Relationship between Pain, Physical Activity, and Quality of Life in Patients with Haemophilia a and Haemophilia B

Introduction: The extended half-life (EHL) registry was established in 2016 to ascertain the long-term outcomes in patients with HaemophiliaA(HA) and B(HB) receiving replacement therapy. The aim was to quantify disease burden and quality of life at baseline and after switching to EHLs. Method(s): The study is a prospective, observational cohort study that enrolled patients switching EHLs or on standard replacement therapy after informed consent following local ethics approval and was registered at www.clinicaltrials.gov (NCT02938156). The study was paused during the COVID pandemic. Here the baseline results are presented for pain, activity and quality of life and their correlations. Pain evaluation was assessed through the brief pain inventory (BPI) 7-day recall, quality of life by EuroQol-5 Dimension (EQ5D5L) and physical activity through the international physical activity questionnaire (IPAQ). The BPI assess severity of pain and the interference with activities. IPAQ assess physical activity undertaken across a comprehensive set of domains. Three levels of physical activity are used to classify the populations: 'low', 'moderate', and ' high'. Result(s): A total of 231 HA and 97 HB were included in the analysis, of whom 231 had switched to EHL products and 96 were on standard replacement therapy. The levels of Physical Activity were similar between Haemophilia types, with approximately 46%, 32% and 22% of patients reporting high, moderate, and low physical activity, respectively. BPI mean (+/-SD) severity score in HA was 2.86 (+/-2.1), HB 3.24 (+/-2.0);interference score HA 3.22 (+/-2.8), HB 3.09 (+/-2.5), mean EQ5D5L visual analogue scale (VAS) for HA 72.92 (+/-15.5) and HB 71.10 (+/-18.2). Within instruments, IPAQ sub-scores and BPI average scores were highly correlated. Between instruments, the strongest linear correlations were seen between theVAS and the BPI scores (R=-0.59, p< 0.0001, n=206 for the average interference score, R=-0.57, p< 0.0001, n=208 for the average pain severity, v.s. the VAS). Correlations between the IPAQ total score and either VAS or BPI scores were weaker, even when limiting to patients with moderate or high activity and using a log scale given the skewed distribution of the IPAQ summary measure. Discussion/Conclusion: The study demonstrates for the first time a strong correlation between pain and quality of life, and weaker correlation between physical activity and quality of life.

Experience with tumour necrosis factor-alpha inhibitors for the treatment of cardiac sarcoidosis in a UK medical centre

P217 Table 1Case series outcomes table Case no. IFX dose& regime Follow-up duration (months) Change in prednisolone dose Change in FDG-PET uptake Change in LV systolic function Change in arrythmia burden Adverse events Composite Endpoint Dose pre-IFX(mg) Dose post-IFX(mg) Pre-IFX Post-IFX LVEF pre-IFX (%) LVEF post-IFX(%) Pre-IFX Post-IFX Infections Heart failure VT/VF (requiring device) All-cause mortality Aborted SCD (device) Cardiac Transplant Case 1 IFX 3 mg/kg every 8 weeks (break after 10th dose due to covid pandemic;restarted 3 months later) 29 20 15 Active CS(SUVmax 11.1) Improvement(SUVmax3.5) 58 59 N/A N/A 0 0 0 0 0 0 Case 2 IFX 3 mg/kg every 8 weeks. Stopped after 15.6 months due to resolution 15.6 10 10 Active CS(SUVmax 10.2) Improvement(SUVmax 2.65) 55 62 VA 0 1 (chest infection) 0 0 0 0 0 Case 2Relapse (7 months after stopping IFX) due to VT and FDG uptake IFX 3 mg/kg every 8 weeks 12 10 10 Active CS(SUVmax 3.3) Improvement(no uptake) N/A 50 VA 0 0 Mild LVSD 0 0 0 0 Case 3 IFX 3 mg/kg0 weeks and 4 weeks;missed 8 weeks’ appointment due to COVID-19 10 20 20 Active CS(SUVmax 11.3) N/A 55 N/A 0 N/A 1 (Covid-19) 0 0 0 0 0 Case 4 IFX 3 mg/kg at 0, 2 and 8 weeks afterwards 16 20 10 Active CS(SUVmax 13) Improved(SUVmax 3.4) 45 66 VA N/A 0 0 0 1 (PFO and shunt/complications) 0 0 Case 5 IFX 3 mg/kg 0, 2, 6 and every 8 weeks 8.5 30 15 Active CS(SUVmax 11.3) Improved(no uptake) 46 51 VA 0 0 0 0 0 0 0 Totals 6 IFX 3 mg/kg Mean=15.2 Mean=18.3 Mean=13.3 All had active CS 5 improved;1 data not available Mean=51.8 Mean=57.6 4 had VAs;1 data not available None had VA;3 had data not available 2 1 0 1 0 0 CS = cardiac sarcoidosis;FDG-PET =fluorodeoxyglucose positron emission tomography;IFX = Infliximab;LV = left ventricular;LVEF = left ventricular ejection fraction;LVSD = left ventricular systolic dysfunction;N/A = data not available;PFO= patent foramen ovale;

PHYSICIAN PERCEPTIONS OF STRESS AND TELEMEDICINE

Introduction: Telemedicine is an emerging field in which physicians can interact electronically with patients to improve health. During the COVID-19 pandemic, the use of telemedicine has grown exponentially. As physicians work to provide equally high-quality care for their patients remotely, their experiences must be considered. Methods: This study utilized an online anonymous survey of physicians to assess their satisfaction, comfort level and student involvement when using telemedicine for patient care. Results: Overall, physicians’ experiences with the integration of telemedicine into their practices varied based on gender, the presence of medical students, age and prior experience with telemedicine. Physicians are more comfortable with telemedicine now than they had been prior to the start of the COVID-19 pandemic, and physicians who had prior experience were less likely to find it stressful to incorporate. Physicians in both the youngest (30–39 years old) and oldest (60 and older) categories reported the highest levels of satisfaction with telemedicine. Female physicians indicated they will be more likely to incorporate more telemedicine into practice in the future, beyond the COVID-19 pandemic. Of the specialties surveyed, family physicians report the lowest levels of comfort and satisfaction with telemedicine. Conclusion: Physician respondents of this survey provided valuable data on the perceptions of the widespread incorporation of telemedicine during the COVID-19 pandemic. Further research can follow which physicians choose to keep telemedicine integrated into their practices and how the demand for these virtual visits may change in the coming months.

Mapping Vancouver’s Slow streets in the context of equity

To respond to the COVID-19 pandemic, cities across Canada focused efforts on creating more space for pedestrians and cyclists to access recreation opportunities, make essential trips, and get to work while maintaining physical distancing. The City of Vancouver implemented over 40 kilometres of ‘Slow Streets’ as traffi c calming measures to create more space for walking, cycling, and rolling. This article presents an analysis of Vancouver’s Slow Streets using GIS mapping and Census data to illustrate how planners can use spatial data to examine the equity implications of active transportation interventions. © 2021, Canadian Institute of Planners. All rights reserved.

Follow-up of small & diminutive colonic polyps – how to balance the risks in the COVID-19 era

Abstract The COVID-19 pandemic has led to a reduced colonoscopy capacity in the UK resulting in increased waiting times for investigation. To increase diagnostic capacity and reduce the risk of diagnostic delay, CT colonography (CTC) and colon capsule endoscopy (CCE) are increasingly being relied upon. Endoscopic assessment and treatment will be required for those patients with large colonic polyps or malignant tumours detected by CTC or CCE, provided they are fit enough to undergo further investigation. The management of patients with intermediate (6-9mm) and diminutive (<6mm) colonic polyps, reported by CTC and CCE, will increasingly be decided by clinicians. Published literature suggests the risk of progression to malignancy of intermediate or diminutive polyps over 3 years is low. Furthermore, the risk of intermediate or diminutive polyps harbouring malignancy is extremely low. The benefits, and timeline, for the removal of these polyps must be carefully considered for patients. We present a pragmatic approach to managing intermediate and diminutive polyps. We suggest delayed polypectomy (up to one year) for patients with intermediate polyps who are likely to benefit. For those patients with diminutive polyps, we advocate further surveillance only for younger patients where clinical concern exists. This meets the aspirations of Realistic Medicine, providing a risk-based approach for patients, while appropriately prioritising resources.

Evaluating a “virtual” urology out-patient clinic to address delays in review patients

Introduction: Ireland has the one of the lowest urologist per population ratios in Europe1. Out-patient department (OPD) visits are time consuming, costly and frequently patients cannot be reviewed in the intended timeframe2. With the COVID-19 crisis innovative virtual models of care are essential. Methods: Patients for OPD review were assessed by a Consultant in a “virtual” clinic using electronic records (letters, imaging, blood results) and chart review if required. Patients were either discharged, discharged for GP testing with specified re-referral criteria, phone/letter follow up by a LUTS clinical nurse specialist, investigated and reviewed by phone/letter, or returned for face-to-face consultation. Results: 400 patients were assessed. The majority were seen previously by SHO or junior registrar. 160 (40%) patients were discharged directly via letter and advice. 121 (30%) required further imaging and could be contacted by phone with the results. 79 (20%) could be contacted by the LUTS clinical nurse specialist for phone/written review. 40 (10%) necessitated face-to-face OPD review for clinical assessment or investigation review. In 47 patients there was insufficient information available in the electronic platforms, thus requiring formal chart review. Overall, 360 patients could be managed via “virtual” means. The potential out-patient cost savings were estimated at €27,000. Conclusion: With this COVID-19 pandemic, innovative models of care are necessitated. Introduction of a “virtual” OPD clinic allows reliable review of patients with reduced face-to-face follow-up attendances. Further study of staff training and patient satisfaction is required.