Innovative Methods for Integrating Social Determinants of Health Data with Administrative Claims to Facilitate Health Equity Research

Objectives: The Covid-19 pandemic highlighted the importance of considering Social Determinants of Health (SDoH) in healthcare research. Administrative claims databases are widely used for research, but often lack SDoH data or sufficient transparency in how these data were obtained. This study describes innovative methods for integrating SDoH data with administrative claims to facilitate health equity research. Method(s): The HealthCore Integrated Research Database (HIRD) contains medical and pharmacy claims from a large, national US payer starting in 2006 and includes commercial (Comm), Medicare Advantage (MCare), and Medicaid (MCaid) populations. The HIRD includes individually identifiable information, which was used for linking with SDoH data from the following sources: national neighborhood-level data from the American Community Survey, the Food Access Research Atlas, and the National Center for Health Statistics' urbanicity classification;and member-level data on race/ethnicity from enrollment files, medical records, self-attestation, and imputation algorithms. We examined SDoH metrics for members enrolled as of 05-July-2022 and compared them to the respective US national data using descriptive statistics. We also examined telehealth utilization in 2022. Result(s): SDoH data were available for ~95% of currently active members in the HIRD (Comm/MCare/MCaid 12.5m/1m/7.6m). Socioeconomic characteristics at the neighborhood-level differed by membership type and vs. national data: % of members with at least a high-school education (90/88/84 vs. 87);median family income ($98k/$76k/$70k vs. $82k);% of members living in low-income low-food-access tracts (9/14/18 vs. 13);urban (57/52/47 vs. 61). At the member-level, the % of White Non-Hispanics, Black Non-Hispanics, Asian Non-Hispanics, and Hispanics were 61/6/5/6 (Comm), 76/12/2/2 (MCare), and 45/26/5/19 (MCaid). Imputation contributed 15-60% of race/ethnicity values across membership types. Telehealth utilization increased with socioeconomic status. Conclusion(s): We successfully integrated SDoH data from a variety of sources with administrative claims. SDoH characteristics differed by type of insurance coverage and were associated with differences in telehealth utilization.Copyright © 2023

Psychological wellbeing and sleep in human immunodeficiency virus (HIV): a retrospective analysis of assessment and interventions within HIV services in the UK and Ireland (UKI)

Background: People living with HIV are disproportionately affected by psychological wellbeing and sleep issues which can detrimentally impact their quality of life, adherence and health outcomes. Despite monitoring and assessment being imperative to improve long-term health;evidence indicates a variation in incidence of this and absence in guidance for sleep issues. To support generation of evidence in this field, a market research study was designed to gain insights into current interventions for psychological wellbeing and sleep assessment within HIV services in UKI. Method(s): The study was managed by a market research agency where an online survey link was disseminated to healthcare professionals (HCPs) in multiple HIV centres across UKI. To ensure accuracy of data, HCPs randomly selected a maximum 20 patient notes reviewed between 2020 to 2022. No identifiable patient information was recorded or shared with resulting data presented at an aggregate level. Result(s): 39 clinics participated contributing 665 patient notes with demographics reflective of UKI population. Since Covid- 19 77% of HCPs perceived an increasing demand for mental health support with 64% stating they routinely assess mental health;however, the majority express issues with capacity and resourcing to sufficiently support these patients. 33% of patients included were identified as experiencing a decline in psychological wellbeing, the majority of which self-reported during face to face (F2F) routine appointments;14% of these patients had a PHQ9. 78% received support with the majority signposted to external resources. For those who did not receive support, the primary driver was patient request. 46% of services state they do not routinely assess for sleep issues. A lower proportion of patients (17%) were identified as having such issues;however, of those identified the primary method was self-reporting during F2F routine appointments. 6% of these patients had a PSQI. Of those who did not receive sleep support, a lack of guidance was the main cited reason. Conclusion(s): This study indicates high variation between local management of psychological wellbeing and sleep in HIV, in addition to key gaps in clinical guidance, identifying, managing and ongoing monitoring which is required to ensure long term health.

Back and neck problems as well as disadvantageous ergonomic behavior patterns in university students: Concomitants of the pandemic?

Background: As a part of the coronavirus disease 2019 (COVID-19) lockdown measures, universities converted courses to digital formats, leading to remote studying. It is unclear how these measures affect university students in terms of musculoskeletal problems (i.e., neck and back pain), e.g., by non-ergonomically equipped home offices or reduced physical activity. Material(s) and Method(s): Students from Osnabruck University weresurveyed via fully standardized online questionnaires from early March to mid-April 2022 (6 weeks) about neck and back problems, movement behavior in home offices, and personal information. Result(s): Of 447 students who clicked on the link, 378 students (80.4% female, mean age: 24.1 +/- 4.2 years) answered the questionnaire (response rate: 84.6%). 299 (79.1%) students suffered from neck pain and 294 (77.8%) from back pain during the pandemic. 206 (54.4%) students generally used ergonomic furniture, 83 (22.0%) used ergonomic sitting furniture, 57 (15.1%) used a standing desk, and 212 (56.1%) used aids for a more comfortable use of laptops in home office. 203 (53.7%) students took movement breaks in home office, 207 (54.8%) worked out regularly, and 65 (17.2%) moved regularly in the fresh air. Conclusion(s): The present study found a high rate of neck and back pain amongst university students. Measures are needed to prevent neck and back pain in this group, considering that increased physical activity and enhanced home office equipment might be beneficial.Copyright © 2022 Elsevier GmbH

Co-designing an intervention to support safe medicines self-management for older people living with frailty and polypharmacy

Introduction: Older people face numerous challenges and safety risks when managing multiple medicines. They are required to cope with complex and changing regimens and co-ordinate input from multiple healthcare professionals. If not well managed, medicines can cause harm, and older people are more susceptible to errors. Some older people can devise and implement strategies to manage their medicines, e.g. creating checklists, ensuring timely supplies, solving problems, and seeking help (1). However, no interventions address the multiple tasks polypharmacy patients must perform to safely manage their regimens. Aim(s): To develop an intervention to support medicines self-management for older people living with frailty and polypharmacy using experience-based co-design (EBCD) (2). Method(s): Following video or audio-recorded qualitative interviews with 32 older people taking 5 or more medicines, a 'trigger film' of patients' medicines management experiences was produced and used during EBCD to facilitate priority setting. Separate meetings were held (1) with 16 staff (2 GPs, 4 GP practice administrators, 4 GP practice pharmacists, 1 practice lead, 2 senior nurses, 2 pharmacy technicians, 1 community pharmacist) and (2) with 13 patients and 2 family members, followed by a joint meeting with 8 older people and 9 staff where a shared set of three priorities was agreed. Two subsequent co-design workshops with 6 patients, 2 family members and 7 staff developed three candidate interventions. Workshop 1 explored key themes from the trigger film to develop solutions. Workshop 2 reviewed solutions and further developed design ideas. Intervention components were merged and those addressing patient safety challenges were retained to form the prototype intervention. Ethical approval was obtained for the interviews included in the trigger film, but not required for EBCD. EBCD meetings and workshops were conducted as quality improvement: people involved were collaborators, personal information was not captured, discussions were not recorded or analysed. Result(s): Co-design priorities were to support patients in: day-to-day practical medicines management;understanding the wider medicines management system;communication with healthcare teams. The three solutions were: a quick-start guide to managing multiple medicines including talking about medicines and managing new routines;tips and tricks to support day-to-day management, including planning and adherence tools;a tool supporting preparation for medication reviews and asking questions about medicines. After merging intervention components and identifying those addressing medicinesself- management patient safety challenges, five areas were retained for the prototype intervention: checking what you get;keeping on top of supplies;monitoring how you take your medicines;times when problems are more likely;and how do I know if I need help? Discussion/Conclusion: Through EBCD patients and staff worked together to improve people's experiences of managing medicines and to enhance safety. The prototype intervention addresses five areas where older people with complex medicines regimens require support. The intervention requires feasibility testing and subsequent robust evaluation. Strengths and limitations: * A variety of staff roles joined the co-design, offering multiple different perspectives on medicines management * EBCD meetings and workshops were run online to avoid Covid infections. This may have excluded older people with no access to internet.

Evaluation of the association between fear of COVID-19 and pregnancy distress

Background: Mental health problems experienced during pregnancy negatively affect both maternal and fetal wellbeing. Objective(s): This study aimed to investigate the relationship between fear of COVID-19 and pregnancy distress in healthy pregnant women living in Turkey. Method(s): A descriptive, relational/cross-sectional study was conducted by interviewing 363 pregnant women in person. Data were collected using a personal information form, the Fear of COVID-19 Scale (FCV-19S), and the Tilburg Pregnancy Distress Scale (TPDS). Result(s): The mean FCV-19S score was 19.03+/-5.65 and the mean TPDS score was 19.97+/-7.97. According to the TPDS cut-off score, 19.0% of the participants were at risk of pregnancy distress. There was a significant positive correlation between FCV-19S and TPDS scores (r = 0.263, p<0.05). According to the regression analysis, age (beta=-0.217), years of education (beta=-0.272), and number of births (beta= 0.502) were associated with fear of COVID-19, and fear of COVID-19 was associated with TPDS scores (beta= 0.369) (p<0.05). Conclusion(s): The pregnant women in this study had moderate fear of COVID-19. Compared to the literature data, the prevalence of pregnancy distress was slightly higher than pre-COVID-19 reports but quite low compared to other studies conducted during the pandemic.Copyright © 2023 Mamuk R et al.

Errors Detected in the Telepharmacy Procedure

Background and Importance After the rise of telemedicine with the COVID-19 pandemic, a telepharmacy consultation has been implemented in our hospital in the pharmacy outpatient area, sending medicines to community pharmacies within a population area of 600,000 inhabitants. Aim and Objectives The purpose of this study is to analyse the medication errors (ME) that have occurred during a specific period of time, throughout the process of medication delivery. The aim is finding causes and possible improvements. Material and Methods We carried out a retrospective descriptive study. The errors that occurred between January 2021 and August 2022 (20 months) in the telepharmacy process were analysed, taking into account everything from the preparation in the hospital pharmacy to the collection of the medication by the patient in the community pharmacy. The MEs were collected in a local database. We described date, personal data of the patient, codes assigned to the single shipping route and destination community pharmacy, type of error and step in which the ME was detected. Results In the period studied, a total of 69 MEs were recorded. We break them down into the following types: 20 cases with a quantitative lack of medication (28.99%), 19 cases in which a different medication was sent (27.54%), 15 with another patient's medication (21.74%), 10 with medicine with wrong dose (14.49%), 2 cases in which the medicine was not sent (2.90%) and another 2 in which the medicine was sent badly packaged (2.90%), 1 case in which the one in which the misidentified medicine was sent (1.45%) and 1 case in which a larger quantity was sent (1.45%). 48 MEs were detected by the patient (69.56%), 15 were detected in the community pharmacy (21.74%), 4 were detected in the hospital pharmacy (5.80%) and 2 cases were detected during the transportation of the medication (2.90%). None of the errors detected had consequences for the patient to our knowledge. Conclusion and Relevance Among the MEs detected, the most common were those related to a quantity defect or lack of a medication and those in which a different medication was sent. In general, they are errors that could be avoided by automating processes that are currently carried out manually.

Postmarketing data collection and evidence evaluation

AIFA Monitoring Registries (wMRs) constitute a collection of drug registries (product registries) deployed to physicians and pharmacists through a national web platform. They have been adopted in the clinical practice since 2005 and are used to define the population for which the drug is available under the umbrella of the National Health Service (NHS - Servizio Sanitario Nazionale SSN), monitor prescription appropriateness and ensure the rapid access to potentially priority medicines allowing the implementation of patient-based managed entry agreements (MEAs). Each registry consists of specific data entry forms, collecting data at the patient level and filled in by authorized clinicians and pharmacists. The required information includes: 1. Registration form with patient personal data (anonymized after registration);2. Eligibility and clinical data form;3. Prescription and administration forms;4. Evaluation of disease status and treatment update form;and 5. End-of-treatment form. Evaluation and end-of-treatment forms provide main safety and effectiveness data at a patient level. Moreover, since entry forms are the same throughout the nation, this platform allows access to treatment in a homogeneous manner throughout the country. Recently, a new type of registry has been released, with the primary aim of monitoring the pregnancy prevention programme (PPP) following the prescription of potentially teratogenic medicinal products. All this information is collected in a national database that represents a key source of postmarketing evidence that is frequently exploited to answer both administrative and clinical questions, such as drug utilization among a specific pharmacological class or the effectiveness of a drug in a census consisting of all Italian patients treated with that medicinal product. For example, given the prospective nature of the data contained inside the wMRs, AIFA together with members of the relevant scientific associations were able to evaluate the effect of the COVID- 19 pandemic and lockdown measures on the new prescription (i.e. first prescription) of some cardiovascular drugs in Italy and suggest new studies to analyse the occurrence of new cardiovascular- related events resulting from the decline in the activation of these treatments. Equally important is the work assessing the effectiveness of tyrosine kinase inhibitors in chronic myeloid leukaemia (CML) patients in Italian clinical practice, which was able to highlight important aspects on both expected mortality and consequential use in first and second line TKIs in Italy. Finally, the wMRs were also a critical instrument in the management of the COVID-19 medicinal products since 29 October 2020, providing essential evidence on drug availability through the country, predicting possible shortages and publishing hundreds of freely available reports on the utilization trend of COVID-19 drugs in the different Italian Regions. In conclusion, the wMRs represent a key tool to generate pharmaco-epidemiological evidences in the Real-world setting and monitoring drug appropriateness for expensive, innovative drug.

Sleep disorders in healthcare workers

Introduction: COVID-19 has killed more than 5 millions people worldwide. The effects on mental health are also significant, especially among healthcare personnel. Our aim is to determine the prevalence and the factors of sleep disorders on healthcare workers. Method Descriptive and analytical cross-sectional study including 87 healthcare workers during February 2022, using an anonymous online questionnaire containing personal data, the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). Result(s): The average age was 31.71 +/- 5.93 years. Sex ratio was 1.04. The participants were doctors (69.6%) and paramedical staff (30.4%), 23.2% of them had comorbidities: cardiovascular pathologies (27.2%), respiratory pathologies (24.7%) psychiatric pathologies (18.1%), neurological pathologies (13.9%) and immunodeppression (11.2%). 86.3% were working in the public sector. 62.3% had worked in a COVID-19 unit. Severe clinical insomnia was found in 9.7% and moderate severity clinical insomnia in 13.1%. For the PSQI, 41.5% had an overall score>5, which is an indicator of sleep disorders. A sleep latency>30 minutes was observed (22%), nocturnal awakenings (15.9%), a feeling of fatigue at work (61%) and difficulty concentrating was reported in 38%. For behavioral disorders during sleep, participants had nightmares (35.2%), sleep paralysis (17.7%), sleep talking (10.9%), bruxism (1%) and somnombulism (1.2%). Sleep disorders were correlated with the presence of newborns or infants at home (p=0.001), the number of shifts and working hours per week (p=0.034) and the presence of psychiatric comorbidities (p<0.05). Conclusion(s): Sleep disorders among caregivers are quite common, long-term follow-up for better prevention and management is necessary.

The Effect of Strengthening and Relaxation Exercises on Pain, Anxiety and Sleep Quality in People with Covid-19

Musculoskeletal pain, anxiety and sleep problems may continue after COVID-19. In our study, it was aimed to examine the effects of strengthening and relaxation exercises on musculoskeletal pain, anxiety and sleep quality in people with ongoing COVID-19 symptoms. The study, which was carried out at XXX Hospital between 18 January 2021 and 31 March 2021, included 76 patients aged between 18-65 who were diagnosed with COVID-19 in last 3 months. While strengthening and relaxation exercises were applied to 38 of the patients included in the study (experimental group), no exercise was applied to 38 of them (control group). Personal information form, McGill pain scale short form (SFMPQ), short form 36 (SF-36), Pittsburgh sleep quality scale (PUKI) were administered to all patients before and after the study. There was no significant difference between the experimental and control groups for the demographic characteristics and baseline results (p>0.05). After the study, a significant difference was found in the experimental group in terms of SF-36, Mcgill, Beck Anxiety Scale and PUKI (p<0.05). In the control group after the study, statistically significant difference was found in all evaluations except, SF-36's Physical Role Difficulty, Social Functioning and Pain sub-dimension scores (p<0.05). The changes before and after the study for Mcgill, Beck Anxiety scale, PUKI, SF-36 (except emotional) scores were significantly higher in the experimental group than the control group (p<0.05). In conclusion, it was determined that strengthening and relaxation exercises had a significantly positive effect on post-COVID-19 musculoskeletal pain, anxiety and sleep quality in our study.

Regulatory and Medico-legal Aspects of Technology and Psychiatry in India -3rd National Official workshop of the IPS Technology and Psychiatry Specialty Section

Globally, Technology and Psychiatry have emerged significant during the COVID-19 Pandemic. Technology is rapidly evolving and is definitely impacting the world of Psychiatry and mental health care across academics, research, training and clinical care. Technology is here to stay. It is pertinent that Psychiatrists and Allied professionals get adequate skills and training in Technology and Psychiatry for its application to clinical care and research. Many countries have relevant regulations, Guidelines, Bills, Policies, Acts, and Compliances regarding Technology and Health Care. The Telemedicine Guidelines were released during the COVID-19 Pandemic in India. Subsequently, The Telepsychiatry Guidelines were released by IPS and NIMHANS. There are certain regulations, such as EHR standards, Personal Data Protection Bill, DISHA, Information Technology Act, Drugs and Cosmetic Act, etc., for healthcare and technology in India. Aims and objectives of the workshop: * To create awareness of the regulatory and medicolegal aspects of Technology and Psychiatry in India * To improve the knowledge and skills Psychiatrists in Technology and Psychiatry Speakers and Topics: Dr Darpan Kaur : Conceptual Overview Framework of Needs and Perspectives of Regulatory and Medicolegal Aspects of Technology and Psychiatry in India, Dr Parmod Kumar: Telemedicine Guidelines and TelePsychiatry Guidelines in India Dr Shahul Ameen: Electronic Health Record (EHR) Standards and Personal Data Protection Bill Dr Vijay Chandra: Information Technology (IT) Act and Drugs and Cosmetic Act Dr Sudhir Bhave: Digital Information Security Health Care Act (DISHA).

Basic Solutions For Development Of Vietnam's Digital Economy

The Fourth Industrial Revolution and the emergence of the Internet of Things (IoT) mark a remarkable development in the use of data in activities of social life, especially in the field of manufacturing business. In that context, the digital economy is becoming an important development feature and trend, researched, applied and developed by many countries. In recent years, Vietnam has actively approached opportunities from the digital economy for economic growth. The Covid-19 pandemic has made the Vietnamese Government's interest in the digital economy even stronger. The article analyzes and clarifies the basic solutions to develop Vietnam's digital economy today. The results show that the value of Vietnam's digital economy is growing, besides, there are still difficulties and challenges in the process of implementing and implementing the digital economy. The article also analyzed and pointed out three problems facing Vietnam's digital economy today, reflected in the content that Vietnam needs to continue to harmonize between institutional reform in terms of business processes and business processes. technological opportunities for more effective governance in the digital age;development of digital financial services is to improve access and use of financial services;efforts to ensure inclusive digital transformation. The study also provides and analyzes three related solutions: institutions;develop high-quality human resources;network security, personal information security to develop the digital economy in the context of the 4th industrial revolution and post-Covid-19 in Vietnam today. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Challenges and privacy concerns related to mental health

The outbreak of the COVID-19 pandemic, since time surged across nations, has affected millions of people in several nations. With over 268 million cases and 5.28 million reported deaths, the caseload is rising further in many countries. The stipulated measures are undertaken worldwide to contain the spread of infections through social distancing, quarantine, and lockdown in the regions. The numerous lockdowns imposed across nations in the past several months to contain terrorism have slowed economic growth. Isolation, grief, and loss of income trigger mental health conditions or aggravate existing ones. In the long term, the impacts on the population are wide-ranging from depression, posttraumatic stress syndrome, anxiety, insomnia, domestic and substance abuse, emotional chaos, and behavioral changes. People with preexisting morbidities face higher chances of acute severe medical outcomes that may eventually be fatal. These factors affect an individual's mental health, leading to economic and social withdrawal. The first global data drawn from the survey of the 130 severely affected countries suggests that symptoms of anxiety, depression, and severe psychological reactions amount to 15 to 30%. Addressing such a population's mental health conditions has become a pressing issue for healthcare providers. The challenges involve the identification of the population segment requiring medical services to treat psychological and mental illnesses post-COVID-19 pandemic. At the same time, addressing the privacy concerns of such a large population is also pivotal. The privacy regulatory frameworks adopted by the regional and federal governments are pressing upon procedures to preserve the privacy of people suffering from post-COVID-19 psychological distress syndrome. In this chapter, the privacy mechanisms are detailed, which will provide non-disclosure of personal and sensitive data during treatments. The exchange of health-related data and personal identifiers is subject to territorial privacy rules without revealing personally identifiable information (PII). © 2022 Nova Science Publishers, Inc. All rights reserved.

New medication-related developments in The Hungarian Electronic Prescription System and other eHealth services

In all countries, where electronic health services such as e-prescriptions have been introduced, patient safety has improved and the standard of medical and pharmaceutical care has increased. ePrescription (eRecept) - launched in Hungary as well - has become the most used eHealth module of the EE SZT (National eHealth Infrastructure) by all healthcare providers in the past near 3 years. During the COVID epidemic emergency e-prescription system has been a huge help to patients, relatives and caregivers too. In this period the proportion of electronic issued prescriptions exceeded 90% of all prescriptions written. The e-prescription system contributes to the better and faster information of healthcare professionals, supports the well-based therapy decisions, helps preventing and eliminating medication errors. Adverse drug reactions (allergies, interactions, polypharmacy etc.) can be more easily identified with the daily use of this service. Less paper administration can increase the time and quality of patient counseling both at the doctor's and in the pharmacies. Medication adherence can also be simply monitored by pharmacist as well. After patient registration - using social security number (SSN / TAJ) -, written maximum 1 year earlier and/ or by other pharmacy dispensed prescriptions will be also downloadable soon from the central database. These functions and real time data contribute to the implementation of high-quality pharmacotherapy advising services in pharmacies as healthcare institutions, made in accordance with the specific standards and protocols. The new functions of the Patient Portal (e.g. Legal Representation) and mobile surfaces provide patients and their relatives access to follow their care process, prescriptions, labs, etc., already on their smartphone too. From the beginning of May 2020, serial-produced medical aids mostly sold in pharmacies, can be electronically issued. The full integration of all the medical aids may be completed next year in a separated module. A simple web-based prescriber (socalled miniHIS) has been developed for connected private doctors, who do not consult in institutions. Measured values of the (smart) medical devices can be uploaded into the personal data repository of the Patient Portal on a voluntary basis. Good measurement results of the blood pressure, sugar, body weight, etc. recorded here demonstrate therapy fidelity, providing feedback to the patient and professionals. Telemonitoring services can be build on this module, so the software can send alerts to the assigned doctor, pharmacist or family member. Keeping data protection rules strict, depersonalized pharmacotherapy data uploaded to the central eHealth database will be searchable soon for professional and scientific purposes.

ERN-EUROBLOODNET EUROPEAN REGISTRY OF PATIENTS AFFECTED BY RED BLOOD CELL DISORDERS AND COVID-19

Background: Patients with red blood cell disorders (RBCD), are likely to be at increased risk of complications from SARS-Co-2 (Coid-19), but eidence in this population is scarce due to its low frequency and heterogeneous distribution. Aims: ERN-EuroBloodNet, the European Reference Network in rare hematological disorders, established a European registry to determine the impact of COVID-19 on RBCD patients and identify risk factors predicting seere outcomes. Methods: The ERN-EuroBloodNet registry was established in March 2020 by VHIR based on Redcap software in accordance with the Regulation (EU) 2016/679 on personal data. The local Research Ethics Committee confirmed that the exceptional case of the pandemic justifies the waier of informed consent. Eligible patients had confirmed RBCD and COVID-19. Data collected included demographics, diagnosis, comorbidities, treatments, and COVID-19 symptoms and management. For analysis of COVID-19 seerity, two groups were established 1) Mild: asymptomatic or mild symptoms without clinical pneumonia and 2) Seere: pneumonia requiring oxygen/respiratory support and/or admission to intensie care unit. Continuous ariables were compared using the Wilcoxon rank-sum test or Kruskall Wallis test, while categorical ariables were analyzed using the Chi-square test or Fisher's Exact test. Releant factors influencing disease or seerity were examined by the logistic regression adjusted for age. Results: As of February 25, 2022, 42 medical centers from 10 EU countries had registered 428 patients: 212 Sickle cell disease (SCD), 186 Thalassemia major and intermedia (THAL). The mean age of SCD was lower (22y) than of THAL (39.4y). Splenectomy and comorbidities were higher in THAL (51.4% and 61,3%) than in SCD (16,3% and 46,8%) (p<0.001, p=0.004). Age and BMI correlated with COVID-19 seerity, as described in the general population (p=0.003, p<0.001). Fig 1 shows age distribution and COVID-19 seerity by disease seerity groups. The mean age for seere COVID-19 was lower in patients with seere SCD (SS/SB0 s SC/SB+: 23y s 67.5y) and THAL (major s intermedia: 43.5 s 51.3y) (p<0.001). Potential risk factors such as eleated ferritin, current chelation or history of splenectomy did not confer additional risk for deeloping seere COVID-19 in any patient group. Only diabetes as a comorbidity correlated with seerity grade in SCD (p=0.01) and hypertension in THAL (p=0.009). While seere COVID-19 infection in SCD was associated with both ACS (p<0.001) and kidney failure requiring treatment (p<0.001), this was not predicted by a history of preious ACS or kidney disease in steady state. Oerall, 14,6% RBC patients needed oxygen/respiratory support, 4% were admitted to ICU with an oerall mortality rate of 1%, much lower than reported in other similar cohorts. Hospital Son Espases, Palma de Mallorca, Spain;54 Clinical Pharmacology Serice, Hospital Uniersitari Vall d'Hebron, Barcelona, Spain;55 Vall d'Hebron Institut de Recerca, Barcelona, Spain;56 Diision of Hematology and Oncology, Department of Internal Medicine, American Uniersity of Beirut Medical Center, Beirut, Lebanon;57 UOC Pediatric Hematology Oncology, Uniersity of Padoa, Padoa, Italy;58 Department of Haematology, Oxford Uniersity Hospitals NHS Foundation Trust, Oxford, United Kingdom;59 Translational Research in Child and Adolescent Cancer, Vall d'Hebron Institut de Recerca, Barcelona, Spain Background: Patients with red blood cell disorders (RBCD), are likely to be at increased risk of complications from SARS-Co-2 (Coid-19), but eidence in this population is scarce due to its low frequency and heterogeneous distribution. Aims: ERN-EuroBloodNet, the European Reference Network in rare hematological disorders, established a European registry to determine the impact of COVID-19 on RBCD patients and identify risk factors predicting seere outcomes. Methods: The ERN-EuroBloodNet registry was established in March 2020 by VHIR based on Redcap software in accordance with the Regulation (EU) 2016/679 on personal data. The local Research Ethics Committee confirm d that the exceptional case of the pandemic justifies the waier of informed consent. Eligible patients had confirmed RBCD and COVID-19. Data collected included demographics, diagnosis, comorbidities, treatments, and COVID-19 symptoms and management. For analysis of COVID-19 seerity, two groups were established 1) Mild: asymptomatic or mild symptoms without clinical pneumonia and 2) Seere: pneumonia requiring oxygen/respiratory support and/or admission to intensie care unit. Continuous ariables were compared using the Wilcoxon rank-sum test or Kruskall Wallis test, while categorical ariables were analyzed using the Chi-square test or Fisher's Exact test. Releant factors influencing disease or seerity were examined by the logistic regression adjusted for age. Results: As of February 25, 2022, 42 medical centers from 10 EU countries had registered 428 patients: 212 Sickle cell disease (SCD), 186 Thalassemia major and intermedia (THAL). The mean age of SCD was lower (22y) than of THAL (39.4y). Splenectomy and comorbidities were higher in THAL (51.4% and 61,3%) than in SCD (16,3% and 46,8%) (p<0.001, p=0.004). Age and BMI correlated with COVID-19 seerity, as described in the general population (p=0.003, p<0.001). Fig 1 shows age distribution and COVID-19 seerity by disease seerity groups. The mean age for seere COVID-19 was lower in patients with seere SCD (SS/SB0 s SC/SB+: 23y s 67.5y) and THAL (major s intermedia: 43.5 s 51.3y) (p<0.001). Potential risk factors such as eleated ferritin, current chelation or history of splenectomy did not confer additional risk for deeloping seere COVID-19 in any patient group. Only diabetes as a comorbidity correlated with seerity grade in SCD (p=0.01) and hypertension in THAL (p=0.009). While seere COVID-19 infection in SCD was associated with both ACS (p<0.001) and kidney failure requiring treatment (p<0.001), this was not predicted by a history of preious ACS or kidney disease in steady state. Oerall, 14,6% RBC patients needed oxygen/respiratory support, 4% were admitted to ICU with an oerall mortality rate of 1%, much lower than reported in other similar cohorts. Summary/Conclusion: Results obtained so far show that seere COVID-19 occurs at younger ages in more aggressie forms of SCD and THAL. Current preentie approaches focus on age oer disease seerity. Our data highlights the risk of seere COVID-19 infection in some young patients, particularly those with SS/SB0 SCD, suggesting that immunization should be considered in this pediatric group as well. Results between similar sized cohorts of RBCD patients ary between each other and those presented here, highlighting the importance of collecting all of these small cohorts together to ensure adequate statistical power so that definitie risk factors can be reliably identified and used to guide management of patients with these rare disorders in the light of the ongoing pandemic. (Figure Presented).

A Quality Improvement Project Determining if Dietitian Input with the UHS Lung Oncology Team Improved Patient Outcomes

Introduction: Unintentional weight loss is common in lung cancer, with 40-60% of patients presenting with this at diagnosis. Weight loss and depleted nutritional status have been identified as negative prognostic variables for survival and directly impact the effectiveness of cancer treatments. The Lung Oncology team at the University Hospital Southampton (UHS) received external funding from Bionical Solutions and AstraZeneca for a part time oncology Dietitian to join the team in treating this patient group. The aim was to determine if specialist Dietitian input improves patients’ nutritional outcomes in those diagnosed with Stage III Non-Small Cell Lung Carcinomas (NSCLC) undergoing radical treatment. Methods: Over 12 months (February 2021-February 2022) all patients with stage III NSCLC received specialist Dietitian input during their radiotherapy treatment. Non-patient identifiable data was collected, which included;whether patients were enterally fed, admission rates and reason, and their weights at the start, middle, end and 2 weeks post radiotherapy. This data was compared to previously collected data in 2018 with the same patient group. No ethical approval was required. Results: A total of 50 patient data sets and 11 feedback questionnaires were collected over 11 months. Between the start and end of radiotherapy, patients experienced;2.1% overall average weight loss, 64% experienced <3.0% unintentional weight loss and 0% experienced >9.6% unintentional weight loss. In 2021 patients reached their lowest weight earlier at 70% of their way through radiotherapy compared with 86% in 2018. Patients maximum unintentional weight loss was 3.2% in 2021 compared with 4.4% in 2018. This is likely due to closer monitoring and dietitian input in 2021. Admission rates were higher in 2021 (n=13, 26%) compared to 2018 (n=5, 18.5%). However, this may be due to changes to patients’ radiotherapy treatment plans in 2021 due to the covid pandemic, resulting in more intense treatments. Patients requiring nasogastric (NGT) feeding increased from 0 in 2018 to 6 in 2021. This is likely due to increased awareness of the importance of nutritional support attributable to dietetic involvement in the multidisciplinary team. All patients who completed the feedback questionnaire found dietetic consultations useful and were able to follow most, or all dietary advice. 91% felt well supported during their treatment with dietetic input. Final Outcomes: Patients experienced reduced weight loss during treatment with Dietitian input compared to 2018 data where there was minimal dietetic input. Increased number of patients required NGTs compared to 2018, therefore Dietitian input is required in this area of oncology. Most patients felt well supported receiving dietetic input during treatment. Increased admission rates compared to 2018, however more nutrition support related admissions in 2021. Conclusions: Overall, patients lost less weight during treatment with Dietitian involvement in their care which is a positive factor in the prognostic outcomes. In addition, most patients felt seeing a Dietitian during treatment improved their experience and felt well supported. The final outcomes support the British Dietetic Associations’ recommendation that there is a dedicated dietetic service for lung cancer patients’, and they are seen by a Dietitian during their treatment. Keywords: Dietitian involvement, Reduced weight loss, Improved patient outcomes

Epidemiology of ulcerative colitis in the Zabaykalsky Krai

Ulcerative colitis (UC) is a chronic immune-mediated inflammatory disease of the colon characterized by high disability in the work-ing-age population. Data on the epidemiology of UC in Russia are limited. Objective. To study UC epidemiology over the last 5 years in Zabaykalsky Krai according to the regional register of inflammatory bowel disease (IBD). Material and methods. Since 2017, the outpatient department of the Krai Clinical Hospital has provided medical care for patients with IBD. Clinical and personal data of patients are recorded in a regional register. From January 2017 to June 2021, 110 patients with UC were included in the study. Quantitative parameters are presented as median and interquartile interval: Me (25%;75%). In the statistical analysis, the nominal data were described with percentages. Statistical analysis of the significance of differences in annual incidence was performed using Pearson’s criterion (χ2). Results. The median age of UC patients at the time of analysis was 45 (43.1;48.8) years, and the age of disease onset was 35 (28.5;45.0) years and was independent of gender (p>0.05). The prevalence of mild types over moderate and severe ones was detected: 44%, 28%, and 24%, respectively. Proctitis accounted for 43%, and left-sided and total colitis 31% and 26%, respectively. Ex-traintestinal manifestations occurred in 15% of cases. Fifteen percent of patients were treated with genetically engineered biolog-ical therapies. Indications for surgical treatment were reported in 7.3% of patients. The incidence rate of UC in 2019 was significantly higher than in 2017 (OR 2.1;95% CI 1.205—3.820;p=0.008). Due to the decrease in visits in 2020, the value of this parameter decreased by more than 3.6 times compared to that in 2019 (OR 3.6;95% CI 1.776—7.213;p=0.001). Conclusion. Establishment of the office for medical care of patients with inflammatory bowel diseases and maintaining the register allowed to obtain epidemiological data on ulcerative colitis in Zabaykalsky Krai that are consistent with the results of domes-tic and foreign studies. The COVID-19 pandemic had a negative impact on the frequency of detection of ulcerative colitis in Zabaykalsky Krai in 2020.

Surveying the Prevalence of Mental Health Disorders among Healthcare Workers During the COVID-19 Pandemic ABS0140)

The COVID-19 pandemic has ravaged populations across the globe. The toll taken is unprecedented in the modern age. Aside from this obvious morbidity and mortality, there is an under-appreciated pandemic of mental illness that is sweeping across the world. Mental health issues in health care professionals have long since been identified to be a significant problem. Our experiences during previous similar epidemics have shown that such situations take a huge toll on the physical as well as mental health of personnel affected, either directly by infection or indirectly by the social and economic consequences of the pandemic. The health care worker may find him/herself in a very challenging situation, dealing simultaneously with multiple sources of stress in an ever-changing environment. These manifest in the form of serious mental issues such as depression, anxiety, stress, sleep disturbances, and posttraumatic stress disorder, to name a few. These can have a longlasting impact on the psychological makeup of the victims. We conducted this survey-based study to assess the prevalence of depression and anxiety among a wide range of personnel involved in health care, in different settings, working in the front line and nonfront line scenarios. Aims and objectives: To assess the prevalence of developing anxiety and depression among health care workers during the COVID-19 pandemic and to compare the prevalence thereof based on various factors such as occupation, pre-existing health issues, level of work, social background, working directly with infected patients. Materials and methods: Survey-based, prospective, observational cohort study including data collection over 1 month. The online survey was circulated as a Google Form and made available to all healthcare workers pan India. The study included the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7) scale along with other personal information, gathered anonymously. The paired t-test and Mann- Whitney U-test were used to determine the statistical significance. Results: The mean age of the population was 39.9 years, with equal distribution among the sexes. 70% of subjects were married and 76% lived with their families. The commonest co-morbidities were hypertension (n = 66), obesity (n = 61), diabetes (n = 37). 60.4% had PG qualifications, 69.3% were treating physicians, and 49.4% were consultants. 90.3% worked in urban settings, 65.5% worked at the tertiary level. 37.4% worked directly with COVID-19 patients. 24.4% of respondents worked in ICU, 14.7% in OPD, 12% in ward settings. Gross prevalence of depression was 43% (mild: 22.6%, moderate 11.2%, moderate-severe 5.1%, severe: 3.9%). Prevalence of anxiety was 47% (mild 26%, moderate 13%, severe 7%). Depression was commoner among men (p = 0.04), those in a relationship (p = 0.00), those with children (p = 0.00) in older age groups, with higher positions and educational qualifications, and those with co-morbidities (p = 0.0). It was less prevalent in front-line workers, including physicians (p = 0.00). Among the front-line workers, depression and anxiety were more prevalent among physicians (p = 0.01). Depression was commoner in OPD and ED settings (p = 0.00), and less for people getting quarantine period (p = 0.00). Conclusion: Our survey shows a higher than average prevalence of anxiety and depression among health care workers in India as compared to non-pandemic periods. We have also identified groups that are at higher risk for mental health issues .

EXPLORING ATTITUDES TO VIRTUAL GASTROENTEROLOGY CLINIC PROVISION: A PATIENT SURVEY

Introduction The COVID-19 pandemic has forced patients to rapidly adjust to virtual consultations in outpatients. A perceived benefit is reducing unnecessary travel. However, there is a paucity of literature describing acceptability of virtual consultations to gastroenterology patients. Methods In collaboration with the Patient Experience team, satisfaction surveys were disseminated in Gastroenterology and Hepatology clinics at Bristol Royal Infirmary electronically via SurveyMonkey® and paper format between June and August 2021. These consisted of multiple choice questions and Likert 5-scale ranking questions, ranging from 'strongly agree' to 'strongly disagree'. Virtual clinics were defined as telephone or video consultations. Data was collected on patient demographic, travel method, satisfaction with virtual clinics, and preferences for service delivery. Results 100 patients completed the survey (27% aged 55- 64yrs;21% aged 65-74 years). 50%, 27% and 23% of patients were from hepatology clinic, inflammatory bowel disease clinic and general gastroenterology clinic respectively. 84% were follow-up patients. 56% of patients normally drove to appointments, with a further 30% taking public transport. 23% of patients were travelling over 10 miles to attend appointments. 38% of patients were in full-time employment of which 63.1% had to take annual leave to attend appointments (n=24/38). 82% of patients owned a laptop of which 19.5% (n=16/82) disagreed or strongly disagreed with feeling comfortable using their computer for an online appointment. Face-to-face (F2F) consultation was the preferred mode of appointments in almost half of patients (49%), followed by a mix of F2F and telephone consultations (19%). 54% of patients agreed or strongly agreed that clinicians could address their concerns virtually, with only 16% disagreeing or strongly disagreeing with this. 65% of patients agreed or strongly agreed they felt comfortable sharing personal information during a virtual consultation, with 14% of patients disagreeing or strongly disagreeing with this. 80% of patients stated they would want to receive bad news in a F2F consultations. Conclusions Virtual consultations appear to be acceptable rather than preferable to gastroenterology patients. F2F consultations remain the overall preference, particularly when receiving bad news. Virtual consultations can provide flexibility in service delivery. This is important given almost two thirds of patients in full time employment had to take annual leave to attend an appointment. Furthermore, as services consider their carbon footprint, with half of patients driving to their appointments in Bristol, virtual consultations offer a genuine opportunity to provide a greener service.

IMPLEMENTATION OF A NARRATIVE MEDICINE CURRICULUM FOR INTERNAL MEDICINE RESIDENTS

SETTING AND PARTICIPANTS: The initial narrative medicine sessions were held virtually over Zoom during the 2020-2021 academic year due to COVID-19. Sessions were held in person during the 2021-2022 academic year. Each session included 8-16 internal medicine residents. Residents participated in a single session during their ambulatory block. DESCRIPTION: Narrative medicine has been integrated into medical training with increased depth and frequency to enhance competencies such as observation, reflection, and self-care among trainees. The narrative medicine sessions in this pilot curriculum consisted of one-hour interactive workshops. The workshops began with a brief introduction to the field of narrative medicine, followed by a discussion of a short literary text. After reading and discussing the text, participants were asked to complete a brief writing exercise designed to elicit a personal narrative, and responses were then shared with the larger group. EVALUATION: Following the workshop, participants (N=100) completed a retrospective pre- and post- survey assessing the impacts of this intervention on several different variables. Descriptive statistics were used to evaluate pre- and post-workshop differences. Participants also completed open-ended questions assessing what they learned from the session and what they could apply to their future practice, and key themes were extracted. The survey was administered through a HIPAA-compliant online platform, and no personally identifiable data were collected. Participants' interest in learning about the field of narrative medicine increased significantly after the workshop compared to prior (p<0.01). After the workshop, participants noted significantly higher levels of confidence in their ability to listen to patient stories, analyze short pieces of literature, and engage in reflective writing (p<0.01). They also expressed significantly greater agreement with the notions that engaging in literary analysis and reflective writing could improve patient care, reduce provider burnout, and improve connectedness to one's colleagues (p<0.01). Analysis of open-ended questions demonstrated that participants found the sessions to be engaging and worthwhile, and that many skills could be applied to their future practice. DISCUSSION / REFLECTION / LESSONS LEARNED: The results of this pilot study suggest that incorporating a brief narrative medicine curriculum into an internal medicine residency program is both feasible and valuable. A single, one-hour session was easily integrated into a pre-existing ambulatory block;participation fostered meaningful reflection, development of observational skills, and connection with colleagues. The session was positively received, and participants were able to appreciate the ways in which narrative medicine could enhance their own medical practice. Future directions include expanding the curriculum over all 3 years of residency and integrating it into existing curricula that address issues such as Social Determinants of Health and Equality, Diversity, and Inclusion.

Extra-analytical Point of Care Testing errors in the pandemic era

Introduction: during the current SARS-CoV-2 pandemic phase, the use of rapid diagnostic devices outside the laboratory has expanded enormously, creating great opportunities but also new risks. Methods: the present observational study evaluated the type and frequency of errors of the extra-analytical phases through an active search on all unclear or ambiguous cases. 252 241 rapid antigenic tests performed outside the laboratory in different health facilities over a 132-day period were considered. The requests, the patient demographics and the results were later entered manually onto the Laboratory Information System (LIS). Results: through a number of data checks and internal reports, 2 556 cases of errors in the pre-examination phase were recorded, with a relative frequency of 12,274 parts per million (ppm). The vast majority of errors were observed in this phase;these were due mainly to computer communication problems induced by human errors that made the loading of results or the issuing of the reports difficult. The remaining cases involving erroneous personal data or patient identification amounted to 16 (64 ppm), confirming the relative safety of this phase in decentralized analysis. The errors identified in the post-examination phase were 540, with a relative frequency of 2140 ppm. The assessment of the severity of the errors with Failure Mode and Effect Analysis (FMEA) allowed us to identify in particular, the attribution of the report to the wrong person (20 ppm) and the manual transcription of an incorrect result (20 ppm). Discussion: this study contributes to the comprehension of the critical issues connected to the Point of Care Testing and made it possible to establish corrective actions: improving staff training, choice of instruments with reading devices and establishing direct computer connection for the entering of the requests and results to the LIS.