.1.7 variant, targeting spike protein mutations at three independent genomic loci that are highly predictive of B.1.1.7 (HV69/70del, Y144del, and A570D). Our assays can reliably detect and quantify low levels of B.1.1.7 with low cross-reactivity, and at variant proportions down to 1% in a background of mixed SARS-CoV-2. Applying our method to wastewater samples from the United States, we track the occurrence of B.1.1.7 over time in 19 communities. AS RT-qPCR results align with clinical trends, and summation of B.1.1.7 and wild-type sequences quantified by our assays matches SARS-CoV-2 levels indicated by the U.S. CDC N1 and N2 assays. This work paves the way for AS RT-qPCR as a method for rapid inexpensive surveillance of SARS-CoV-2 variants in wastewater. © 2021 The Authors. Published by American Chemical Society.

Safety of emergency ent procedures during COVID-19 pandemic

Aims The aim of this study is to assess the safety of performing various emergency ENT procedures in a single institution during the COVID-19 pandemic and the impacts on patients and healthcare workers that potentially would have risen from aerosol generating procedures. Methods We retrospectively reviewed patients that underwent any ENT procedure in the ENT Casualty department of South Infirmary University Hospital Cork, from the month of December 2019 until April 2020. Patients were contacted via telephone call and symptoms of COVID-19 were enquire as per standard questionnaire. Two time periods were defined;Period 1 from 1st December 2019 to 28th February 2020 and Period 2 from 29th February to 23rd April 2020. Results 332 patients were included in this study. 226 (80.1%) patients attended in Period 1 and 66 (19.9%) attended in Period 2. In Period 1, 12 (4.5%) patients reported COVID-19 symptoms within 2 weeks of attending and 5 (7.6%) patients reported symptoms in Period 2 of which, 2 of those underwent swabs. Both swabs were negative. None of the clinical staff developed COVID-19 during the study. Conclusion With appropriate PPE and social distancing measures, ENT Casualty services were safe to proceed during the COVID-19 pandemic.

ACE inhibitors, angiotensin receptor blockers and endothelial injury in COVID-19.

BACKGROUND: COVID-19 is caused by the coronavirus SARS-CoV-2, which uses angiotensin-converting enzyme 2 (ACE-2) as a receptor for cellular entry. It is theorized that ACE inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) may increase vulnerability to SARS-CoV-2 by upregulating ACE-2 expression, but ACE-I/ARB discontinuation is associated with clinical deterioration. OBJECTIVE: To determine whether ACE-I and ARB use is associated with acute kidney injury (AKI), macrovascular thrombosis and in-hospital mortality. METHODS: A retrospective, single-centre study of 558 hospital inpatients with confirmed COVID-19 admitted from 1 March to 30 April 2020, followed up until 24 May 2020. AKI and macrovascular thrombosis were primary end-points, and in-hospital mortality was a secondary end-point. RESULTS: AKI occurred in 126 (23.1%) patients, 34 (6.1%) developed macrovascular thrombi, and 200 (35.9%) died. Overlap propensity score-weighted analysis showed no significant effect of ACE-I/ARB use on the risk of occurrence of the specified end-points. On exploratory analysis, severe chronic kidney disease (CKD) increases odds of macrovascular thrombi (OR: 8.237, 95% CI: 1.689-40.181, P = 0.009). The risk of AKI increased with advancing age (OR: 1.028, 95% CI: 1.011-1.044, P = 0.001) and diabetes (OR: 1.675, 95% CI: 1.065-2.633, P = 0.025). Immunosuppression was associated with lower risk of AKI (OR: 0.160, 95% CI: 0.029-0.886, P = 0.036). Advancing age, dependence on care, male gender and eGFR < 60 mL min-1 /1.73 m2 increased odds of in-hospital mortality. CONCLUSION: We did not identify an association between ACE-I/ARB use and AKI, macrovascular thrombi or mortality. This supports the recommendations of the European and American Societies of Cardiology that ACE-Is and ARBs should not be discontinued during the COVID-19 pandemic.