ABSTRACT
Background/Aims Nailfold capillaroscopy has a key role in the assessment of patients with Raynaud’s phenomenon (RP) providing a window of opportunity for the early diagnosis of systemic sclerosis (SSc). Anecdotal evidence indicates that this opportunity is not being fully realised across UK rheumatology centres. Reasons for apparent discrepancies in use of capillaroscopy may relate to a lack of expertise, confidence or equipment. Exploratory work has demonstrated the potential for an internet-based standardised system for clinical reporting of nailfold capillaroscopy images to mitigate current inequities in care provision. The overall aim of this study was to understand current practices in the diagnosis of SSc in UK rheumatology centres with specific reference to identifying barriers to the use of nailfold capillaroscopy. A secondary aim was to understand rheumatologists’ views on a standardised system to facilitate the timely diagnosis of SSc. Methods An online survey comprising closed and free-text questions was developed using expert (n = 7) opinion from clinicians, scientists and health service researchers. The survey was piloted (n = 5) and sent to UK-based rheumatologists using established electronic mailing lists between 2nd October 2020 and 8th March 2021. Respondents were asked to describe workloads and practices typically seen before the COVID-19 pandemic. Data were analysed using descriptive statistics and thematic analysis. Results Survey responses were received from 104 rheumatologists representing centres across the UK. Wide variation in terms of workloads and practices were described (See Table 1). Only 41% (n = 43) of respondents reported using nailfold capillaroscopy provided at their centres. Key barriers were access to equipment and a lack of expertise in terms of acquiring and analysing images. Respondents indicated that a centralised internet-based system for storing images and sharing diagnoses would provide access to expertise and the possibility of timely diagnoses. P117 Table 1: Use of nailfold capillaroscopy (NFC) across UK centresNumber (n = 104)%Do you use nailfold capillaroscopy at your site?No6159Yes4341Total104100In what context are nailfold capillaroscopy images taken?At the general clinic appointment2251At a separate hospital appointment1637Other12Either general clinic or separate hospital appointment25Missing/unclear25Is there a dedicated room where imaging is done?No2354Yes1842Unclear/missing25What type of equipment do you use for NFC?Video microscope921Stereomicroscope12USB microscope1228Dermatoscope1330Ophthalmoscope12Stereomicroscope & dermatoscope12Don't know614Who usually does NFC imaging in your centre?I do it myself2047Another consultant or SpR921Nurse/AHP37Technician/medical physics614Medical photography49Clinical scientist12Who usually interprets the NFC imaging in your centre?I do it myself2558Another consultant or SpR819Nurse/AHP25Technician/medical physics512other12Clinical scientist12Technician & consultant/SpR12From how many RP patients do you obtain NFC images?0381 to 5386 to 1092311 to 2061521 to 30410more than 30923Not sure513How many of those patients imaged were diagnosed with SSc?04101 to 516416 to 1082111 to 203821 to 3025more than 3025Not sure410How are results of NFC reported to the patients?Face-to-face at imaging session1126Face-to-face at clinic appointment1433Letter / as part of treatment plan1330No specific nailfold capillaroscopy reporting25Other25Letter / face-to-face12Do you (also) refer patients to other centres for NFC?No6260Yes4240How many patients per year do you refer to other centres?1 to 526636 to 10112711 to 201221 to 3025more than 3012 *participants asked to base answers on the situation in 2019 before the COVID-19 pandemic Conclusion Substantial variation in approaches to the diagnosis of SSc across the UK was identified. Potential benefits of a standardised system were described by respondents including the improved diagnosis and management of SSc, realising potential patient benefits and reducing current health inequalities. Survey findings provide evidence to help develop future studies to develop and evaluate the proposed new system. Disclosure M. Eden: None. S. Wilkinson: None. A. Murray: None. P. Gurunath Bharathi: None. C. Taylor: None. K. Payne: None. A.L. Herrick: None.
ABSTRACT
Research Objectives Report safety, feasibility and outcomes of 30 patients undergoing acute rehabilitation following hospitalization for COVID-19 infection. Design Case Series. Setting Acute rehabilitation unit within a large, metropolitan academic hospital. Participants Thirty patients (ages 26-80) undergoing acute rehabilitation following hospitalization for complications from COVID-19 of which 90% required critical care and 83% required mechanical ventilation. Interventions Physical therapy, occupational therapy and speech therapy within an acute rehabilitation unit. Main Outcome Measures Acute rehabilitation unit length of stay, therapy minutes per day, discharge destination, readmission to hospital from acute rehabilitation unit. Results The average acute rehabilitation unit length of stay was 11 days (ranging from 4-22 days). Patients averaged 165 minutes per day (ranging from 140- 205 minutes) total of physical therapy, occupational therapy, and speech therapy. Twenty eight of the 30 patients (93%) discharged home. One patient required readmission from the acute rehabilitation unit to the acute hospital. All 30 patients improved their functional status with acute rehabilitation. Conclusions In this cohort of 30 patients, acute rehabilitation after severe COVID-19 was safe and feasible. Patients were able to participate in intensive rehabilitation with nearly all patients discharging to home. Clinically, acute rehabilitation should be considered for patients with functional limitations following COVID-19. Given 90% of our cohort required critical care, future studies should investigate the efficacy and effectiveness of acute rehabilitation following hospitalization for critical illness. Intensive rehabilitation shows promising potential to address functional impairments associated with COVID-19 requiring hospitalization. Author(s) Disclosures No disclosures noted by any author on this paper.
ABSTRACT
OBJECTIVE: he objective of this study was to evaluate safety, feasibility, and outcomes of 30 patients within an inpatient rehabilitation facility following hospitalization for severe Coronavirus Disease 19 (COVID-19) infection. METHODS: This was an observational study of 30 patients (ages 26-80 years) within a large, metropolitan, academic hospital following hospitalization for complications from severe COVID-19. Ninety percent of the participants required critical care, and 83% required mechanical ventilation during their hospitalization. Within an inpatient rehabilitation facility and model of care, frequent, long-duration rehabilitation was provided by occupational therapists, physical therapists, and speech language pathologists. RESULTS: The average inpatient rehabilitation facility length of stay was 11 days (ranging from 4-22 days). Patients averaged 165 min/d (ranging from 140-205 minutes) total of physical therapy, occupational therapy, and speech therapy. Twenty-eight of the 30 patients (93%) were discharged to the community. One patient required readmission from an inpatient rehabilitation facility to an acute hospital. All 30 patients improved their functional status with inpatient rehabilitation. CONCLUSION: In this cohort of 30 patients, inpatient rehabilitation after severe COVID-19 was safe and feasible. Patients were able to participate in frequent, long-duration rehabilitation with nearly all patients discharging to the community. Clinically, inpatient rehabilitation should be considered for patients with functional limitations following severe COVID-19. Given 90% of our cohort required critical care, future studies should investigate the efficacy and effectiveness of inpatient rehabilitation following hospitalization for critical illness. Frequent, long-duration rehabilitation shows promising potential to address functional impairments following hospitalization for severe COVID-19. IMPACT: Inpatient rehabilitation facilities should be considered as a discharge location for hospitalized survivors of COVID-19, especially severe COVID-19, with functional limitations precluding community discharge. Clinicians and administrators should consider inpatient rehabilitation and inpatient rehabilitation facilities to address the rehabilitation needs of COVID-19 and critical illness survivors.