Ongoing shielding behavior one year post COVID-19: results from a longitudinal study of patients with inflammatory arthritis.

Many patients with inflammatory arthritis (IA) were instructed to shield during the COVID-19 pandemic. Despite the ending of lockdowns and vaccination, large proportions of IA patients were continuing to shield when it is no longer needed. Given the detrimental effects of shielding on mental and physical health, understanding the rates and reasons for shielding is needed to help clinicians advise patients accordingly. This study was a 12-month prospective study following participants with IA during the COVID-19 pandemic. The proportions of IA patients shielding at each time point were calculated. Additionally, regressions and odds ratios for shielding were determined to assess medication type, mental health, and risk perception. While the extent of shielding fluctuated over the year of lockdowns, nearly all IA patients (93.5%) were still engaging in some shielding in 2021, with nearly half (43%) still shielding most or all of the time. Medications that were previously considered higher risk were not significantly associated with higher rates of shielding (OR = 1.60, p = 0.29), but greater symptoms of depression in June 2020 (OR = 1.07, p = 0.03) was both associated with increased the odds of shielding in June 2021. The high rates of IA patients continuing to shield in 2021 put more strain on patients and professionals as social isolation is linked with worsening mental and physical health, as well as greater difficulty with self-management. It is important for clinicians to be aware of this trend to ease the stress on patients.

Impact of incremental initiation of haemodialysis on mortality: a systematic review and meta-analysis.

BACKGROUND: Incremental haemodialysis initiation entails lower sessional duration and/or frequency than the standard 4 h thrice-weekly approach. Dialysis dose is increased as residual kidney function (RKF) declines. This systematic review evaluates its safety, efficacy and cost-effectiveness. METHODS: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library databases from inception to 27 February 2022. Eligible studies compared incremental haemodialysis (sessions either fewer than three times weekly or of duration <3.5 h) with standard treatment. The primary outcome was mortality. Secondary outcomes included treatment-emergent adverse events, loss of RKF, quality of life and cost effectiveness. The study protocol was prospectively registered. Risk of bias assessment used the Newcastle-Ottawa Scale and the revised Cochrane risk of bias tool, as appropriate. Meta-analyses were undertaken in Review Manager, Version 5.4. RESULTS: A total of 644 records were identified. Twenty-six met the inclusion criteria, including 22 cohort studies and two randomized controlled trials (RCTs). Sample size ranged from 48 to 50 596 participants (total 101 476). We found no mortality differences (hazard ratio = 0.99; 95% CI 0.80-1.24). Cohort studies suggested similar hospitalization rates though the two small RCTs suggested less hospitalization after incremental initiation (relative risk = 0.31; 95% CI 0.18-0.54). Data on other treatment-emergent adverse events and quality of life was limited. Observational studies suggested reduced loss of RKF in incremental haemodialysis. This was not supported by RCT data. Four studies reported reduced costs of incremental treatments. CONCLUSIONS: Incremental initiation of haemodialysis does not confer greater risk of mortality compared with standard treatment. Hospitalization may be reduced and costs are lower.

Exploring perceptions of digital technology and digital skills among newly registered nurses and clinical managers.

BACKGROUND: Digital technology has an increasing role in healthcare, but staff lack opportunities to develop their digital skills and there is a lack of research on education and training in digital technology for staff. AIM: To explore nurses' perceptions of the use of digital technology in their practice and to identify the digital skills required by newly registered nurses to work in a digitally enabled environment. METHOD: Individual semi-structured interviews were conducted on an online communication platform with nine participants - four newly registered nurses and five senior nurses working in clinical and/or management roles. Inductive thematic analysis was used to analyse the data. FINDINGS: Several barriers and facilitators to the use of digital technology were identified, including around infrastructure, time, skills, training, support, leadership, familiarity and confidence. The use of digital technology may enhance care consistency and increase patient autonomy, but it may also erode nurse-patient relationships. CONCLUSION: Digital technology can enhance patient care but organisational barriers, notably in relation to digital literacy training, need to be addressed for nurses to fully adopt it.

The Role of Patient-Reported Experience and Outcome Measures in Kidney Health Equity-Oriented Quality Improvement.

Risk, prevalence, management, and outcomes in chronic kidney disease (CKD) are influenced by social and broader determinants of health. Consequently, there are wide-ranging kidney health inequities. As patients are key stakeholders, their perspectives on the care they receive and on health status are central in guiding health system improvement, particularly to reduce the impact of disadvantage. Patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) are important self-report tools in quality improvement, acting to guide initatives aimed at enhancing access to timely and relevant support. However, the extent to which PREMs and PROMs address the reduction of kidney health inequities is unclear. The aim of this review is to summarize how PREMs and PROMs are designed and implemented, highlighting key dimensions that are integral to health equity-oriented quality improvement in kidney care. There are several problems yet to be overcome so that such tools do not unintentionally reproduce kidney health gaps. Inclusive generation of the scope of tools, transparent reporting on attributes of patients who engage, and embedding PREMs and PROMs within a framework of value-based quality improvement is fundamental to their impact as part of equitable health system transformation. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.

Mental health, quality of life and self-management behaviours: online evaluation of inflammatory arthritis patients over 1 year of COVID-19 lockdowns.

Objective: Patients with inflammatory arthritis were especially vulnerable to the psychosocial and health impacts of coronavirus disease 2019 (COVID-19) and the lockdowns. This study investigated the impact of these changes on mental health, physical health and quality of life for inflammatory arthritis patients over 1 year following the initial lockdown in the UK. Methods: Three hundred and thirty-eight participants with inflammatory arthritis completed an ambidirectional study consisting of online questionnaires at four time points for 1 year. The questionnaires assessed demographic information, inflammatory arthritis condition, mental health, physical symptoms, self-management behaviours, COVID-19 status and impacts. Means, linear regressions and structural equation modelling for mediations were conducted over 12 months. Results: Physical health concerns peaked during June 2020, then declined, but did not return to baseline. Depression was associated with worse quality of life at baseline, as shown by the beta coefficient, (ß= 0.94, P < 0.01), September (ß = 0.92, P < 0.01), November (ß= 0.77, P < 0.01) and 1 year (ß = 0.77, P < 0.01). Likewise, anxiety was associated with worse quality of life at baseline (ß = 1.92, P < 0.01), September (ß = 2.06, P < 0.01), November (ß = 1.66, P = 0.03) and 1 year (ß = 1.51, P = 0.02). The association between depression and quality of life was mediated by physical activity (ß= 0.13, P < 0.01) at baseline. The association between anxiety and quality of life was also mediated by physical activity (ß = 0.25, P = 0.04) at baseline. Conclusion: Physical health continued to be worse 1 year later compared with before the COVID-19 lockdowns in patients with inflammatory arthritis. Mental health showed long-term effects on quality of life, with an impact for ≥12 months. Lastly, physical activity mediated between mental health and quality of life in the short term.

Evaluating digital competencies for allied health professionals in the United Kingdom.

The Covid-19 pandemic accelerated the move to virtual and remote consultations in clinical practice with digital technologies widely implemented. eHealth interventions and use of applications in a variety of conditions means that patients and their families, as well as healthcare professionals, can access and interpret data in real-time, as well as providing trends in various clinical parameters including blood pressure for instance. Despite the aim of digital transformation in the National Health Service in the United Kingdom, this has not been fully realised and there is no consensus on the skills and competencies required for allied health professionals (AHPs). This qualitative study undertook two focus groups with twelve AHPs to evaluate the AHP Digital Competency Framework in the UK. The participants recognised the importance of a digital technology in their clinical practice and perceived digital literacy as essential for AHPs. In relation to the AHP framework, participants agreed that competencies in digital technology were clinically relevant, and assessment of these competencies should be performed regularly in practice. However, the majority were unaware of the AHP digital competency framework and suggested improvements to optimise its use in practice and identified areas for improvement. Overall, the AHP Digital Competency Framework has the potential, with better dissemination and further refinement of the wording, to become a useful tool to support the enhancement of digital competency in AHPs and improve the delivery of patient care.

Evaluating digital competencies for pharmacists.

BACKGROUND: Digital technologies are widely used in healthcare. In the UK, Health Education England developed a framework on digital capabilities so that healthcare professionals could determine their health literacy, evaluate their competencies and identify their learning needs. For pharmacists, specific digital capabilities were developed - Digital Capabilities for the Pharmacy Workforce. AIM: The aim of this study was to explore the views of pharmacists on digital competency in the workplace and evaluate the suitability of the Digital Capabilities Framework for the Pharmacy Workforce for use within clinical practice. METHODOLOGY: A focus group of experienced pharmacists working within the NHS in the UK was conducted and thematic analysis of the content was undertaken. RESULTS: Seven pharmacy staff took part in an online focus group. They held senior positions across various London NHS hospitals and in community settings. From the content of the focus group, four themes were identified: Theme 1 - Use of digital technology, Theme 2 - Digital competency and training of the pharmacy workforce, Theme 3 - Assessment of digital competency and Theme 4 - Evaluation of the Digital Capabilities Framework for the Pharmacy Workforce. The pharmacists in this study suggested that the Digital Capabilities Framework could be used as a helpful assessment tool to ensure that all staff should have the appropriate digital skills and capabilities to fulfil their pharmacy role. CONCLUSION: With widespread use of digital technologies in practice, there is a need for formal digital technology training for pharmacists. The Digital Capabilities Framework has the potential to be utilised as an assessment tool to ensure pharmacy staff have the appropriate levels of digital skills to fulfil their clinical duties and make their service more efficient.

Measures of treatment burden in dialysis: A scoping review.

BACKGROUND: Dialysis is a life-sustaining treatment for patients with advanced kidney failure, but it is extremely burdensome. Despite this, there are very few tools available to assess treatment burden within the dialysis population. OBJECTIVE: To conduct a scoping review of generic and disease-specific measures of treatment burden in chronic kidney disease, and assess their suitability for use within the dialysis population. DESIGN: We searched CINAHL, MEDLINE and the Cochrane Library for kidney disease-specific measures of treatment burden. Studies were initially included if they described the development, validation or use of a treatment burden measure or associated concept (e.g., measures of treatment satisfaction, quality of life, illness intrusiveness, disease burden etc.) in adult patients with chronic kidney disease. We also updated a previous scoping review exploring measures of treatment burden in chronic disease to identify generic treatment burden measures. RESULTS: One-hundred and two measures of treatment burden or associated concepts were identified. Four direct measures and two indirect measures of treatment burden were assessed, using adapted established criteria, for suitability for use within the dialysis population. The researchers outlined eight key dimensions of treatment burden: medication, financial, administrative, lifestyle, health care, time/travel, dialysis-specific factors, and health inequality. None of the measures adequately assessed all dimensions of treatment burden. CONCLUSION: Current measures of treatment burden in dialysis are inadequate to capture the spectrum of issues that matter to patients. There is a need for dialysis-specific burdens and health inequality to be assessed when exploring treatment burden to advance patient care.

The use of culturally adapted and translated depression screening questionnaires with South Asian haemodialysis patients in England.

BACKGROUND: Depression is common amongst patients receiving haemodialysis (HD). Assessment and intervention when faced with language and cultural barriers is challenging. To support clinician decisions, we conducted a cross-sectional study to assess the use of culturally adapted and translated versions of commonly-used depression screening questionnaires with South Asian patients receiving HD in England. METHODS: Patients completed adapted versions of the Patient Health Questionnaire (PHQ-9), the Centre for Epidemiological Studies Depression Scale Revised (CESD-R), and the Beck Depression Inventory II (BDI-II). All questionnaires were available in Gujarati, Punjabi, Urdu, and Bengali. A comparative sample of white-Europeans completed the questionnaires in English. The research was based across 9 National Health Service (NHS) Trusts in England. Structural validity of translated questionnaires was assessed using confirmatory factor analysis. Diagnostic accuracy was explored in a subgroup of South Asians against ICD-10 categories using the Clinical Interview Schedule Revised (CIS-R) with receiver operating curve (ROC) analysis. RESULTS: 229 South Asian and 120 white-European HD patients participated. A single latent depression factor largely accounted for the correlations between items of the PHQ-9, CESD-R and BDI-II. Issues with measurement equivalence implied that scores on the translations may not be comparable with the English language versions. Against CIS-R based ICD-10 diagnosis of depression, sensitivity was modest across scales (50-66.7%). Specificity was higher (81.3-93.8%). Alternative screening cut-offs did not improve positive predictive values. CONCLUSIONS: Culturally adapted translations of depression screening questionnaires are useful to explore symptom endorsement amongst South Asian patients. However, data indicate that standard cut-off scores may not be appropriate to classify symptom severity. Use of the CIS-R algorithms for optimal case identification requires further exploration in this setting. Strategies to encourage recruitment of under-represented groups in renal research are also warranted, especially for in-depth discussions related to psychological care needs.

The impact of COVID-19 on clinical care, self-management and mental health of patients with inflammatory arthritis.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) lockdown and ongoing restrictions in the UK affected access to clinical care, self-management and mental health for many patients with inflammatory arthritis. The aim of this study was to determine the impact of lockdown on inflammatory arthritis clinical care, self-management, disease outcomes and mental health. METHODS: In total, 338 people with inflammatory arthritis participated in a prospective study, completing a series of online questionnaires. The questionnaires assessed demographics, inflammatory arthritis condition and management, clinical care, quality of life and mental health. Visual analogue scales (VASs) were completed at each assessment. Linear regression, controlling for confounders, was conducted to determine factors associated with physical and mental health outcomes. RESULTS: More than half of participants reported worsening VAS by >10 points for patient global assessment (PGA), pain, fatigue and emotional distress during the initial lockdown. Changes in clinical care were associated with worse PGA (b = 8.95, P = 0.01), pain (b = 7.13, P = 0.05), fatigue (b = 17.01, P < 0.01) and emotional distress (b = 12.78, P < 0.01). Emotional distress and depression were also associated with worse outcomes in PGA, pain and fatigue, whereas loneliness was not. In contrast, physical activity seemed to mitigate these effects. Loneliness did not show any associations with outcomes. Over time, these effects decreased or disappeared. CONCLUSION: Changes to clinical care owing to lockdown were associated with worse disease outcomes in patients with inflammatory arthritis. There has also been a clear impact on mental health, with possibly complex relationships between mental health and psychosocial factors. Physical activity emerged as a key influence on disease outcomes and mental health.

The impact of consecutive COVID-19 lockdowns in England on mental wellbeing in people with inflammatory arthritis.

BACKGROUND: During the first UK COVID-19 lockdown, studies identified over half of inflammatory arthritis (IA) patients in the UK reported a worsening of emotional distress. Given the prolonged nature of the pandemic, and the strict 'shielding' restrictions imposed on 'extremely clinically vulnerable' populations, it is likely that the implementation of the second lockdown period in England, during November 2020, may also have had a negative impact on the mental health of IA patients. The aim of this study was to qualitatively explore the impact of consecutive lockdown periods on mental wellbeing in people with IA. METHODS: Nine IA patients took part in semi-structured telephone interviews at both baseline (June/July 2020) and follow-up (November 2020). The interview schedule, which was developed and piloted with a Patient Research Partner, explored patient experiences and mental health impacts of the COVID-19 lockdown periods. Interviews were analysed using inductive thematic analysis. RESULTS: Five males and four females, with rheumatoid arthritis, psoriatic arthritis, or spondylarthritis, aged between 24-79 years (mean = 49.9, SD = 20.9) were included in the sample. Four main themes impacting on mental wellbeing were identified from the data: (1) Pandemic fatigue versus pandemic acclimatisation, (2) Social interaction and isolation, (3) Clarity of information, (4) Seasonal changes. CONCLUSION: The first two COVID-19 lockdown periods in England had an ongoing impact on the mental health of patients with IA. Healthcare professionals, in conjunction with government support, should ensure that adequate information and mental health resources are available to support IA patients during periods of ongoing restrictions, whilst also continuing to encourage behaviours which promote good mental health and wellbeing.

The impact of COVID-19 on self-management behaviours and healthcare access for people with inflammatory arthritis.

BACKGROUND: Inflammatory arthritis (IA) patients have been identified as at greater risk of severe illness from COVID-19. It is likely that lockdown restrictions (enforced by the UK government in response to the COVID-19 pandemic) and subsequent changes made to healthcare provision could impact patients' abilities to effectively manage their condition. The aim of this study was to qualitatively explore the impact of COVID-19 on self-management behaviours and healthcare access for people with IA. METHODS: Semi-structured interviews were conducted with 21 IA patients in June-July 2020, with nine follow-up interviews in November 2020. Interview schedules were developed with a Patient Research Partner and explored participants' experiences of the COVID-19 pandemic. Interviews were conducted via telephone and analysed using inductive thematic analysis. RESULTS: Participants were aged between 24 and 79 years (mean = 50.1, SD = 15.8), largely female (71%) and White British (86%). Four initial themes were identified: (1) Impact of COVID-19 on medication adherence, (2) Impact of COVID-19 on physical activity, (3) Impact of COVID-19 on diet, and (4) Impact of COVID-19 on healthcare access and delivery. Subthemes focused on positive and negative changes made to these areas, as well as behaviours which remained consistent. Follow-up interviews highlighted differences in participants' experiences during the two lockdown periods. CONCLUSION: COVID-19 has affected patients' abilities to manage their IA. Healthcare professionals need to recognise the ongoing impact of COVID-19 on patient self-management and healthcare access to ensure that adequate understanding and support is available to patients who may have inadequate disease control as a result.

Management of anaphylaxis in the ED: a clinical audit.

Anaphylaxis is one of the potentially life threatening conditions which present to the ED however there is no universal understanding or definitive diagnostic test to aid ED practitioners in its management. Evidence suggests this leads to confusion for ED staff and may compromise patient care. This paper reviews the existing evidence around the effective diagnosis, emergency treatment and long term management of anaphylaxis. It then describes a clinical audit which was carried out in the ED of a large UK University hospital. A retrospective audit design sampled all patients presenting with anaphylaxis in one calendar year, 146 cases were eligible for inclusion. The audit results were consistent with the existing understanding and showed widespread inconsistencies in the diagnosis and treatment of this patient group. The implications the findings may have for the wider ED nursing community are discussed and we conclude that further research and service development is needed to ensure the best possible care for patients with anaphylaxis.