Investigating mental defeat in individuals with chronic pain: Protocol for a longitudinal experience sampling study.

INTRODUCTION: Previous qualitative and cross-sectional research has identified a strong sense of mental defeat in people with chronic pain who also experience the greatest levels of distress and disability. This study will adopt a longitudinal experience sampling design to examine the within-person link between the sense of mental defeat and distress and disability associated with chronic pain. METHODS AND ANALYSIS: We aim to recruit 198 participants (aged 18-65 years) with chronic pain, to complete two waves of experience sampling over 1 week, 6 months apart (time 1 and time 2). During each wave of experience sampling, the participants are asked to complete three short online surveys per day, to provide in-the-moment ratings of mental defeat, pain, medication usage, physical and social activity, stress, mood, self-compassion, and attention using visual analogue scales. Sleep and physical activity will be measured using a daily diary as well as with wrist actigraphy worn continuously by participants throughout each wave. Linear mixed models and Gaussian graphical models will be fit to the data to: (1) examine the within-person, day-to-day association of mental defeat with outcomes (ie, pain, physical/social activity, medication use and sleep), (2) examine the dynamic temporal and contemporaneous networks of mental defeat with all outcomes and the hypothesised mechanisms of outcomes (ie, perceived stress, mood, attention and self-compassion). ETHICS AND DISSEMINATION: The current protocol has been approved by the Health Research Authority and West Midlands-Solihull Research Ethics Committee (Reference Number: 17/WM0053). The study is being conducted in adherence with the Declaration of Helsinki, Warwick Standard Operating Procedures and applicable UK legislation.

Pandemic and student mental health: mental health symptoms among university students and young adults after the first cycle of lockdown in the UK.

BACKGROUND: Early COVID-19 research suggests a detrimental impact of the initial lockdown on young people's mental health. AIMS: We investigated mental health among university students and young adults after the first UK lockdown and changes in symptoms over 6 months. METHOD: In total, 895 university students and 547 young adults not in higher education completed an online survey at T1 (July-September 2020). A subset of 201 university students also completed a 6 month follow-up survey at T2 (January-March 2021). Anxiety, depression, insomnia, substance misuse and suicide risk were assessed. RESULTS: At T1, approximately 40%, 25% and 33% of the participants reported moderate to severe anxiety and depression and substance misuse risk, clinically significant insomnia and suicidal risk. In participants reassessed at T2, reductions were observed in anxiety and depression but not in insomnia, substance misuse or suicidality. Student and non-student participants reported similar levels of mental health symptoms. Student status was not a significant marker of mental health symptoms, except for lower substance misuse risk.Cross-sectionally, greater symptoms across measures were consistently associated with younger age, pre-existing mental health conditions, being a carer, worse financial status, increased sleep irregularity and difficulty since lockdown. Longitudinally, T2 symptoms were consistently associated with worse financial status and increased difficulty sleeping at T1. However, these associations were attenuated when baseline mental health symptoms were adjusted for in the models. CONCLUSIONS: Mental health symptoms were prevalent in a large proportion of young people after the first UK lockdown. Risk factors identified may help characterise high-risk groups for enhanced support and inform interventions.

Quality initiative to improve emergency department sepsis bundle compliance through utilisation of an electronic health record tool.

INTRODUCTION: Sepsis is a common cause of emergency department (ED) presentation and hospital admission, accounting for a disproportionate number of deaths each year relative to its incidence. Sepsis outcomes have improved with increased recognition and treatment standards promoted by the Surviving Sepsis Campaign. Due to delay in recognition and other barriers, sepsis bundle compliance remains low nationally. We hypothesised that a targeted education intervention regarding use of an electronic health record (EHR) tool for identification and management of sepsis would lead to increased EHR tool utilisation and increased sepsis bundle compliance. METHODS: We created a multidisciplinary quality improvement team to provide training and feedback on EHR tool utilisation within our ED. A prospective evaluation of the rate of EHR tool utilisation was monitored from June through December 2020. Simultaneously, we conducted two retrospective cohort studies comparing overall sepsis bundle compliance for patients when EHR tool was used versus not used. The first cohort was all patients with intention-to-treat for any sepsis severity. The second cohort of patients included adult patients with time of recognition of sepsis in the ED admitted with a diagnosis of severe sepsis or septic shock. RESULTS: EHR tool utilisation increased from 23.3% baseline prior to intervention to 87.2% during the study. In the intention-to-treat cohort, there was a statistically significant difference in compliance between EHR tool utilisation versus no utilisation in overall bundle compliance (p<0.001) and for several individual components: initial lactate (p=0.009), repeat lactate (p=0.001), timely antibiotics (p=0.031), blood cultures before antibiotics (p=0.001), initial fluid bolus (p<0.001) and fluid reassessment (p<0.001). In the severe sepsis and septic shock cohort, EHR tool use increased from 71.2% pre-intervention to 85.0% post-intervention (p=0.008). CONCLUSION: With training, feedback and EHR optimisation, an EHR tool can be successfully integrated into current workflows and appears to increase sepsis bundle compliance.