PSYCHOLOGICAL DISTRESS OVER 12 MONTHS POST-DIAGNOSIS IN A NATIONAL EARLY INFLAMMATORY ARTHRITIS COHORT

BackgroundIn inflammatory arthritis patients, the concomitant decline of their mental wellbeing is an increasing concern[1,2]. It is important to not only describe the trajectory of psychological distress in early disease stages, but also understand which clinical outcome measures are most associated with these changes.ObjectivesUsing data from the National Early Inflammatory Arthritis Audit (NEIAA), we assessed trends in psychological wellbeing over 12 months after initial diagnosis and mapped these against clinical outcomes to identify significant associations.MethodsNEIAA collects data from patients referred with suspected early inflammatory arthritis in rheumatology services in England and Wales. We used data provided by 20,472 patients eligible for follow-up (diagnosis of inflammatory arthritis) between May 1st, 2018, and April 1st, 2022. Data items included baseline demographics e.g., age and gender, and clinical variables e.g., rheumatic disease comorbidity index (RDCI), DAS28, and patient reported outcomes.Psychological distress was measured by the sum score of Patient Health Questionnaire Anxiety and Depression Screener (PHQ4ADS). Using mixed effects regression models, we analysed the co-variability of PHQ4ADS with demographic factors and clinical outcomes over 12 months. Time was included as a dummy-coded covariant.ResultsThe analysis included 36% of patients (7,378 out of 20,472) who completed the baseline patient outcome survey. In this cohort, PHQ4ADS scores decreased from a baseline average of 4.7 (CI: [4.6, 4.8]) to 2.62 (CI: [2.5, 2.8]) at 12 months post-diagnosis. The proportion of patients screening positive decreased from 50.0% (CI: [48.9, 51.1]) at baseline to 23.8% (CI: [21.8, 25.9]) at 12 months.At baseline, psychological distress correlated significantly with age, gender, ethnicity, RDCI, prior depression diagnosis, and baseline DAS28 (Figure 1). No significant correlations were found between psychological distress and working diagnosis, seropositivity, or the assessment being recorded after the start of the COVID-19 pandemic. Younger ages were nonlinearly associated with higher distress levels (coefficient per decade: -0.006;p<0.001;CI: [-0.009, -0.003]) (Figure 1a). Distress levels in females were higher than that of males (coefficient: 0.5;p<0.001;CI: [0.4, 0.7]) (Figure 1b). White patients reported lower PHQ4ADS scores compared to non-white patients (coefficient: -0.7;p<0.001;CI: [-1.0, -0.4]) (Figure 1c). Higher distress levels were also associated with higher RDCI (coefficient: 0.2;p<0.001;CI: [0.1, 0.3]) and prior diagnosis of depression (coefficient: 1.8;p<0.001;CI: [1.5, 2.2]) (Figure 1d, 1e). Furthermore, higher baseline DAS28 scores correlated with more severe psychological distress (coefficient: 0.8;p<0.001;CI: [0.7, 0.8]) (Figure 1f).By 12-months, psychological distress decreased significantly overall, which correlated significantly with ethnicity (coefficient: 0.8;p=0.005;CI: [0.3, 1.4]) and baseline DAS28 (coefficient: -0.5;p<0.001;CI: [-0.6, -0.4]). Compared to white patients, the reduction was significantly greater for non-white patients, but the level of distress was no longer different at 12 months (Figure 1c). While those with higher baseline DAS28 showed a greater reduction in psychological distress, the distress levels remained higher at 12 months (Figure 1f).Figure 1.Changes in psychological distress correlated with age, gender, ethnicity, RDCI, prior depression diagnosis, and baseline DAS28.[Figure omitted. See PDF]ConclusionIn this early inflammatory arthritis cohort, mental health burden was high. Age, gender, ethnicity, RDCI, prior depression diagnosis and baseline DAS28 significantly correlated with psychological distress at baseline. Supporting mental health should be a focus of clinical care for this population and it may be beneficial to use an approach that is culturally valid for non-white patients and accounts for multimorbidity.References[1]Euesden, J, et al. Psychosomatic medicine 79.6 (2017): 638.[2]Lwin, MN, et al. Rheumatology and therapy 7.3 (2020): 457-471.AcknowledgementsThe authors would like to thank the Healthcare Quality Improvement Partnership (HQIP) as the commisioner of NEIAA, British Society for Rheumatology as the audit providers, Net Solving as the audit platform developers, and the Wellcome Trust (ST12406) for funding to support L.Z..Disclosure of InterestsLucy Zhao: None declared, James Galloway Speakers bureau: Has received honoraria from AbbVie Celgene, Chugai, Gillead, Janssen, Eli Lilly, Pfizer, Roche, and UCB, Jo Ledingham: None declared, Sarah Gallagher: None declared, Neena Garnavos: None declared, Paul Amlani-Hatcher: None declared, Nicky Wilson: None declared, Lewis Carpenter Consultant of: Statistical consultancy for Pfizer, Kirsty Bannister: None declared, Sam Norton Speakers bureau: Has received honoraria from Janssen and Pfizer.

Effectiveness of Train-the-Trainer Workshops in Intelligent Industrial Robotics

In this work we investigate the effectiveness of two train-the-trainer workshops on intelligent industrial robotics. The two workshops, which took place in summer 2021 in Tennessee and Alabama, were the first of a series of six workshops. A total of 32 persons applied to the two summer workshops from 10 states, of whom 15 attended and successfully completed the workshops. Evaluation results show that the participants' knowledge on industrial robotics significantly improved after the workshops, and the vast majority indicated that the training will be used in their home institutions. The major challenge faced during the workshops was the spread of the delta variant of CoVid-19 at the time the workshops were scheduled to take place, and the wide diversity of the educational background of participants. © 2023 IEEE.

Does inflation trigger early repayment on Covid-19 UK guaranteed loans?

The UK government underwrote more than 1.68 million business loans totalling 78.4bn pound during the COVID-19 pandemic. Given that the Bounce Back Loan (BBL) had a 100% guarantee and the Coronavirus Business Interruption Loan Scheme (CBILS) 80%, the public sector contingent liability is very large. In this article, we explore whether or not the recent and dramatic rises in UK inflation have prompted firms with COVID-19 BBL and CBILS guaranteed loans to repay their outstanding debt early (in advance of the full 6-year loan term as specified in the original loan agreement). Our results show that this was indeed the case with increasing inflation exerting a strong and positive effect on early loan repayment on both guarantee schemes. This is consistent with the firm's debt aversion and a desire to reduce existing debts in anticipation of a future economic recession, liquidity problems and high interest rates.

Safety first, but for whom? Shifts in risk perception for self and others following COVID‐19 vaccination

Vaccines can affect the mind as well as the body. Research on the psychological impact of vaccines has largely focused on risk‐related judgments and behaviors involving the recipient. Here, we extend this work to risk‐related judgments of others. In a prospective cohort study involving three samples and two timepoints (N = 588 adults), we tested competing hypotheses about the effects of receiving a COVID‐19 vaccine on perceived risks to the unvaccinated: (1) a self/other differentiation hypothesis (vaccination will lead to estimation of lower risk for the self but higher risk for others) versus (2) a self/other correspondence hypothesis (vaccination will lead to estimation of lower risk from contracting COVID‐19 for both self and others). Results revealed risk estimates as well as preferences for COVID‐related social policies more consistent with the latter hypothesis. We discuss potential psychological mechanisms and implications of these findings. [ FROM AUTHOR] Copyright of Social & Personality Psychology Compass is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

International Nursing Actions to Reduce Health Inequities Faced by People with Intellectual andDevelopmental Disability

The impact of the COVID-19 pandemic highlighted health inequities for people with intellectual and developmental disability (PWIDD). It was alsothe stimulus for an international group of nurse researchers with shared expertise and experience to create a Global IDD Nursing Collaboratory. Acollaboratory is a networked environment or "center without walls” where interaction oriented to common research areas occur without regard tophysical location. The overarching goal of this Global Nursing Collaboratory is to assure the highest quality of life for PWIDD across the lifespan.Applying their unique skills and expertise, nurses working across health and social contexts are often the bridge over the healthcare gapsencountered by PWIDD. This paper describes the potential practice, education, and research contributions nurses can make to reduce healthinequities experienced by PWIDD. We will examine how we talk about disability, the impact of the current COVID 19 crisis, and our educationalsystems which in some countries leave nurses and other health professionals ill prepared to meet the unique needs of this population We willdescribe the context, access issues, and health service organizations for and with PWIDD across countries to equip nurses with basic knowledge ofhealth care for PWIDD and energize meaningful improvement in delivery of this care. Importantly, we offer action steps for all nurses towardreducing stigma and health inequities related to living with an intellectual and developmental disability (IDD). © 2022,Online Journal of Issues in Nursing. All Rights Reserved.

Deeds and Words

'Complexity chaos high rates of change serious safety and quality issues and workforce shortages in health care are some of the reasons why clinical leadership is important.' Joseph & Huber (2015). Increasingly Practice Education is involved in the early stages of managing an emerging crisis- historically this has not always been the case. We describe key elements used to succeed and in what ways these positively impacted on the teams. Arguably clinical leadership in nursing education reflects that described by Joseph and Huber (2015);'the process of influencing point-of-care innovation and improvement in both organizational processes and individual care practices to achieve quality and safety of care outcomes.' Necessity combined with strong senior leadership during the initial stages of the first wave of the Covid-19 pandemic, led to the Lead Practice Education team taking up leadership positions across the trust to ensure that teams were clinically supported with effective responsive nursing education. This re-modelling of the team coupled with adaptations to workstreams enabled a singular focus on clinical nursing. Whether through upskilling and refreshing those in non-ward based roles disseminating changeable infection control advice or developing education plans for emerging conditions such as PIMS-TS the leadership of this team was highly effective and well received. Since this time Lead Practice Educators have been called upon to support the delivery of high flow humidified oxygen to more patients transferring from ICU and most recently in supporting the Parenteral Nutrition intravenous lines crisis. The 'traditional' educational approach combining clinical leadership with compassion and common sense utilised the following key elements;. Rapid Training Needs Analysis . Wide organisational reach . Rapid translation of policy into practice . Clinical credibility and visibility.

COVID-19 lending support and regional levelling up: evidence from UK loan guarantee schemes

The economic consequences of COVID-19 were severe with restricted economic activity generating a liquidity crisis for many firms. To address the systemic impact of this liquidity shock, governments around the world rapidly introduced a range of loan guarantee schemes. In the UK, more than 1 million businesses accessed these schemes. Using a novel, comprehensive dataset, this paper explores the regional distribution of access to these schemes and how this was mediated by regional differences in lending institution. Our results show that while the schemes were national and unaligned with regional policy, access favoured firms in poorer regions, and regional differences in lending institutions had a significant influence on the nature of lending. © 2023 Regional Studies Association.

The NSW Telestroke Service: A cross-agency collaboration to implement and sustain a virtual care hyperacute stroke service at 23 regional and rural hospitals

Background: The $21.7 million NSW Telestroke Service was a 2019 NSW Government election commitment. Implementation of the service is a collaboration between South Eastern Sydney Local Health District, the NSW Agency for Clinical Innovation, eHealth NSW and the NSW Ministry of Health. Between March 2020 and June 2022, the telestroke service launched at 23 sites across regional and rural NSW, providing access to specialist stroke physicians for rapid assessment, diagnosis and treatment through virtual care. The service has treated over 2200 patients with a reperfusion rate for acute ischaemic stroke patients of 34%. Aim(s): To understand the factors driving the successful implementation of a major project led by multiple health organisations in a complex environment. Interrogating and documenting the success factors will help NSW Health agencies implement similar large-scale, complex projects. Method(s): The implementation team adopted a reflective approach to draw out key lessons during the implementation at each site. Lessons learnt discussions were held at a local and program-wide level, focusing on areas including resourcing, leadership, education and training, and sustainability. Result(s): Key elements of successful implementation highlighted by the reflective lessons learnt approach include: * Division of responsibility that reflected the strengths of each partner agency * Clear implementation roadmap including comprehensive implementation and training packages * Flexibility to adapt the implementation approach based on contextual factors and intervening events * Strong executive support at each partner agency * Upfront focus on sustainability to identify and mitigate issues early on The telestroke service was implemented by the target schedule, despite the significant impacts caused by the COVID-19 pandemic and natural disasters. The service was a finalist in the 2021 NSW Premier's Awards. Conclusion(s): The implementation of telestroke can offer insights for partner agencies into the key factors driving success of transformative projects to improve access to healthcare.

Virtually Transforming healthcare at scale: Implementing improved access to stroke care across regional and rural areas

Aim: The NSW Telestroke project implemented a virtual model of care to improve access to hyperacute stroke treatment across 23 hospitals. To understand and extrapolate the success factors involved in effective project implementation and sustainability. Objective: The successful implementation of large-scale service redesigns with demonstrated improvement in patient outcomes are limited. The implementation at scale to 23 hospitals with varying local contextual features including resourcing, culture, leadership and facility set up has provided insights into the key elements of successful implementation. Undertaking a systematic approach to implementation including formulating a well-developed and attainable proposal for change in practice with clear targets, assessing the performance and mapping potential barriers indicates markers for successful implementation. Lessons learned has provided a gauge of what future endeavours should consider to inform large scale system transformation. Results: The Telestroke project has been implemented across 18 hospitals to date, with a further five sites by June 30, 2022. This is within the expected timeframe despite COVID-19 outbreaks in NSW and subsequent restrictions limiting activity at crucial time periods. Discussion: Through reflective lesson learned discussions at a program, hospital and individual level key drivers for successful implementation and sustainability of the project were highlighted. They include: 1. A clear roadmap, detailing the implementation approach with matching resources and education packages, have allowed expedited delivery of the program at a site level 2. Skilled, dedicated and consistent staffing in program implementation lead roles has enabled stability in coordination and knowledge management. This supports key learnings being adapted and utilised for future go-lives. 3. Leveraging skill mix at each site to fill knowledge/experience gaps to support and embed Telestroke. 4. A supportive executive team and clearly identified key champions in each department to drive the change forward. 5. Adapting training to suit the local environment including resources and COVID-19 restrictions was crucial during implementation.

TAKOTSUBO SYNDROME IN COVID-19 AND INFLUENZA INFECTIONS: A COMPARATIVE SYSTEMATIC REVIEW OF CLINICAL CHARACTERISTICS AND OUTCOMES

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Coronavirus disease 2019 (COVID-19) and influenza infections are associated with systemic inflammatory reactions that predispose to Takotsubo cardiomyopathy (TTS). Studies have investigated the epidemiology and clinical features of TTS in COVID-19 and influenza infection, however, there are limited data comparing TTS between patients with COVID-19 and influenza. METHODS: We searched PubMed/Medline, Web of Science, SCOPUS, EMBASE, and Google Scholar until November 1st, 2021, for case reports, case series, and observational cohort studies using these keywords: takotsubo syndrome/takotsubo cardiomyopathy, stress-induced cardiomyopathy, and broken heart syndrome combined with the terms COVID-19 and/or SARS-CoV-2, flu and/or influenza. All the published case reports included in the final analysis were in English and were categorized into patients with ‘COVID-19 + TTS’ and ‘Flu + TTS’. RESULTS: We identified 37 studies describing 64 patients with COVID-19+TTS and 10 case reports describing 10 patients with Flu + TTS. The mean age of patients in the COVID-19 + TTS was similar to the influenza group (69 years). Although women were more disproportionately affected by TTS in both groups, COVID-19 + TTS patients had a higher proportion of men than the Flu + TTS group (44% vs 30%) and previously reported incidence of TTS in men in the general population. Compared to patients with Flu + TTS, COVID-19 + TTS had a longer mean time from testing positive to developing TTS (7.3 days vs. 3.1 days), higher incidence rates of acute respiratory distress syndrome (77% vs. 40%), hypoxemic respiratory failure (86% vs. 60%), more likely to require invasive mechanical ventilation (63% vs. 40%) and higher in-hospital mortality rates (36%, n=23 vs 10%, n=1) CONCLUSIONS: Our systematic review highlights some important differences in the presentation and outcomes of TTS in patients with COVID-19 compared to seasonal influenza. Patients with COVID-19 + TTS had higher rates of respiratory complications and excess all-cause mortality compared to Flu + TTS. In contrast to the general population and patients infected with influenza, TTS tends to affect more men with COVID-19 infection. CLINICAL IMPLICATIONS: Hospitalized patients with COVID-19 who develop TTS appear to have a more severe disease course and poorer outcome compared to hospitalized patients with Flu+TTS. The study findings provide additional knowledge comparing complications between COVID-19 and influenza infections and may contribute to the continued efforts to manage the COVID-19 pandemic. DISCLOSURES: no disclosure on file for Temidayo Abe;No relevant relationships by Thomas Allingham No relevant relationships by Omovefe Edika No relevant relationships by Hammad Khalid No relevant relationships by Ifeoma Ogbuka No relevant relationships by Titilope Olanipekun No relevant relationships by Richard Snyder No relevant relationships by Abhinav Vedire No relevant relationships by Nicholas Wilson

Scottish COVID CAncer iMmunity Prevalence (SCCAMP): A longitudinal study of patients with cancer receiving active anti-cancer treatment during the COVID-19 pandemic

Background: Cancer and systemic anti-cancer treatment (SACT) have been identified as possible risk factors for infection and related severe illness associated with SARS-CoV-2 virus as a consequence of immune suppression. The Scottish COVID CAncer iMmunity Prevalence (SCCAMP) study aimed to characterise the incidence and outcomes of SARS-Cov-2 infection in patients undergoing active anticancer treatment during the COVID-19 pandemic and their antibody response following vaccination. Methods: Eligible patients were those attending secondary care for active anti-cancer treatment for a solid tumour. Blood samples were taken for total SARS-CoV-2 antibody assay (Siemens) at baseline and after 1.5, 3, 6 and 12 months. Data on COVID-19 infection, vaccination, cancer type, treatment and outcome (patient death) was obtained from routine electronic health records. Results: The study recruited 766 eligible participants between 28th May 2020 and 31st October 2021. During the study period there were 174 deaths (22%). The median age was 63 years, and 67% were female. Most received cytotoxic chemotherapy (79%), with the remaining 14% receiving immunotherapy and 7% receiving another form of anti-cancer therapy (radiotherapy, other systemic anti-cancer treatment). 48 (6.3%) tested positive for SARS-CoV-2 by PCR during the study period. The overall infection rate matched that of the local adult general population until May 2021, after which population levels appeared higher than the study population. Antibody testing detected additional evidence of infection prior to vaccination, taking the total number to 58 (7.6%). There was no significant difference in SARS-CoV-2 PCR positive test rates based on type of anti-cancer treatment. Mortality rates were similar between those who died within 90 days of a positive SARS-CoV-2 PCR and those with no positive PCR (10.4% vs 10.6%). Death from all causes was lowest among vaccinated patients, and of the patients who had a positive SARS-CoV-2 PCR at any time, all of those who died during the study period were unvaccinated. Multivariate analysis correcting for age, gender, socioeconomic status, Charlson co-morbidity score and number of previous medications revealed that vaccination was associated with a significantly lower infection rate regardless of treatment with chemotherapy or immunotherapy with hazard ratios of 0.307 (95% CI 0.144-0.6548) or 0.314 (95% CI 0.041-2.367) in vaccinated patients respectively. Where antibody data was available, 96.3% of patients successfully raised SARSCoV-2 antibodies at a time point after vaccination. This was unaffected by treatment type. Conclusions: SCCAMP provides real-world evidence that patients with cancer undergoing SACT have a high antibody response and protection from SARS-CoV-2 infection following COVID-19 vaccination.

THE EMOTIONAL IMPACT OF AXIAL SPONDYLOARTHRITIS: A SYSTEMATIC REVIEW AND THEMATIC SYNTHESIS OF QUALITATIVE STUDIES AND A REVIEW OF ONLINE FORA

Background/Aims Psychological distress is prevalent in people with inflammatory arthritis. In populations with axial spondyloarthritis (SpA), the risk of developing mental ill-health is high - for depression more than twice that of control populations. Positive emotions are protective against psychological distress and emotional wellbeing is favourably associated with physical illness prognosis. However, the emotional experiences of people who live with axial SpA are not well understood. This study aimed to explore and synthesise qualitative data about the emotional experience of living with axial SpA and identify barriers and facilitators to emotional wellbeing. Methods First, a systematic review and thematic synthesis was conducted. Nine databases were searched from inception to December 2019. Qualitative and mixed methods studies were included if they reported qualitative participant level data about the lived emotional experiences of people with axial SpA and were published in English or German. The search was updated in March 2021. Study quality was assessed using a modified version of the CASP (Critical Appraisal Skills Programme) qualitative tool. Grey literature was appraised using the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) checklist. Data were extracted, coded and categorised. Synthesis involved translation of concepts from one study into another and development of descriptive themes. Second, four axial SpA online forums were searched from inception to June 2020 for posts from UK-based individuals with axial SpA containing data about their emotional experiences of axial SpA. Thematic analysis was undertaken. Results Of 10,824 database records screened, 27 studies, published between 1995 and 2020, went forward for synthesis. Study populations included people diagnosed with Ankylosing Spondylitis (n=1143), axial SpA (n=53) and non-radiographic axial SpA (n=18). Two studies with mixed populations (n=37) did not specify numbers diagnosed with axial SpA. Most participants were male and had established disease. No studies specifically focused on the psychological experiences of living with axial SpA. 537 posts were identified from online fora, 278 (52%) of which were from men. Seven descriptive themes were generated from the qualitative synthesis: delayed diagnosis: a barrier to emotional wellbeing;disruptive symptoms: a source of mood swings;work disability: a loss of self-esteem;obstacles in interpersonal relationships: a trigger of distress;taking up exercise: 'personal pride' or 'unwelcomed reminders';anti-TNF therapy: hope reignited despite concerns;journey of acceptance: worry mixed with hope. The findings from our review of online fora supported and validated these themes. One additional theme - COVID-19: uncertainty and anxiety during the pandemic - was developed from constructs identified from online posts. Conclusion Our findings highlight substantial negative and mixed emotions experienced by people with axial SpA. However, data about the emotional experiences of women, people diagnosed with non-radiographic axial SpA, and those in the early stages of diagnosis, are limited.

“Simplicity is Key”: Literacy Graduate Students’ Perceptions of Online Learning

Even before COVID-19, literacy graduate coursework was increasingly offered online, replacing the traditional campus-based courses This study investigated how graduate literacy students perceive coursework in an online learning environment. This understanding is important because (a) student perceptions regarding online learning are critical to motivation and learning;and (b) faculty designing courses need to consider student voice in course development. This survey research queried literacy master’s degree candidates their perceptions prior to and after taking online classes, their confidence levels using technology, and about the technological tools that have impacted their learning. Results indicated initial perceptions of online learning changed positively after engagement in coursework, but course design influenced collaboration and engagement. Statistical significance was found in changes in initial perceptions of online learning to a more positive overall feelings toward online learning. The results of this study raise important considerations for implementing online coursework for literacy graduate students. © 2022, The Online Learning Consortium. All rights reserved.

COVID-19: Extensive epithelial damage and ciliary dyskinesia in hospitalised patients.

Infection with SARS-CoV-2 can cause severe respiratory disease and it is predicted that the COVID-19 pandemic will leave a substantial number of patients with long-term respiratory complications (1).

Keep your distance: Different roles for knowledge and affect in predicting social distancing behavior.

The current study examines predictors of social distancing behavior across populations (students and community members) and across time in the early months of the COVID-19 pandemic, focusing on two factors commonly associated with risk perception and prevention: knowledge and affect. Results showed that, despite similar levels of social distancing, student distancing was predicted only by feelings of threat about COVID-19, whereas community distancing was predicted by both feeling informed and threatened. Examining longitudinal effects, which were limited to students only, students became more informed about COVID-19 over time, and increases in being informed (but not feeling threatened) predicted more distancing.