The mediating effects of socio-behavioral factors on the needs for help among Asian American breast cancer survivors

Background: Breast cancer survivors often report their high needs for help during the transition to cancer survivorship. During the COVID-19 pandemic, technology-based programs are increasingly popular because of their high flexibility and accessibility in delivering information and coaching/support to address the current needs for help among cancer survivors. Yet, little is known about how socio-behavioral factors influence the effects of a technology-based intervention on the needs for help of racial/ethnic minority breast cancer survivors, especially Asian American breast cancer survivors. Purpose(s): The purpose of this secondary analysis was to examine the multiple socio-behavioral factors (including attitudes, self-efficacy, perceived barriers, and social influences related to breast cancer survivorship) mediated the effects of a technology-based intervention on the needs for help among Asian American breast cancer survivors. Method(s): This analysis was conducted with the data from 199 Asian American breast cancer survivor women who were recruited from January 2017 to June 2020 through online and offline communities/groups. The needs for help were measured using the Support Care Needs Survey-34 Short Form (SCNS) with five domains on psychological, information, physical, support, and communication needs. Mediation analysis was conducted using the PROCESS macro within SPSS. The analysis determined the mediating effects of four socio-behavioral mediators on the needs for help at pre-test [T0 ], post 1-month [T1 ], and post 3-months [T2 ] of a technology-based intervention. Result(s): Overall, all the mediators had statistically significant mediation effects on all types of needs for help (p < .05) at different points. Attitudes and social influence presented statistically significant mediation effects on the total needs for help score over 3 months (T0 , T1 , and T2 ). Perceived Barriers had mediation effects on all types of needs for help over 1 month (T0 , T1 ). Self-efficacy mediated the effects on all types of needs for help only at post 1 month (T1 ). Conclusion(s): The findings supported that all the socio-behavioral factors (attitudes, self-efficacy, perceived barriers, and social influences) mediated the effects of a technology-based intervention on the needs for help of Asian American breast cancer survivors. Future research and practice should consider socio-behavioral factors to reduce their needs for help during their survivorship process.

COVID-19 and Food Insecurity in Latin America and the Caribbean

The objective was to determine the prevalence of household food insecurity (FI) in Latin America and the Caribbean (LAC) during the COVID-19 pandemic. Secondary analysis was performed using the waves 1 to 3 of the 2020 COVID-19 High Frequency Phone Surveys in 13 LAC countries. The countries with the highest FI in the first wave were Honduras (60.3%), Peru (58.1%) and Ecuador (57.9%). Likewise, the countries with the greatest differences in the prevalence of FI between the first and last waves in percentage points (PP) were Peru (-29), Guatemala (-27.7) and Bolivia (-21.8). LAC countries face a great burden of FI.Copyright © 2022 Taylor & Francis Group, LLC.

Differences in Concussion Diagnosis By Sex and Age Group in a General Population

Objectives: Female athletes have a higher risk of concussion than their male counterparts but there is a need to investigate these differences in a general population. We assessed reported concussions during a pre-COVID time period in a claims database to compare the prevalence across sexes and ages. Method(s): Using the MerativeTM MarketScan Commercial and Medicare Databases and Treatment Pathways tool, patients were included in the current study if they had continuous enrollment in the database from January 1, 2018 - December 31, 2019 and were between the ages of 14-65. The prevalence of concussions, identified using ICD-10-DX codes, was calculated for all cohorts (14-17, 18-23, >=24 years) and compared statistically between males and females. A secondary analysis, restricted to those with at least one year of continuous enrollment after the initial concussion, was conducted to determine if the proportion of patients who had a diagnosis code for a concussion at least 30 days after the first concussion differed across cohorts. Result(s): Approximately 9 million patients met the inclusion criteria for the study. A total of 66,098 patients had a claim for a concussion during the study period (56% female). The prevalence of concussions was 0.7% and 0.8% among males and females, respectively (p-value<.0001). Females were more likely to be diagnosed with a concussion than males in all age cohorts, with prevalence decreasing with age. Among patients with at least one concussion, 11.7% of males and 16.9% of females had a diagnosis code for a concussion at least 30 days after the initial code (p-value<.0001). Conclusion(s): This study supports previous research done in athletic populations and provides evidence that in a general population the prevalence of concussions is higher among females across all age groups. Further research is needed to investigate why the risk of concussion differs across sexes.Copyright © 2023

A Multi-Center, Randomized, Placebo-Controlled, Double-Blinded Trial of Efficacy and Safety of Riluzole in Acute Spinal Cord Injury Study (RISCIS)

INTRODUCTION: Riluzole, a sodium-glutamate antagonist which is FDA approved for ALS has shown promising pre-clinical results and is clinically safe in SCI patients. METHOD(S): The RISCIS trial is an international, multi-center, prospective, double-blinded, randomized, placebo-controlled Phase II/ III trial. Patients with ASIA A-C, C4-C8 SCI and <12 hours from injury were randomized between Riluzole, at an oral dose of 100mg BID for the first 24 hours followed by 50mg BID for the following 13 days, and placebo control. RESULT(S): Due to the impact of the global COVID-19 pandemic this trial was terminated prior to completion. 193 patients were randomized with a follow-up rate of 82.7% at 180-days. No statistical difference was noted in the demographics and baseline injury characteristics between the two groups. At 6 months there was a median gain in total motor scores (TOTM) of 30.0 in the Riluzole group compared to 20.0 for the Placebo group. The improved motor outcomes did not reach statistical significance. Given the decreased sample size, additional sensitivity analyses were conducted. In the ASIA-C population, Riluzole was a significant improver of total motor scores (coefficient estimate: 14.10, p = 0.020) and upper motor scores (CE: 7.68, p = 0.040) at 6 months. ASIA B patients had higher reported independence, as measured by the SCIM score (45.3 vs. 27.3;p = 0.071) and change in mental health scores as measured by the SF-36 mental health domain (2.01 vs. -11.58;p: 0.0205) at 180 days. CONCLUSION(S): Despite the premature termination of the RISCIS trial due to the COVID-19 pandemic, 193 subjects were recruited into this trial. Primary analysis showed a 10-motor point gain in riluzoletreated subjects which did not reach significance. However, on secondary analysis, incomplete cervical SCI subjects (AIS B and C) showed significant gains in functional recovery.

Prescribing of oral antibacterial drugs in primary care out-of-hours services: a scoping review

Introduction: The rapid spread of antimicrobial resistance (AMR), which causes a serious threat to both human health and the global economy, is primarily linked to the overuse and misuse of antibacterial drugs. The AMR crisis is significantly impacted by the use of antibacterial drugs in primary care (1). Within these settings, oral antibacterial drugs are considered one of the most frequently prescribed group of medicines. It has been claimed that within primary care, the proportion of antibacterial drug prescribing is higher outside the regular working hours (out-of-hours (OOH) services) compared to in-hours (IH) services (2). Aim(s): To identify the existing body of literature around oral antibacterial drug prescribing within primary care OOH services. Method(s): The scoping review was guided by the Joanna Briggs Institute manual and reported in accordance with the PRISMA-ScR. Seven electronic databases (Medline, Embase, Emcare, CINAHL, Scopus, Web of Science, and Cochrane Library) were systematically searched, and the results were screened against pre-defined eligibility criteria. Original and secondary analysis studies that addressed oral antibacterial prescribing in OOH primary care and were published in English were included. Titles and s were independently screened by three reviewers. A pre-piloted extraction form was used to extract relevant data. A narrative synthesis approach was used to summarise the results. Result(s): The initial search yielded 834 records. Upon screening, 28 publications fulfilled the eligibility criteria. Included studies originated from nine high-income countries, with the most frequent being the United Kingdom (six studies, 21.4%) followed by Belgium (five studies, 17.9%). Literature on antibacterial prescribing in OOH services was mostly from quantitative studies (23 studies, 82.14%), with only a few employing a qualitative design (five studies, 17.86%). Different themes and sub-themes were identified across these studies. The majority discussed antibacterial prescribing data in terms of the commonly prescribed medications and/or associated conditions. Eleven studies provided a comparison between IH and OOH settings. Seven studies reported the trends of prescribing over time;of these, three explored prescribing trends before and during COVID-19. The impact of intervention implementation on prescribing was investigated in two studies, an educational intervention in one study and the use of an interactive booklet in the other study. Four studies assessed the quality/appropriateness of prescribing either by adherence to guidelines or antibiotic prescribing quality indicators. Limited studies explored prescribing predictors and patients' expectations and satisfaction with OOH services. In contrast, qualitative studies focussed more on exploring prescribers' experiences, perspectives, behaviours, and the challenges they face during consultations within OOH settings which may influence their decision-making process. Of these, one study explored why patients consult OOH services and how they communicate their problems. Conclusion(s): This review shows the key areas around oral antibacterial prescribing in primary care OOH services. While there is a satisfactory number of published articles covering various areas within OOH, the use of different approaches to OOH across countries may confound the comparison of practice. A strength of this work is using three reviewers to screen identified records independently. Further research is needed to provide a better understanding of current practice in these settings and how it may be contributing to AMR.

To summarise the approach to and findings of the PPIE undertaken as part of a programme of secondary research with a vulnerable, hard to reach population during the COVID-19 pandemic.

BACKGROUND: Public and patient involvement and engagement (PPIE) is an important part of research. The inclusion of PPIE in research is becoming more widespread, however, there are some areas where it is still uncommon. For example, undertaking PPIE in secondary analysis projects is uncommon and PPIE with difficult to reach populations and vulnerable groups can be seen as being too difficult to facilitate. The aim was to summarise the approach to and findings of the PPIE undertaken as part of a programme of secondary analysis with a vulnerable, hard to reach population; residents of residential care facilities (RCFs), during the COVID-19 pandemic. METHODS: As part of a project to develop a publically available database of statutory notifications of adverse events from RCFs in Ireland, residents (n = 9) from RCFs for older people and people with disability were telephone interviewed. Residents were engaged through gatekeepers and posted participant information and consent forms. Themes were identified using content analyses of interview notes. RESULTS: Three parent themes were identified, each with two subthemes: privacy concerns, enthusiasm and dissemination of research findings. Residents highlighted the importance that no personal information be shared in the database. Once data were anonymized, residents thought that the database should be published and shared. Residents reported being happy about research being undertaken using the data and thought that publishing the database would help inform the public about RCFs. Completing a PPIE project with a vulnerable group during the global COVID-19 pandemic required planning and resources. Resources included finances, time and expertise. CONCLUSIONS: The involvement of residents informed the data inclusion in the published database and the approach taken in the protection of personal data. Enthusiasm for publication and research using the database by residents encouraged the developers as it was considered something that was wanted by residents. The benefits of PPIE can be achieved with vulnerable groups during unprecedented times with the appropriate planning. It requires dedication of time, finances and expertise. Overcoming the obstacles was achievable and worthwhile. The approach outlined can be used as an example to support PPIE in secondary analysis projects and or with vulnerable groups.

When doing research, it is important to involve the people that the research is going to impact. Research projects are increasingly including this involvement, however, there are some areas of research where it is not yet commonplace. For example, when undertaking projects with existing data or when the people of interest are considered a difficult to reach or vulnerable group. The LENS project (LEarning from Notifications in Social care) is a research project that developed and published a database using existing data on safety incidents in care homes. We carried out a consultation with people living in care homes as part of this project. People were asked for their input on the development of the database and the research that was being carried out on it. This work was completed during the COVID-19 pandemic and, as such, the people giving input were considered a vulnerable group. The people living in care homes were concerned about personal details being included in the database. Once they were reassured that no personal information would be included they were supportive of the database being made public. They also offered ideas about how the research that used the database could teach people working and living in care homes. The article describes how the researchers engaged the people and what was needed to achieve this. The article shows that involving people from vulnerable groups and in research relating to existing data, adds value even though there are obstacles to overcome. It is summarised here as an example for researchers undertaking similar work.

A moderated mediation effect of symbolic and substantive preventive actions on employees' preventive behavior in the context of Covid‐19

This study utilizes Social Information Processing (SIP) theory to investigate the relationship between organizational preventive actions (substantive vs. symbolic), employee preventive behavior, the mediating role of conspiracy beliefs, and moderating role of leadership integrity in the context of Covid‐19. The study explains leadership integrity as a boundary condition to facilitate or hinder the mediated relationship between organizational actions and employee preventive behavior (EPB). The hypothesized model was tested using partial least square structural equation modeling (PLS‐SEM) on two‐wave data collected from 281 respondents. The results revealed that substantive actions do not predict EPB directly but through conspiracy beliefs. Contrary to these, symbolic actions negatively predict EPB directly. Leadership integrity moderates the relationship between substantive actions and conspiracy beliefs, while the interaction effect with symbolic actions is not supported. The findings of this study caution managers to walk their talk because employees critically observe the most apparent actions, especially when management fails to practice them. The study contributes to social information processing theory by pointing to leadership integrity as a source of authenticity to curb the negative impact of symbolic actions and catalyst the effect of substantive actions on employee preventive behavior.

Identifying Empathic Opportunities During Care Planning Discussions with Chinese Patients with Advanced Cancer and Their Caregivers (Sch434)

Outcomes: 1. Describe unique barriers that Chinese North American patients with advanced cancer face in expressing emotions and discussing future planning. 2. Identify empathic opportunities (ie, topics associated with emotional expression) during care planning discussions with Chinese North American patients. Introduction: Recognizing emotions in intercultural contexts represents a core competency in palliative care. Yet, a paucity of literature describes the types, patterns, and contexts of patient-expressed emotions during high-stakes conversations with patients from linguistically marginalized communities. We sought to address this gap by analyzing the emotional content during care planning conversations with Chinese patients with advanced cancer and their caregivers. Method(s): We conducted a secondary analysis of 22 semistructured interviews of Chinese patients (n=20) with metastatic cancer and their caregivers (n=8) recruited at one American comprehensive cancer centre. Informed by the Empathic Communication Coding System and existing literature, we conducted template analysis to code the transcripts for patients' and caregivers' expressed emotions. We also thematically analyzed the patterns and contexts in which emotions arose. Result(s): Participants were middle-aged (55.6+/-13.5 years), born in China (89.3%), 60.7% female, 85.7% partnered/married, and 89.3% college educated. Most of the interviews were conducted with patients alone (72.7%). Happiness was the most prevalent emotion (62%) followed by gratitude (43%), fear (43%), sadness (38%), anger (14%), surprise (14%), and humour (5%). When a caregiver was present, the interviews trended toward lower frequency of emotional expression. Regarding intensity, only one instance (anger) was categorized as most severe. Regarding context, emotions were only expressed in discussions about the past or present. Specifically, participants expressed positive emotions when discussing clinician attributes, symptom relief, and immigration to North America. Participants expressed negative emotions when discussing burdensome symptoms, diagnostic journey, the COVID-19 pandemic, and experiences with linguistic or cultural discordance. Discussion(s): Emotional expression during high-stakes care planning conversations with Chinese patients and caregivers may be infrequent and grounded in social, topical, and temporal context. Future work is necessary to understand how clinicians could best respond to distressing emotions during naturally occurring palliative care conversations with Chinese patients and their caregivers.Copyright © 2023

Accessing Bereavement Support: A Secondary Analysis of Uk Commission on Bereavement (Ukcb) Evidence

Introduction There are significant social and healthcare inequalities in the provision and access to bereavement services. With the increase in deaths and experiences of bereavement, the Covid-19 pandemic accelerated the need to address this crucial area of psychological, social and healthcare support. The UKCB was set up to respond to the challenges of the pandemic by hearing about the lived experience of bereavement. Aims The study aimed to draw on UKCB data to analyse the experiences of those bereaved in the last five years to explore how age, gender, ethnicity, and sexual orientation were associated with inequalities relating to access, effectiveness, satisfaction, and delivery of services. Methods An in-depth qualitative thematic secondary analysis was conducted of free text data from 1119 individual and 130 organisational UKCB survey responses. Results Age Those over 50 reported not wanting to cause a fuss, saw seeking help as a weakness and were reluctant to access digital support. Family pressures, lack of time, and perceptions of less support available for younger people were reported in respondents under 50 years. Ethnicity: The value of support was compromised where there were language barriers and a lack of cultural and religious understanding. Sexuality: LBGTQ + respondents valued non-judgemental understanding and a feeling of belonging from support where this is lacking on a wider level. Gender: Men leaned toward a preference for more informal and practical support. In more formal support they found difficulties in talking with those unconnected with family and friends. Conclusions Age, gender, ethnicity, or sexual orientation affected many respondents' access to formal and informal bereavement support as well as the effectiveness, satisfaction, and delivery of services. Impact The study contributed recommendations which add to those of the UKCB, that can help to reduce inequalities in effective bereavement support.

Predictors associated with critical care need and inhospital mortality among children with laboratoryconfirmed Covid-19 infection in a high HIV burden region

Introduction: Despite the extra mortality associated with Covid-19 death globally, little is known on COVID-19- related pediatric mortality in Africa. We assessed predictors of critical care needs and in-hospital mortality in South African children with laboratory-confirmed SARS-CoV-2 infection. Method(s): A secondary analysis of AFREhealth cohort children (large cohort of paediatric Covid-19 clinical outcomes across six African countries) admitted to Inkosi-Albert-Luthuli hospital, KwaZulu-Natal, South Africa. We used multivariable logistic regression and cox-proportional hazards models to explore predictors for intensive care and inhospital death. Result(s): Of the 82 children with PCR-confirmed SARS-CoV-2 infection, 35(42.7%) were younger than one year and 59(71%) had a comorbidity. 37(45.2%) children required critical care and 14(17%) died. Significant predictors of critical care need were age<=1year (vs.10-12years)(aOR:5.38,95%CI:1.28- 22.54,p=0.02), >=1comorbidity (aOR:6.62,95%CI:1.49-29.53,p=0.01) and increase in blood urea nitrogen/BUN (aOR:1.53,95%CI:1.13-2.07,p=0.001). HIV-infection (aHR:8.46,95%CI:1.45-49.26,p=0.02), invasive ventilation (aHR:3.59,95%CI:1.01-12.16,p=0.0.048), and BUN (aHR:1.06,95%CI:1.01-1.11,p=0.017) predicted death. Children admitted primarily (vs referred)to a quaternary hospital were less likely to die. Conclusion(s): Children with Covid-19 have a significant hospital death rate. A timely referral system and triage of children at risk for critical care and death, like those under 1 year and with comorbidities, should minimize excess mortality, especially in high HIV-infection burden regions.

Reason for Consultation and Waiting Time in Public Health Establishments during the COVID-19 pandemic, Peru 2020.

Objective: Identify whether the reason for care influences the waiting time in the health facility in the PeruvianpopulationduringtheCOVID-19 pandemic,according to analysis by ENAHO2020. Material(s) and Method(s): Cross-sectional study with secondary analysis of data from the ENAHO of the Institute of Statistics and Informatics (INEI) done in year 2020. For the analysis, regarding the reason for going to the health facility, symptoms were considered compatible with COVID- 19 and other acute symptoms. Result(s): Data of 1363 participants were analyzed No association was found between reason for consultation and waiting time. In the multivariate analysis found an association with female sex (PR: 2,97;IC: 1,09 - 1,54), being attended in centers of Ministerio de Salud (MINSA) establishment (PR:2,18;CI: 1,02 - 1,59)) and be attended by a doctor (PR: 6,52;IC: 1,53 - 2,21). Conclusion: Variables that have association with longer waiting time were female sex, MINSA as establishment of attendance and profesional of attendane is the doctor.Copyright © Colegio Medico del Peru. All rights reserved.

Nurses with workplace violence in pneumology settings during Covid-19

Background: Workplace violence (WPV) has consequences both for healthcare workers and healthcare organizations. Nurses are the most exposed healthcare workers to vertical WPV. Aims and Objectives: Describe the Italian WPV and identify its predictive factors. Method(s): This is a secondary analysis conducted in hospital pneumology settings from a larger study between January and April 2021. Data were collected through the Practice Environment Scale of the Nursing Work Index (PES-NWI;Likert scale 1 to 4) and the Violence in Emergency Nursing and Triage (VENT) Questionnaire. Result(s): The analysis was conducted on 484 pulmonary nurses (72.9% female;mean age 38.9 years, SD 9.8). Thirty-four per cent (n=164) of them have had an experience of WPV in last year and/or their last week and 16.7% (n=81) only in their last week. Comparing main results between nurses with WPV vs no WPV the number of patients was higher for nurses with WPV (MD +4.8;p<.001). The PES-NWI results were significantly worse for nurses with WPV: global mean scores (MD +0.2;p<.001);nurse participation in hospital affairs (MD +0.3;p<.001);nurse manager ability leadership, and support of nurses (MD +0.2;p<.001);physician-nurse relationship (MD +0.2;p<.001). Conclusion(s): Public health companies should reduce WPV by investing in resources for the management and prevention of the phenomenon. Integrated and multimodal programs of prevention and management of WPV are useful to combat it. Improving the work environment and job satisfaction should reduce WPV.

2022 ABA Annual Meeting Abstracts/Poster

The proceedings contain 7 papers. The topics discussed include: pediatric burn care: how burn camps survived and thrived during the coronavirus pandemic;a retrospective chart review to determine hypophosphatemia incidence and phosphorus supplementation requirements in patients with severe thermal cutaneous injuries receiving high-volume hemofiltration;setting the standard: using the aba burn registry to benchmark risk adjusted mortality;burn injury from smoking electronic cigarettes while on supplemental oxygen;focused wound care handoff improves burn center physician-nursing communication and wound care education;modified frailty index is an independent predictor of death in the burn population: a secondary analysis of the transfusion requirement in burn care evaluation (TRIBE) study;and topical hemostatic agents in burn surgery: a systematic review.

The 6 A's model of social worker associations and COVID-19: A preliminary insight

This paper offers the 6 A's model of social worker associations and COVID-19, which includes (i) 'Apprehend', (ii) 'act', (iii) 'advocate', (iv) 'alliance', (v) 'an emphasis on solidarity and resilience' and (vi) 'a future prospect'. The model is based on the findings of qualitative analysis of social worker associations' reports on COVID-19. It also offers insights that can be utilised in similar crises in the future.

The Risk of COVID-19 Infection in Individuals with Alopecia Areata

OBJECTIVE: We sought to determine the risk of contracting coronavirus disease (COVID-19) in individuals with alopecia areata (AA) compared to individuals without AA. METHOD(S): We queried the Symphony Health-derived data from the COVID-19 Research Database, and individuals with a diagnosis of AA from 2019 to 2020 were included in the AA cohort. Subjects with no record of AA diagnosis from 2019 to 2020 were randomly placed in the control group in a 4:1 size ratio compared with the AA group. Laboratory-confirmed cases of COVID-19 between January 1, 2020, and September 1, 2021, were identified. RESULT(S): The AA and non-AA cohorts included 73,784 and 280,991 subjects, respectively. The COVID-19 incidence rate ratio (IRR) for adults with AA was 0.72 (95% CI 0.68, 0.76) compared with adults without AA (p<0.001). Within the AA cohort, moderate-severe AA showed a similar decreased risk in COVID-19 infection compared to mild AA. LIMITATIONS: This study is limited by its retrospective nature and the use of ICD-10 codes for the identification of individuals with AA and COVID-19, which may underestimate the true burden of disease. CONCLUSION(S): Individuals with AA have a slightly decreased risk of contracting COVID-19. Notably, it has been demonstrated that interferon-gamma (IFN- gamma) leads to the downregulation of the angiotensin-converting enzyme 2 (ACE2), the SARS-CoV receptor.1 Thus, it is possible that increased levels of IFN- gamma seen in individuals with AA confer some protection against this viral infection.Copyright © 2022 Matrix Medical Communications. All rights reserved.

Factors Associated With Telemedicine Use Among Patients With Rheumatic and Musculoskeletal Disease: Secondary Analysis of Data From a German Nationwide Survey.

BACKGROUND: Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the COVID-19 pandemic, TM experienced a massive upswing. A previous study revealed that physicians' willingness to use TM and actual use of TM are closely connected to their knowledge of TM. However, it remains unclear which factors are associated with patients' motivation to use TM. OBJECTIVE: This study aims to identify the factors that determine patients' willingness to try TM (TM try) and their wish that their rheumatologists offer TM services (TM wish). METHODS: We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with rheumatic and musculoskeletal disease (RMD). Bayesian univariate and multivariate logistic regression analyses were applied to the data to determine which factors were associated with TM try and TM wish. The predictor variables (covariates) studied individually included sociodemographic factors (eg, age and sex) and health characteristics (eg, disease type and health status). All the variables positively or negatively associated with TM try or TM wish in the univariate analyses were then considered for the Bayesian model averaging analysis after a selection based on the variance inflation factor (≤2.5). All the analyses were stratified by sex. RESULTS: Of the total 102 variables, 59 (57.8%) and 45 (44.1%) variables were found to be positively or negatively associated (region of practical equivalence ≤5%) with TM try and TM wish, respectively. A total of 16 and 8 determinant factors were identified for TM try and TM wish, respectively. Wishing that TM services were offered by rheumatologists, having internet access at home, residing 5 to 10 km away from the general practitioner's office, owning an electronic device, and being aged 40 to 60 years were among the factors positively associated with TM try and TM wish. By contrast, not yet being diagnosed with an RMD, having no prior knowledge of TM, having a bad health status, living in a rural area, not documenting one's health status, not owning an electronic device, and being aged 60 to 80 years were negatively associated with TM try and TM wish. CONCLUSIONS: Our results suggest that health status, knowledge, age, and access to technical equipment and infrastructure influence the motivation of patients with RMD to use telehealth services. In particular, older patients with RMD living in rural areas, who could likely benefit from using TM, are currently not motivated to use TM and seem to need additional TM support.

To Include an Error Once May Be Regarded as a Misfortune, to Include It Again Looks Like Carelessness

Objectives: Retractions related to COVID-19 publications has highlighted how prevalent retractions of primary research can be. Whilst there is a responsibility for authors of primary research to correct errors or remove fraudulent studies, the responsibility of correcting errors in downstream research is less clear. To further understand the situation we identifyed case studies where evidence synthesis has included retracted articles or articles with subsequently identified errors, how it has been handled and propose potential solutions. Method(s): Identified case studies from work the authors were undertaking where evidence synthesis ended up including primary studies with errors or retractions included. Result(s): Case studies with different responses to errors in primary articles were identified: A typographical error in a primary study was identified in evidence synthesis used to support a NICE health technology assessment;authors of the primary study acknowledged the error but did not correct the publication meaning the error remained in the publication and subsequent meta-analyses. Retracted COVID-19 publications were acknowledged by authors of one published meta-analysis;authors updated analysis to remove the offending research. A primary study was retracted whilst the evidence synthesis publication was under peer-review;following publication authors were notified of the retraction and opted to retract rather than revise their analysis. Conclusion(s): Prevailing errors in evidence synthesis, despite retraction or correction of a primary study, could negatively influence healthcare decision making. Living systematic reviews or meta-analyses are one solution but may not always be practicable. To minimise the risk of perpetuating errors, authors of secondary analyses could commit to ensure data included in their analyses is accurate for a defined period after the initial analysis has been conducted, e.g., 2 years, after which the analyses could be presumed to be outdated. The defined period could be influenced by several factors including rate of new studies being published in the indication. Copyright © 2022

Factors Associated With Telemedicine Use Among German General Practitioners and Rheumatologists: Secondary Analysis of Data From a Nationwide Survey.

BACKGROUND: Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the SARS-CoV-2 pandemic, TM experienced a massive upswing. However, in rheumatology care, the use of TM stagnated again shortly thereafter. Consequently, the factors associated with physicians' willingness to use TM (TM willingness) and actual use of TM (TM use) need to be thoroughly investigated. OBJECTIVE: This study aimed to identify the factors that determine TM use and TM willingness among German general practitioners and rheumatologists. METHODS: We conducted a secondary analysis of data from a German nationwide cross-sectional survey with general practitioners and rheumatologists. Bayesian univariate and multivariate logistic regression analyses were applied to the data to determine which factors were associated with TM use and TM willingness. The predictor variables (covariates) that were studied individually included sociodemographic factors (eg, age and sex), work characteristics (eg, practice location and medical specialty), and self-assessed knowledge of TM. All the variables positively and negatively associated with TM use and TM willingness in the univariate analysis were then considered for Bayesian model averaging analysis after a selection based on the variance inflation factor (≤2.5). All analyses were stratified by sex. RESULTS: Univariate analysis revealed that out of 83 variables, 36 (43%) and 34 (41%) variables were positively or negatively associated (region of practical equivalence≤5%) with TM use and TM willingness, respectively. The Bayesian model averaging analysis allowed us to identify 13 and 17 factors of TM use and TM willingness, respectively. Among these factors, being female, having very poor knowledge of TM, treating <500 patients per quarter, and not being willing to use TM were negatively associated with TM use, whereas having good knowledge of TM and treating >1000 patients per quarter were positively associated with TM use. In addition, being aged 51 to 60 years, thinking that TM is not important for current and future work, and not currently using TM were negatively associated with TM willingness, whereas owning a smart device and working in an urban area were positively associated with TM willingness. CONCLUSIONS: The results point to the close connection between health care professionals' knowledge of TM and actual TM use. These results lend support to the integration of digital competencies into medical education as well as hands-on training for health care professionals. Incentive programs for physicians aged >50 years and practicing in rural areas could further encourage TM willingness.

The experiences of patients, family caregivers, healthcare providers, and health service leaders with compassionate care following hospitalization with COVID-19: a qualitative study.

PURPOSE: This study explored the experiences of patients, caregivers, healthcare providers, and health service leaders of compassion in the care of people hospitalized with COVID-19. MATERIALS AND METHODS: This study is a secondary analysis of qualitative data deriving from primary research data on recommendations for healthcare organizations providing care to people hospitalized with COVID-19. Participants comprised patients with COVID-19 (n = 10), family caregivers (n = 5) and HCPs in COVID-19 units (n = 12). Primary research data were analyzed deductively under the "lens" of compassion, as defined by Goetz. RESULTS: Four interacting themes were found: (1) COVID-19 - to care or not to care? The importance of feeling safe, (2) A lonely illness - suffering in isolation with COVID-19, (3) Compassionate care for people with COVID-19 across the hospital continuum, and (4) Sustaining compassionate care for people hospitalized with COVID-19 - healthcare provider compassion fatigue and burnout. CONCLUSIONS: Compassionate care is not a given for people hospitalized with COVID-19. Healthcare providers must feel safe to provide care before responding compassionately. People hospitalized with COVID-19 experience additional suffering through isolation. Compassionate care for people hospitalized with COVID-19 is more readily identifiable in the rehabilitation setting. However, compassion fatigue and burnout in this context threaten healthcare sustainability.IMPLICATIONS FOR REHABILITATIONHealthcare providers need to feel physically and psychologically safe to provide compassionate care for people hospitalized with COVID-19.People hospitalized with COVID-19 infection experience added suffering through the socially isolating effects of physical distancing.Compassion and virtuous behaviours displayed by healthcare providers are expected and valued by patients and caregivers, including during the COVID-19 pandemic.High levels of compassion fatigue and burnout threaten the sustainability of hospital-based care for people with COVID-19.

INVESTIGATING HETEROGENEITY OF TREATMENT EFFECT FOR CONVALESCENT PLASMA IN SEVERE COVID-19: SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL

SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to Homebound SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: Minimally-biased clustering (MBC) has identified hypoinflammatory (hypo-I) and hyperinflammatory (hyper-I) subphenotypes in ARDS. The hyper-I type exhibits higher inflammatory markers, clinical severity, and mortality. Similar subphenotypes were recently identified in COVID-19-related ARDS. Lower PCR cycle threshold was associated with higher mortality in the hypo-I type, implying an association between viral load (VL) and clinical outcomes in patients with dampened inflammatory responses. In a recent randomized clinical trial (RCT), convalescent plasma (CP) improved survival in severe COVID-19. We hypothesized that the anti-viral effect of CP would more significantly benefit patients without acute hyperinflammation, for whom VL may be associated with mortality. METHODS: From 4/2020-11/2020, 223 adults >18 years of age in New York and Rio de Janeiro with laboratory-confirmed severe COVID-19 were enrolled in a double-blind RCT evaluating the efficacy of CP. 150 patients received CP;73 received control plasma. Hierarchical clustering (HC) of clinical and laboratory data was used to identify sub-groups in the study population. Primary and secondary outcomes were clinical status at 28 days by modified WHO ordinal score (higher scores indicating worse status) and 28-day mortality. Welch’s t-tests, chi-squared tests, and Fisher’s exact tests were used to compare clinical and laboratory data across clusters. Proportional odds and logistic regression were used to assess the association between cluster-derived subgroups and outcome and the interaction between subgroups and randomized treatment assignment. RESULTS: HC identified two clusters (C1;N=156 and C2;N=67) in the population. Patients in C2 had significantly higher markers of inflammation (sedimentation rate, C-reactive protein, interleukin-6), coagulation (D-dimer), and cardiac injury (cardiac troponin) as well as relative lymphopenia, hypoalbuminemia, and lower bicarbonate. At 28 days, patients in C2 had significantly worse clinical status (OR of 1-pt ordinal score increase 3.10, 95% CI 1.72-5.60, p=0.0002) and higher mortality (28.4% vs. 11.5%, OR 3.03, 95% CI 1.47-6.26, p=0.003). There was no significant between-cluster heterogeneity of CP treatment effect on either ordinal score (OR 0.56, 95% CI 0.16-1.95, p=0.36) or mortality (OR 0.52, 95% CI 0.12-2.30, p=0.38). CONCLUSIONS: C2 exhibited elevated inflammatory markers and lymphopenia indicative of an acute hyperinflammatory response. C2 exhibited poorer clinical status and higher mortality at 28 days. There was no evidence of significant heterogeneity of CP treatment effect on 28-day clinical outcomes. CLINICAL IMPLICATIONS: The previously shown mortality benefit of CP in severe COVID may not differ based on inflammatory state. Using MBC methods on larger samples, e.g., patient data from a meta-analysis of CP trials, may reveal a significant impact of inflammatory state on CP effect. DISCLOSURES: No relevant relationships by Matthew Cummings Received a grant sub-award from Amazon relationship with Amazon Please note: 4/2020 -12/2020 Added 03/10/2022 by Max O'Donnell, value=Grant/Research Support No relevant relationships by Tejus Satish No relevant relationships by Allison Wolf