EVALUATION OF TELENURSING FOLLOW-UP IN A COHORT OF STABLE/LOW DISEASE ACTIVITY PATIENTS WITH INFLAMMATORY ARTHRITIDES: A FEASIBILITY STUDY

BackgroundPeriodic follow-up (FU) is necessary for patients with Rheumatic Diseases (RDs). In the case of a stable clinical condition or low disease activity, FU can be carried out also by rheumatology nurses (RNs). Recent studies focusing on FUs led by RNs either in Rheumatology Clinics and with Telenursing (TN), showed promising results in terms of outcomes, cost reduction and users' satisfaction.ObjectivesTo evaluate the feasibility of a Telenursing FU in a Rheumatology Centre in Florence, Italy.MethodsIn this pilot study, patients with stable inflammatory arthritis or low disease activity were contacted, after their first visit, through TN (T0) and then assessed during the following in-person visit (V12) by RNs for treatment adherence, for pain, for mental and physical health, for workability, for perception of disease activity and satisfaction concerning the TN service.ResultsOut of 27 interviewed patients, 59.3% (n=16/27) was affected by Rheumatoid Arthritis (RA), 18.5% (n=5/27) by Spondyloarthritis (AS), 14.8% (n=4/27) by Psoriatic Arthritis (PsA) and 7.4% (n=2/27) by Juvenile Idiopathic Arthritis. The mean age was 57.5±13.1 (M± DS) years and the treatment adherence level was optimal. 11.1% (n=3/27) of patients was referred for medical consultation because of the urgent clinical situation assessed by the RNs according to the clinical multidisciplinary checklist. After specialist consultation, 1 patient was revalued in presence for a transient ischemic attack;1 patient was contacted by the rheumatologist following independent discontinuation of methotrexate therapy;1 patient was redirected to urgent dermatology consultation because of a suspected cutaneous drug reaction.During the TN period (12 months), 33.3% (n=9/27) of the patients contracted SARS-CoV-2 infection and 11.1% (n=3/27) contracted urinary or upper respiratory tract infections.RA patients showed a mean Rheumatoid Arthritis Impact of Disease-RAID score of 2.4 at T0 and 2.5 at V12 (Range 0-10);AS patients showed a mean Assessment of Spondyloarthritis International Society-ASAS score of 0.3 in both periods and PsA showed a mean Psoriatic Arthritis Impact of Disease-PSAID score of 0.7 and 0.8 at T0 and V12, respectively. Among RA, AS and PsA patients, as a pain score of 3 was recorded in both periods.In order to attend the in-person FU visit, 68.4% (n=13/19) of the patients took work leave. 37% (n=10/27) of them waited 40.9±18.6 minutes at V12 control. The average distance between the Rheumatology Centre and patients' home was 29.3±25.6 km. 15.4% (n=5/13) of the respondents did not own a car and 23.1% (n=3/13) was accompanied to visit by their caregiver.All the included patients expressed high satisfaction for the TN service, corresponding to 5 point Likert scale.ConclusionThe data show that TN FU is a valuable model for maintaining an adequate level of therapeutic adherence, reducing the travel time and working day loss, intercepting remotely clinical issues, as well as registering a high level of user acceptance and satisfaction. Further studies on larger samples are needed to confirm our findings.References[1] Bech B et al (2020) 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Annals of the Rheumatic Diseases;79:61-68. doi: 10.1136/annrheumdis-2019-215458.[2] Alcazar B, Ambrosio L. (2019) Tele-nursing in patients with chronic illness: a systematic review. An Sist Sanit Navar;42(2):187-197. doi: 10.23938/ASSN.0645.[3] Larsson I et al. (2013) Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. Journal of Advanced Nursing;70(1), 164–175., 2013 doi:10.1111/jan.12183Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Cardiopulmonary exercise testing in patients with COVID19 at 3 months from hospital discharge

Introduction: The long-term COVID-19 effects are currently unknown. Whether and for how long symptoms extend beyond the acute phase of the disease is unresolved Aim: To determine the functional capacity of COVID-19 survivors by cardio- pulmonary exercise testing (CPET) and describe its association with dyspnoea and pulmonary function test (PFT). Methods and Results: All COVID-19 patients discharged from our tertiary care institution were enrolled in a prospective follow-up study which would assess clinical, instrumental and laboratory characteristics of COVID-19 survivors at 3months from hospital discharge (Careggi University Hospital, Florence). Clinical evaluation included: peripheral blood samples including inflammatory cytokines, pulmonary function test (functional respiratory and 6 minwalking test), lung ultrasound, ECG recording and echocardiographic exam. All patients with peripheral oxygen desaturation at 6 min-walking test (SpO2 < 92%), dyspnoea and with a history of hospitalization in critical care settings were referred for CPET. Dyspnoea was classified with the Medical Research Council (MRC) scale. From June 2020 to May 2021, 198 patients were enrolled;overall, 42% of patients presented with dyspnoea at 3 months from hospital discharge with no difference according to disease severity on hospital admission (P 1/4 0.233) Conclusion(s): At 3-months, almost 1 in 2 patients discharged for COVID-19 pneumonia presented with dyspnoea, irrespective of disease severity. We want to compare CPET and spirometry data (already performed in 110 patients), highlighting differences between ventilated patients (invasive or noninvasive) and patients admitted to the ward. The data are still being analyzed.

RHEUMATIC MUSCULOSKELETAL DISEASES (RMDS) during the FIRST WAVE of the COVID19 PANDEMIC: PATIENTS' POINT of VIEW on the ROLE of TELEMEDICINE

Background: The COVID19 pandemic has caused health problems in people's daily lives with a signifcant psychological impact. In fact, patients with RMDs have experienced diseases' fare and also psychological problems. The lockdown and the 'social quality changes' have impacted the life and the well-being of RMDs patients, influencing directly the implementation of telemedicine during daily practice. Objectives: A descriptive observational study was designed to analyse the short-term effect of the frst wave on RMDs patients on social quality changes and the usefulness of telemedicine. Methods: The survey was carried out by administering a questionnaire consisting of 30 questions, developed ad hoc using Likert scales. Items such as family and work environment, access to healthcare facilities, healthcare provided to the patient, disease activity and the mental health status of individuals (anxiety/depressive symptoms) were investigated. Preliminary data on the frst wave were collected between September and November 2021 through patient associations and social networks. Results: 40 RMDs patients (Rheumatoid Arthritis 57.5%, Psoriatic Arthritis 35%, Fibromyalgia and others 7.5%) prevalently women (97.5%) were included in the survey. During the pandemic, 72% of respondents reported cancellation or delays in scheduled appointments and 50% did not have alternative contacts (telephone consultations, e-mail prescriptions, telematics training) with the hospital. 40.5% of patients reported difficulty in fnding DMARDs and material for the treatment of ulcers, 28.2% reported difficulties in accessing the health facilities. In particular, 34.2% reported the total closure of the hospital facilities. Moreover, our data show a worsening of health status due to an increased anxiety concerning the management of their RMDs, an increased stress within the family, a reduced access to care facilities due to their closure or travel restrictions. In 57% of patients, a worsening of health status was reported, while in 90% stress and a feeling of abandonment was developed since the beginning of the pandemic. In this context, telemedicine was considered useful by 97.5% of patients, although patients felt that an improvement was necessary with an integration with the regular follow up. Conclusion: Patients with RMDs reported that the signifcant delays or cancellation of the outpatient visits provoked an increase of stress, worry and anxiety for their health. The majority was very concerned about the overall management of their RMDs. The worsening of symptoms in more than half of the patients was the most worrisome observation. Almost all patients agreed that Telemedicine might help the clinical evaluation of their RMDs, also providing a signifcant support to their psychological condition because of the direct contact with the caring physician and health professionals.

Design of a wearable device for physiological parameter monitoring in a COVID setting.

The study focuses on the realization of an accurate device for the detection of different physiological parameters. It has been realized a simple portable system containing the necessary electronics and ensuring the monitoring of the blood oxygenation, the body temperature, the air quality, the respiratory rate and the ECG. The main processing unit consists in a Raspberry Pi Zero W connected to the Healthy Pi4. The latter provides the interface for the clinical pulse-oxymeter while the measures of temperature and quality air are provided using the I2C protocol. The Bluetooth module is finally used to provide the ECG and blood rate data. The collected data are elaborated using Matlab and Python. To evaluate the accuracy of the realized device some experimental tests have been conducted on different subjects, comparing subjects working in Covid area with others resting at home. In both cases the monitoring time was 4 hours. Results have shown good performances of the system, detecting accurately the differences of the parameters values between the two situations. The usability of the device was assessed by administering a questionnaire to the healthcare personnel involved in the experimentation. The outcome shows a good usability of the system as well as an acceptable dressing time.

The experience of a rheumatology unit during the COVID19 lockdown: Telemedicine allows a safe follow up of patients with rheumatic diseases

Background: In March this year, most of the routine activities were cancelled during the streaming of the pandemic in Italy. This prompted a pragmatic reorganization of the traditional care model of nursing and medicine, to quickly give an efficient clinical response. During the first phase of the pandemic, outpatient visits dropped by more than 60%, forcefully shifting to telemedicine to assure continuity of care despite the lockdown. Objectives: The aim of the present work was to describe the strategy adopted during and immediately after the lockdown to assure the follow up of patients and the maintenance of their treatment in an outpatient “virtual” telemedicine clinic dedicated to RDs. Methods: the patient flow to a rheumatology division during the lockdown was evaluated retrospectively from March to September 2020 in accordance with local restrictions, and three periods are described. Results: 653/913 (71.5%), 542/542 (100%) and 1.048/1.048 (100%) infusion activities scheduled were performed at the centre for daily infusion and pre-infusion assessment, respectively during the 1st, 2nd and 3rd period. In the outpatient clinic during the 1st period, 96.96% of the cases was shifted to Telemedicine, which decreased to 52.45% in the 2nd period;while in the 3rd period, 97.6% of the performances were carried out at the clinic. Diagnostic procedures, such as ultrasound, capillaroscopy, and joint injection were generally postponed during the 1st period, reduced drastically during the 2nd and performed regularly during 3rd period. Ulcer treatment and the Clinical Trial Unit never stopped their activity. The flow of the activity of the outpatient clinic and the day hospital is represented as monthly trends in graph 1 (See Graph 1). Conclusion: Our data show the feasibility of Telemedicine in a lockdown condition. Shifting stable patients to Telemedicine has the potentiality to minimize the risk of contagion and allow continuity of care. In the future, the use of Telemedicine for specific clinical uses might assure patient assistance also in non-pandemic conditions. (Figure Presented).

Prevalence of nutritional risk and malnutrition during and after hospitalization for COVID-19 infection: Preliminary results of a single-centre experience.

BACKGROUND & AIMS: The effect of the COVID-19 infection on nutritional status is not well established. Worldwide epidemiological studies have begun to investigate the incidence of malnutrition during hospitalization for COVID-19. The prevalence of malnutrition during follow-up after COVID-19 infection has not been investigated yet. The primary objective of the present study was to estimate the prevalence of the risk of malnutrition in hospitalized adult patients with COVID-19, re-evaluating their nutritional status during follow-up after discharge. The secondary objective was to identify factors that may contribute to the onset of malnutrition during hospitalization and after discharge. METHODS: We enrolled 142 COVID-19 patients admitted to Careggi University Hospital. Nutritional parameters were measured at three different timepoints for each patient: upon admission to hospital, at discharge from hospital and 3 months after discharge during follow-up. The prevalence of both the nutritional risk and malnutrition was assessed. During the follow-up, the presence of nutritional impact symptoms (NIS) was also investigated. An analysis of the association between demographic and clinical features and nutritional status was conducted. RESULTS: The mean unintended weight loss during hospitalization was 7.6% (p < 0.001). A positive correlation between age and weight loss during hospitalization was observed (r = 0.146, p = 0.08). Moreover, for elderly patients (>61 years old), a statistically significant correlation between age and weight loss was found (r = 0.288 p = 0.05). Patients admitted to an Intensive Care Unit (ICU) or Intermediate Care Unit (IMCU) had a greater unintended weight loss than patients who stayed in a standard care ward (5.46% vs 1.19%; p < 0.001). At discharge 12 patients were malnourished (8.4%) according to the ESPEN definition. On average, patients gained 4.36 kg (p < 0.001) three months after discharge. Overall, we observed a weight reduction of 2.2% (p < 0.001) from the habitual weight measured upon admission. Patients admitted to an ICU/IMCU showed a higher MUST score three months after discharge (Cramer's V 0.218, p = 0.035). With regard to the NIS score, only 7 patients (4.9%) reported one or more nutritional problems during follow-up. CONCLUSIONS: The identification of groups of patients at a higher nutritional risk could be useful with a view to adopting measures to prevent worsening of nutritional status during hospitalization. Admission to an ICU/IMCU, age and length of the hospital stay seem to have a major impact on nutritional status. Nutritional follow-up should be guaranteed for patients who lose more than 10% of their habitual weight during their stay in hospital, especially after admission to an ICU/IMCU.