The evolution of a charity support services team

Our charity's mission is dedicated to beating blood cancer by funding research and supporting those affected. Since 1960, we have invested over 500 million in blood cancer research, transforming treatments and saving lives. Since 2015 there has been a Support Services team within the charity. This service was established to provide information that the blood cancer community can trust, in a language they can understand. By connecting and listening to our community they deepen our understanding and help shape our work. Research suggests that blood cancer patients are more likely than any other patients to leave their diagnosis appointment feeling they do not fully understand their condition. Our service can often consolidate the information given by clinicians. Patients also need advice and support on how to adapt to day-to- day life after their diagnosis. There are challenges that are unique to blood cancer, such as living with cancer as a chronic condition, being on 'watch and wait' or fluctuating remissions and relapses. In 2023 the Support Services team have a 7 day presence on our phone line, email and social media platform where people can communicate with one of our trained blood cancer support officers, or one of three Registered Nurses, all who can provide information about blood cancer diagnosis and help with emotional and practical support. We also run an online community forum where people affected by blood cancer can connect, share experiences and provide peer support. The highly experienced haematology nurses provide a clinical aspect to the support of the Blood Cancer Community that enhances the established patient centred support given historically by the charity. The nurses advanced knowledge and experience of haematological cancers, treatments, side effects, holistic care and NHS process can further guide the community. This is in addition to the invaluable information from their treatment teams. In 2023 the Support Services team are now reaching thousands of the blood cancer community. We understand that in the past 3 years the COVID-19 pandemic and the work of our charity around this will have influenced the significant increase in contacts but equally the robust and trusted services provided through this charity has contributed too.

Perceptions of COVID-19 Vaccines Side Effects

BACKGROUND: Vaccines are one of the best interventions developed for eradicating COVID-19. In Albania, COVID-19 vaccination uses different types of vaccines: Pfizer, AstraZeneca, CoronaVac, and Sputnik V. Like any other vaccine, these have side effects too. AIM: This study was carried out to identify the perception of the side effects of vaccines. METHOD(S): A quantitative study using a cross-sectional survey was conducted between April and September 2021 to collect data on the effects of the COVID-19 vaccine among individuals in Shkodra region. Data were collected online through a self-administered survey created on Google Forms which had been randomly delivered to individuals (aged >=18 years) using social media sites (Email and WhatsApp). All data collected were analyzed with Microsoft Office Excel 2010, using the exact Fisher's test and x2 test. RESULT(S): This study included 292 citizens, out of which 200 were female and 92 were male;62% were from urban areas and 38% from rural areas of Shkodra region. The random sample of the citizens who took part in this study is 44.5% (18-30 years old). A massive percentage of the participants, 66.4%, had received the second dose of the vaccine. Our study shows that 55.8% of these citizens have had side effects after the first vaccination dose, and only 43.8% have had side effects after the second dose. About 80.6% of the participants were well informed about the type of vaccine they got. CONCLUSION(S): Side effects from vaccines were reported. Injection site pain and fatigue were the most common first dose side effects (55.8%). The same side effects were reported for the second dose. The side effects were presented during the first 12 h after the vaccination in most cases. Side effects were more prevalent in people >50 years old. Older people have a higher probability to have more side effects from the COVID vaccine. There is no statistically significant relationship between gender and the presence of the side effect from the COVID vaccine. People living in urban areas have a higher probability to have side effect from COVID vaccine comparing with people living in rural areas. People being vaccinated with Pfizer vaccine have a higher probability to admit the presence of side effects.Copyright: © 2022 Zamira Shabani, Arketa Guli, Julian Kraja, Arlinda Ramaj, Nertila Podgorica.

Student-teacher out-of-class communication on engineering courses during the COVID-19 pandemic: from face-to-face to videocalls

Out-of-class communication between teachers and students is essential throughout university engineering courses for in-depth explanations of the concepts covered in class. This study evaluates this aspect throughout the COVID-19 pandemic. Thus, a survey that addressed this issue was administered to students at the beginning (March 2020) and at the end (May 2020) of the COVID-19 lockdown in Spain, and at the end of each semester of the 2020/21 and 2021/22 academic years. The results were analyzed with statistical, qualitative, and mixed methods. E-mail usage was widely observed at the beginning of the pandemic, while the use of online videoconferencing tools progressed during that time, thanks to their temporal and spatial flexibility, and the direct and personal nature of student-teacher contact through those channels. Its success was linked to the prior training of teachers in the use of videoconferencing, the establishment of fixed schedules for the meetings, and the use of digital whiteboards that instantaneously display writing when discussing problems. According to the opinions of students, videocalls could be used for questions on theoretical and easy practical aspects despite the resumption of out-of-class face-to-face meetings. Videoconferencing tools for educational communication between engineering students and teachers seem to be here to stay. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Meeting the service needs of youth with and without a self-reported mental health diagnosis during COVID-19

Background: The COVID-19 pandemic catalyzed major changes in how youth mental health (MH) services are delivered. Understanding youth's MH, awareness and use of services since the pandemic, and differences between youth with and without a MH diagnosis, can help us optimize MH services during the pandemic and beyond. Objective(s): We investigated youth's MH and service use one year into the pandemic and explored differences between those with and without a self-reported MH diagnosis. Method(s): In February 2021, we administered a web-based survey to youth, 12-25 years, in Ontario. Data from 1373 out of 1497 (91.72%) participants were analyzed. We assessed differences in MH and service use between those with (N=623, 45.38%) and without (N=750, 54.62%) a self-reported MH diagnosis. Logistic regressions were used to explore MH diagnosis as a predictor of service use while controlling for confounders. Result(s): 86.73% of participants reported worse MH since COVID-19, with no between-group differences. Participants with a MH diagnosis had higher rates of MH problems, service awareness and use, compared to those without a diagnosis. MH diagnosis was the strongest predictor of service use. Gender and affordability of basic needs also independently predicted use of distinct services. Conclusion(s): Various services are required to mitigate the negative effects of the pandemic on youth MH and meet their service needs. Whether youth have a MH diagnosis may be important to understanding what services they are aware of and use. Sustaining pandemic-related service changes require increasing youth's awareness of digital interventions and overcoming other barriers to care.Copyright © 2023, Canadian Academy of Child and Adolescent Psychiatry. All rights reserved.

When Aways Went Away: How the Elimination of Away Rotations During Covid-19 was Perceived by Applicants Across Specialties

Introduction: COVID-19's emergence and subsequent social distancing guidelines resulted in severe restrictions on away rotations (ARs). This multi-institutional cross-sectional study investigated how these restrictions were perceived by residency applicants across specialties. Method(s): In fall, 2020, an online survey regarding COVID-19's impact on graduating medical students' education was distributed to ACGME Medical Schools. Demographics, specialty choice, and pre- COVID plans to participate in ARs verses one's participation post- COVID were collected. Respondents who provided e-mails received a post-Match follow-up survey in which retrospective thoughts on ARs were explored. Participants were grouped by specialty choice (medical, procedural, surgical) and answers were compared between groups using Kruskal-Wallis test. Result(s): 58 Institutions distributed the initial survey to 8200 graduating students. 1473 responded (18%). 81% were 25-29;65% were female. 49% were medical, 24% procedural and 26% surgical. Surgical and procedural applicants were more likely to have planned to participate in ARs (p<0.001) and be concerned that limitations on ARs would negatively impact their match (p<0.001). Of 1221 initial survey respondents who provided e-mails, 458 participated in the follow-up survey (37.5%). Demographics were similar to the index survey. Post-Match, surgical and procedural applicants were more likely to wish they could have participated in ARs and to propose that future ARs only be offered in-person (p<0.001). Conclusion(s): This multi-institutional survey across specialties highlights the perceived value of ARs for surgical and procedural candidates. Should opportunities for ARs continue to be limited, alternative opportunities for applicants to connect with programs and optimize successful matches should be investigated.

Comparison of Methods of Assessment and Results of Traditional Osce with Electronic-Osce

Introduction: The onset and rise of COVID-19 and its sudden progression to a worldwide pandemic lead medical and dental institutes to change their way of teaching and conducting assessments to distance learning as compared to the previously applied conventional approaches. Teaching and assessment during this era have changed vastly, earlier it was solely traditional/live Objective Structured Clinical Examination (OSCE) but due to the current circumstances electronic/online OSCE (E-OSCE) method was introduced. In Pakistan also, Pakistan Medical Council (PMC) and the College of Physicians and Surgeons of Pakistan (CPSP) conducted online exams so that the scheduled exams do not get delayed. Aim(s): The main objective of this paper is to measure the reliability of an E-OSCE and to compare it with the traditional OSCE. Methodology: This was a cross-sectional study which got conducted at the Rawal Institute of Health Sciences, Islamabad. Traditional OSCEs and E-OSCEs were conducted with 71 participants including final year students and house officers. Each OSCEs had 10 stations, including one interactive station in traditional OSCE. Students' scores in both the OSCEs were collected and paired t-test was used to compare the mean scores at p<0.05. Result(s): Total number of house officers were 27 and final year students were 44. The scores of 71 participants were collected. The difference between mean scores of house officers' traditional OSCE and E-OSCE was statistically significant (p=0.000). The difference between final year students traditional OSCE and E-OSCE was also statistically significant (p=0.020). Finally, the overall difference between traditional OSCE and E-OSCE was also statistically significant (p=0.000) Practical implication: The main objective of this study was to assess the reliability of an E-OSCE and to compare whether the electronic method of conducting OSCE is more reliable than the traditional method of conducting OSCE. Conclusion(s): Despite limitations and the biases, the results of E-OSCE proved to be better than traditional OSCE. Further research needs to be conducted on E-OSCE to control the factors causing biases and limitations.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Specifically designed family communication booklet to help staff to communicate effectively with Intensive Care Unit patients' next of kin

Introduction: Families of patients admitted to the Intensive Care Unit (ICU) experience significant emotional distress.1 Visiting restrictions mandated during the COVID-19 pandemic presented new barriers to family communication, including a shift from regular bedside nursing updates and in-person family meetings to scheduled, clinician-led telephone calls and video calls.2 This resulted in loss of non-verbal clues and feedback during family discussions, difficulties establishing rapport with families and risked inconsistent messages and moral injury to staff.3 Objectives: We aimed to design a system where all ICU family discussions were documented in one place in a standardised format, thereby clarifying information given to families to date and helping staff give families a consistent message. In addition, we aimed to provide practical advice for the staff making family update telephone calls and strategies for managing difficult telephone conversations. Method(s): We designed and implemented an ICU family communication booklet: this was colour-coded blue;separate to other ICU documentation within the patient notes;and included communication aids and schematics to help staff optimise and structure a telephone update. Using Quality Improvement methodology, we completed four Plan-Do-Study-Act (PDSA) cycles and gathered qualitative and quantitative feedback: this occurred prior to the project and at one,12,18 and 21 months post introduction. We implemented suggested changes at each stage. We designed staff surveys with questions in a 5-point Likert scale format plus opportunity for free comments. Twenty-one months post implementation, we designed and delivered an MDT awareness campaign using the 'tea-trolley training' method,4 departmental induction sessions for new ICU doctors and nurses and a 'Message of the Week' initiative. An updated version of the booklet was introduced in February 2022 (Figure 1). Result(s): Staff survey results are shown in Table 1. Forty-six staff participated in tea trolley training, feedback form return rate 100%. Following feedback, the family communication booklet was updated to include the following: a prompt to set up a password;a new communication checklist at the front, including documentation of next of kin contact details, a prompt to confirm details for video calls, confirm primary contact and whether the next of kin would like updates during the night;consent (if the patient is awake) for video calls while sedated;information regarding patient property;prompt to give families our designated ICU email address to allow relatives to send in photographs to display next to patients' beds;prompts to encourage MDT documentation and patient diary entry. Conclusion(s): During unprecedented visiting restrictions in the COVID-19 pandemic, we implemented an ICU family communication booklet which has been so successful that we plan to use it indefinitely. We plan to further develop this tool by encouraging MDT involvement, seek further staff feedback in six months' time, incorporate this structure into our electronic patient information system when introduced and collect feedback from patients and their next of kin at our ICU follow up clinic. This communication booklet would potentially be reproducible and transferable to other ICUs and could be used as part of a national ICU family communication initiative.

Which Telehealth Features Matter Most? Ranking Results from HIV Care Providers and Patients Living with HIV in South Carolina

Objectives: During the COVID-19 pandemic, telehealth was rapidly implemented to mitigate disruptions in HIV care services. However, participation in and benefits from telehealth were not distributed equally among people living with HIV (PWH). The acceptability of alternative telehealth options in HIV care remains understudied. This study aims to assess the relative importance of telehealth features among HIV care providers and PWH. Method(s): We compiled a comprehensive list of 21 telehealth features from the literature and formative research. Telehealth features were grouped into four domains with 4-6 features each: administrative (5), technology (6), visit-related (6), and other (4) features. 22 purposively selected participants (10 HIV care providers, 12 PWH) from South Carolina were asked to rank these features within domains and the domains themselves according to their perceived relative importance. Ranking data was analyzed through count analysis. Result(s): Domain rankings indicated that visit-related features such as a prior relationship with the provider and multidisciplinary virtual visits were most important. Administrative features such as scheduling modalities (e.g., virtual walk-in options) and the waiting time for an appointment were second most important, followed by technological features such as the type of provider (artificial intelligence vs. human provider) and type of telehealth (video, voice-only, or email). Other features such as the availability of technical support and the location where telehealth visits take place were least important to our participants. Across telehealth features, the relationship to the provider was most often ranked first (14 out of 22 participants) followed by out-of-pocket cost (9 out of 22 participants). Conclusion(s): Our findings highlight the importance of visit-related and administrative features of telehealth. A pre-existing relationship with the telehealth provider was particularly important to many providers and patient participants. Findings may inform telehealth HIV care options to meet the needs of PWH and HIV care providers.Copyright © 2023

Evusheld prophylaxis increases social interactions and improves anxiety, depression, agoraphobia and quality of life scores

Evusheld is a combination injection of tixagevimab/cilgavimab for pre-exposure COVID-19 prophylaxis and was made available to UK private clinics from October 2022. NICE review is ongoing. Whilst efficacy analysis of Evusheld has focused on the risk-reduction of contracting COVID-19, anecdotal reports suggest additional psychological benefits from Evusheld, although supportive objective data are lacking. In this study, we used 4 well-established psychological health questionnaires to assess different psychological parameters (EQ5D-3 L quality of life (QoL) score, DSM5 Agoraphobia score, Duke's Social Support Index (DSSI) and the hospital anxiety and depression score (HADS)) in blood cancer patients treated with Evusheld at the Genesis Care (GC) Clinic, Cambridge. Patient data (pre-and post-Evusheld) were compared with a control group of GC blood cancer patients who had not received Evusheld. The study was approved by GC and all patients had consented to email contact. Questionnaire replies were anonymised and free-text comments were invited. Questionnaires were completed by 29/40 Evusheld and 54/100 control patients. With EQ5D, Evusheld did not impact mobility, self-care and pain/discomfort scores and patient/ control groups scored at similar levels. EQ5D scores for 'usual activities' and 'anxiety/depression' improved post-Evusheld (patients reporting 'normal activities' increased from 52% to 76% (control = 78%);patients reporting 'no anxiety/ depression' increased from 45% to 66% (control = 65%)). The mean global EQ5D QoL score improved post-Evusheld [69.4% to 72.9% (control = 75.7%)]. With the DSM5 agoraphobia score, Evusheld treatment improved agoraphobia parameters, reducing the mean score from 15.7 to 5.1 (control = 3.7;max = 40) with certain striking changes;72% of pretreatment patients avoided crowded situations all of/most of the time, reducing to 14% post-Evusheld (control = 11%). The DSSI score assessed social/work interactions with external household contacts and post-Evusheld the mean number of interactions over 3 weeks increased from 1.48 to 3.37 (control = 3.77). Pre-Evusheld, 52% of patients had no interactions outside their household, dropping to 20% in the 3 weeks post-Evusheld (control = 17%). Using the HADS 14-point analysis of depression and anxiety revealed on average that each parameter was 25.3% 'significantly improved' and 25.4% 'a little improved' post-Evusheld. Accepting limitations of a small study and potential biases associated with a self-funding patient cohort, Evusheld treatment broadly improved all psychological scores assessed. Free-text comments clearly indicate that Evusheld had a major positive impact on QoL/social mobility for specific patients. The Evusheld patients had higher baseline scores for social isolation, anxiety, depression and agoraphobia compared with control patients, yet Evusheld treatment appeared to improve these parameters to a level similar to control patients.

Assessing the impact of intensive positive feedback on staff morale, culture, civility and psychological safety in a South West maternity unit

Introduction: The importance of psychological safety, staff morale, culture and civility (PSMCC) has been highlighted by multiple recent maternity investigations as key to the provision of safe, high quality maternity care [1]. These factors are also crucial for staff retention and recruitment. Concomitantly, the NHS Staff Survey indicates an almost universal decline in staff motivation and engagement since COVID;a trend also noted in our institution [2]. Regular, authentic, individual and group positive feedback could improve PSMCC by creating a culture of kindness and appreciation, reinforcing positive behaviour and improving teamwork. At UHP, an established 'Learning for Excellence (LfE)' positive feedback system is in place, facilitating provision of volitional, authentic feedback to individuals and enabling organisational learning about what works. The aim of this project was to assess the impact of a shift to a more positive, appreciative narrative in maternity using intensive positive feedback from patients and staff. Method(s): A literature review to derive validated questions for incorporation into a questionnaire to assess baseline levels of PSMCC and perceptions of positive feedback receipt. QI methodology and stakeholder focus groups aided the development of the interventions. Once established, the impact of these positive interventions on PSCMM will be assessed. Result(s): There were 103 responses to the baseline questionnaire. 24% staff felt their actions at work were never positively acknowledged;45% felt undervalued. 63% felt they do not receive enough positive feedback, whilst 93% believed that receiving more positive feedback would improve staff morale, wellbeing, culture and care. Discussion(s): Based on these findings, interventions to provide regular, authentic, positive feedback across our maternity unit have been created. These include: 1)motivational board sharing positive feedback stories from patients and staff obtained via LfE, showcasing the kind, compassionate and high quality care delivered;2) Weekly email shots of LfE stories focussing on specific positive behaviours such as teamwork and patient centred care;3) A white board for staff and patients to share positive messages ad hoc;4)Promotion of the LfE initiative to patients thus increasing positive feedback to staff. The impact of these interventions will be assessed shortly and presented in full.Copyright © 2023 Elsevier Ltd

North American Orthopaedic Spine Fellowships: Evaluating Program Website Content During COVID-19 for Prospective Applicants

Introduction: Prospective applicants utilize the internet to obtain information on fellowship programs they wish to apply to. The COVID-19 pandemic presented challenges to orthopaedic spine fellowship programs, among them the transition to communicating with prospective applicants largely through web-based and virtual platforms. The purpose of this study was to assess the content of information accessible to applicants on orthopaedic spine fellowship program websites during September and October 2020 of the COVID-19 pandemic. Method(s): Seventy-nine accredited fellowship programs were identified from the North American Spine Society Fellowship Program Directory and assessed based upon 18 criteria categorized as composites of three domains: program overview, application information, and education. Information was compiled, tabulated to visualize numerical differences between each program, and analyzed via descriptive statistics. Result(s): No program website mentioned virtual tours or interviews. All websites listed an address for the program location, 99% listed a phone number, and 96% a contact email address. Seventy-seven percent mentioned research requirements, 77% mentioned research outputs, nine percent mentioned call responsibilities, and three percent mentioned international opportunities. Twenty-three percent of programs mentioned meetings or courses, 43% mentioned case log numbers, 37% mentioned didactics, 20% mentioned journal clubs, 20% mentioned clinic duties, and 16% mentioned rotations. Conclusion(s): Spine fellowship programs did not appreciably amend content on their websites during the COVID-19 pandemic. This is consistent with findings from pre-COVID-19, where fellowship programs were also underutilizing website platforms and did not showcase sufficient information online that prospective applicants could potentially benefit from knowing about their program.

Developing Multidisciplinary Models of Care in Rheumatology at University College London Hospital: 18 Months of Learning from Conception to Delivery and Beyond

Background/Aims The COVID-19 pandemic has placed unprecedented pressures on NHS departments, with demand rapidly outstripping capacity. The British Society for Rheumatology 'Rheumatology Workforce: a crisis in numbers (2021)' highlighted the need to provide innovative ways of delivering rheumatology specialist care. At University College London Hospitals (UCLH) we created a rheumatology multidisciplinary team (MDT) clinic to meet rising demands on our service. The aims of the Rheumatology MDT clinic were to: reduce new appointment/follow-up waiting times, increase clinic capacity, incorporate musculoskeletal (MSK) point of care ultrasound, reduce number of hospital visits and add value to each clinic encounter. Methods We ran a 6-month pilot, supported by our outpatient transformation team, incorporating a Rheumatology Advanced Practice Physiotherapist (APP), Clinical Nurse Specialist (CNS) and MSK ultrasound within a Consultant clinic. The success of the pilot helped secure funding for a further 12 months. Over 18 months we have implemented: APP/Consultant enhanced triage - up to 40% of referrals were appropriate for APP assessment, including regional MSK problems and back pain. This increased capacity for consultant-led appointments. Standardisation of time-lapse between CNS and consultant follow-up appointments to ensure appropriate spacing between patient encounters. Facilitated overbooking of urgent cases afforded by additional capacity provided by the APP. MSK ultrasound embedded in the clinic template. 'Zoom' patient education webinars facilitated by MDT members and wider disciplines e.g. dietetics, to empower self-management and reduce the administrative burden of patient emails/phone calls occurring outside the clinic. Patient participation sessions and feedback to help shape the service. Results During the 6-month pilot we reduced our waiting time for follow-up appointments from 9 months to 2. We now have capacity to book 1-2 urgent cases each week. Pre-MDT the average wait from consultant referral to physiotherapist appointment was 55 days. The MDT allows for same day assessment (reducing 2-3 patient journeys a clinic) and where suitable, facilitates discharge or onwards referral to the appropriate service. A dedicated MDT CNS has shortened treatment times, reduced email traffic between CNS and consultant and allows for same day, joint decision-making resulting in fewer appointments. Zoom webinar feedback has been positive. Patients value the broad expertise of allied health professionals which supports self-management. Embedding ultrasound allows for same day diagnostics, decreased referrals to radiology and reduced hospital visits. Conclusion Our MDT model has reduced waiting lists, decreased treatment delays and cut hospital attendances. Point of care ultrasound allows for same day decision making and abolishes the cost and diagnostic delay associated with referrals to radiology or outsourced providers. Shared decision-making adds value to outpatient attendances, which is reflected in patients' positive feedback. The MDT model maximises the existing workforce skill set by enhancing the APP and CNS role, allowing patients immediate access to their expertise.

Rheumatology Advice Lines: How to Manage Rising Demand and Limited Capacity?

Background/Aims Advice lines services (ALS) are a key aspect of providing coordinated patient care in rheumatology. Demand for rapid access to specialist advice increased during the pandemic due to the disruption of routine outpatient services but it is not clear whether this demand is sustained. We aimed to investigate the changes in demand for ALS, how this varied pre/during COVID-19 and audit the effect upon response times. We also aimed to assess the impact of introducing an email advice service on demand. Methods We audited the number of advice line contacts of a single rheumatology department, serving a population of 500,000 people. The telephone adviceline is provided as an answer machine with an email advice service set up in April 2020. The outcome of each contact is recorded as a) advice only b) action required (e.g., prescription, blood test, GP letter) or c) required appointment (monitor/nurse/ medical). We audited response times using the RCN guidelines of a two-day response1 as the gold standard. Results Demand for advice had been increasing pre-COVID with an average of 368 calls/month (1/1/19-1/7/19) to 420/month (1/7/19-31/12/19). Sixty percent were advice only calls but 27% required additional action. Response times met the audit standard in 97% of cases pre-COVID. During the first two months of COVID demand for advice services doubled, however demand continued to rise although outcomes were similar (Table 1). As the number of contacts increased the proportion of telephone contacts responded to within the audit standard fell. Numbers of email contacts were variable, but response times exceeded the audit standard. Conclusion This audit demonstrates the demand of adviceline services has continued to increase throughout the pandemic and beyond, impacting the ability of services to respond within a timely manner. Ongoing QI work is assessing mechanisms to manage increased demand (using healthcare support workers to triage calls) and investigating reasons for accessing ALS to ensure appropriate advice is available. (Table Presented).

Online Mdt Patient Education for Early Inflammatory Arthritis

Background/Aims Patient education in early inflammatory arthritis (EIA) promotes understanding and engagement with treatment, empowering patients to use self-management in their long-term health condition. It is embedded in national guidance and audit. Individual appointments are time consuming, and groups sessions became impossible during the COVID-19 pandemic. Our education sessions have evolved to a monthly online meeting which aims to be engaging, effective and time efficient. Methods Face-to-face group education afternoons were previously embedded into our early arthritis pathway. Presentations and opportunities for questions were given by a rheumatology consultant, nurse, physiotherapist, podiatrist and occupational therapist. Sessions lasted 2 hours and local charity representatives attended. Group education sessions completely stopped with the COVID-19 pandemic restrictions. This successful MDT model was moved to a monthly Microsoft Teams meeting and condensed to 1 hour. Sessions continue to consist of five short presentations, introduction to charity representatives and opportunity for questions. Following the session, all patients received links to videos of the talks for future reference, contact details for the MDT and local charities, and a link to download our local rheumatology self management app. Patients who are unable to attend also receive this content by email. Patient feedback was gathered through an online questionnaire. Results Attendance has increased over time with 75% of our new EIA patients now attending each month. Feedback from 16 patients rated 75% of all talks as extremely useful or useful. 89% are interested in attending future meetings. 93% had already used or plan to use our rheumatology self management app. Positive patient feedback included: ''the whole team were brilliant giving advice and answering questions'', ''nice to see the specialists' faces, and to get the feeling they really cared'', and ''a perfectly sensible and productive way to introduce all the options for help and support''. Some patients did not feel confident to ask questions in the meeting. Email and telephone advice lines were signposted. Attendance was increased by 40% by a short telephone reminder of the appointment. Conclusion An online meeting has proven to be a time efficient and effective way of providing multidisciplinary education and introducing self management. A short time investment from each MDT member gives breadth to the education. Inviting all newly diagnosed early arthritis patients and encouraging attendance by a short telephone call has maximised reach. Ensuring all patients are sent presentation videos to re-watch and the self referral details further facilitates self management. The format could easily be adapted to other patient education events.

Integrating peer support within NHS clinics: a London Fast-Track Cities Initiative (FTCI) project

Background: BHIVA Standards of Care for people living with HIV (PLWH) include quality statements and auditable outcomes for peer-support pathways to improve selfmanagement and engagement in care. FTCI London convened 3-year 'improvement collaborative' projects between HIV charities and NHS clinics. Chelsea and Westminster Hospital (CWHFT) supported the implementation of this initiative to 4 London HIV clinics with a cohort of >10,000 PLWH. We here illustrate the results of this initiative to date. Method(s): Positively UK, NAZ Project, Plus Health and CWHFT trialled approaches to integrating in-clinic peersupport pathways, with the aim of having >90% of those accessing peer-support retained in care, with a VL<50. 3 peer-supporters (2 FTE posts) received NHS honorary contracts, emails and the ability to log interventions within the Trust's EPR. Data on peer-support attendance and outcomes were collected from the EPR into an encrypted NHS database. Result(s): Although planned as an in-person initiative, the COVID-19 pandemic led to a shift to fully remote support and delayed project initiation to 7/2020, when email referrals commenced for newly diagnosed and those identified as being at risk of lost to follow up (LTFU). Referrals reached 4.4/month within the first 3 months. Initiatives such as MDT, focus group participation, staff teaching, and physical presence in clinics increased referrals to 7/month by 4/2021 and 12/month by 11/2021. Median patient age was 45 years (range 16-74), 13% were female, and 47% from BAME background (vs 34.5% in the CWHFT HIV cohort). Median diagnosis length was 2 years (<1-31). Moving from opt-in to opt-out support for newly diagnosed increased uptake of support from 33% in 4/2021 to 67% by 12/2021. Overall, 287 people (66% of referrals) engaged with peersupport between 7/2020 and 11/2022, with 164 (57%) receiving ongoing support. Virtual appointments moved from 100% to 54% over time. Rates of having a VL<50 increased from 71% at referral to 90% following peer-support, including new diagnoses. Conclusion(s): Implementing in-clinic peer-support pathways significantly increased referrals and uptake of support for new HIV diagnosis and those at risk of LTFU, showing the potential of improving clinical outcomes and quality of life of PLWH.

Management of Adults with Systemic Lupus Erythematosus (Sle) in 2021: A Multi-Centre Audit within Wales as Part of an Ongoing Quality Improvement Exercise

Background/Aims Significant changes to working practices within rheumatology have occurred since the beginning of the COVID-19 pandemic: virtual consultations have now become commonplace. This audit was undertaken as part of ongoing quality improvement work to assess the standards of care provided to patients with SLE attending rheumatology departments across Wales. Care was audited against the standards outlined in the 2018 British Society of Rheumatology guideline for the management of adults with SLE. Results were compared with the previous multi-centre audits of SLE care in Wales and the UK. We were interested to see whether changes to working practices had significantly affected the care of patients with SLE across Wales. Methods Rheumatology services in Wales were invited via email to participate. Data collection occurred between June and August 2021. Data was collected via online questionnaire, held securely by the Dudley Group NHSFT. Unit questionnaires were submitted by a lead clinician in each centre. Five centres across Wales submitted data from 62 clinical encounters with patients with SLE. Result(s): Conclusion Results of this multi-centre audit do not demonstrate any widespread significant changes in care for patients with SLE in Wales between 2019 and 2021, despite 48% of consultations audited being undertaken virtually. Blood pressure and urinalysis were not consistently measured in 2021, likely secondary to the increased prevalence of virtual consultations. Group education has been undertaken as to the importance of facilitating observations in the virtual environment and centres have shared their experiences of how they tackle this challenge locally. (Table Presented).

Investigating Novel Risk Factors for Training Injuries Among Runners of the New York City Marathon

Purpose: Given the high incidence of injury duringmarathon training, a better understanding of the factors associated with injury is needed. The purpose of the study was to investigate an expanded set of baseline factors of marathon runners to determine the association with injury during training. Method(s): Adult registrants of the 2022 New York City Marathon were recruited by email for a 16-week observational study. The baseline survey included demographics, running/injury/COVID history, race goal, orthotic use, grit scale, risk-taking scale, injury risk self-assessment, happiness and life satisfaction scales, and perceived risks of running. Injury surveys were collected weekly during training. Result(s): A total of 894 runners registered for the study and were uninjured at the start of the study. Average age was 44.5 years (standard deviation 11.8), 55% were female, and 76% had previously participated in a marathon. During the 16 weeks before the race, 221 of 894 (24.7%) experienced an injury, including 36 of 894 (4.0%) who did not participate in the race. Each of the baseline factors were assessed in a logistic regression model controlling for age, sex, body mass index, base weekly mileage, and number of prior marathons. The baseline factors associated with injury were orthotic use (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.12-2.74, P = 0.01), happiness (OR 0.71, 95% CI 0.58-0.88, P = 0.001), and injury risk self-assessment (OR 1.13 for each 10% selfassessed risk, 95% CI 1.05-1.21, P = 0.001). There was no association with age, sex, body mass index, running/injury/ COVID history, race goal, grit, risk-taking behavior, life satisfaction, and perceived risks of running. Conclusion(s): Although age, sex, experience, and history of injury have been previously identified as risk factors for running-related injury, this was not the case in this large cohort of runners training for a marathon. Instead, orthotic use and self-assessed risk of injury were associated with higher rates of injury training, and a higher level of happiness was associated with lower rates of injury. Significance: The results show the value of a comprehensive running injury risk assessment, which could be standardized to facilitate comparative research. Accounting for these factors is important when assessing future injury prevention interventions.

Rheumatologistadherence to Vaccine Recommendation in Patients with Immune-Mediated Inflammatory Diseases

Objectives: Backgroud: Patients with immune-mediated inflammatory diseases (IMID), have an increased risk of presenting infections, this arises from immunosuppression related to the disease and its treatments. Vaccination in patients with autoimmune diseases is highly recommended by various clinical practice guidelines(1). Studies in Latin America show low rates of adherence, both in patients vaccine application and doctor's recommendations. One study shows that the lack of vaccination in 43% of their patients was due to their rheumatologist not recommending it (2). This is an eye opener on the key role physicians play in the overall outcome. Objective(s): To determine the adherence rate rheumatologists have, when it comes to recommending their patients vaccinations, suggested by clinical practice guidelines. Method(s): A descriptive study was performed, with previous authorization by the research department of the Colombian rheumatology association (ASOREUMA). A survey was sent via email to all its members asking about general knowledge about the subject and percentages on recommendations in their daily practice. Result(s): The survey was sent to 214 rheumatologist members of ASOREUMA, 34 (16%) of whom responded. In clinical practice there is a universal knowledge on the vaccination requirements for patients with IMID, nevertheless just 38.2% of clinicians tell patients to vaccinate against influenza of the 80%-100% of patients they see. For pneumococcus its 26.5%, hepatitis B 20.6%, human papilloma virus 8.8%, herpes zoster 2.9%. When it comes to SARS CoV2 vaccines it's by far the most recommended with 79.4%, and most physicians consider its mechanism of action before prescribing it. In table 1 we are summarizing the primary results. Conclusion(s): Despite the fact that rheumatologists are widely aware of the indications for vaccination in patients with IMID, these recommendations are not transmitted to all patients, due to the limited care time for each patient;in addition to the fact that the vast majority consider that the health system does not allow quick and timely access to these services.

Safety Culture in Irish Community Pharmacies: a cross-sectional study using the Community Pharmacy Survey on Patient Safety Culture

Introduction: Safety culture is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behaviour that determine the commitment to, and the style and proficiency of, an organisation's health and safety management.(1) Community pharmacists play a vital role in ensuring optimum medication safety however the study of patient safety culture in this setting is less developed than in secondary care. Aim(s): The study aim was to measure patient safety culture in Irish community pharmacies using the validated Community Pharmacy Survey on Patient Safety Culture (PSOPSC).(2) Methods: The survey consisted of 39 questions based on a 5-point Likert scale, within 11 dimensions. Demographic questions were asked including the pharmacist's role within the pharmacy. A free-text box allowed respondents to give comments on the survey topic. The online questionnaire, hosted on Microsoft Forms, was emailed to all 3943 community pharmacists registered with the Pharmaceutical Society of Ireland in November 2021. A reminder email was sent 14 days later. Data were analysed in Microsoft Excel. Categorical data were presented as frequencies (%). The positive rate response (PRR) of each survey question and dimension was calculated.(2) The PRR is the mean percentage of positive Likert scale responses to each item and each dimension of the survey. A PRR >75% indicated a strong safety culture, while a PRR <50% indicated a dimension that may be improved upon. Free-text responses were explored by thematic analysis. Result(s): The survey was completed by 173 pharmacists, response rate 4.5%. Of these, 33 (19.1%) were superintendent pharmacist, 65 (37.6%) supervising pharmacist, 53 (30.6%) staff pharmacist and 22 (12.7%) locum pharmacist. The mean %PRR across the 11 survey dimensions was 72.3%. Individual statements with highest PRR were Our pharmacists tell patients important information about their new prescriptions (PRR=91.3%) and Staff are treated fairly when they make mistakes (PRR=87.3%). Individual statements with lowest PRR were Interruptions/distractions in this pharmacy (from phone calls, faxes, customers, etc.) make it difficult for staff to work accurately (PRR=6.4%) and We feel rushed when processing prescriptions (PRR=8.1%). The dimension of Organizational Learning-Continuous Improvement demonstrated the highest PRR (81.6%), followed by Response to Mistakes (PRR=81.2%). The dimension of Staffing, work pressure and pace demonstrated the lowest PRR (35.6%). Respondents rated overall patient safety in their pharmacy as excellent/very good/good (88.4%). Differences in perception of patient safety emerged between pharmacists with different levels of responsibility. Patient safety rating was described as fair/poor by 0.0% of superintendent pharmacists, 6.3% of supervising pharmacists, 17.0% of staff pharmacists and 31.8% of locum pharmacists. Fifty-one (29.0%) respondents provided free-text comments. Emergent themes were impact on safety culture of staffing issues;staff training;dispensary workload;and dispensary work pressures. Conclusion(s): The study was limited by low response rate. This may reflect its timing during the COVID-19 pandemic and pharmacists' prioritisation of clinical roles at that time. Respondents reported a broadly positive patient safety culture in the pharmacy in which they work. Differences in perception of safety culture were observed between those with differing levels of responsibility in community pharmacy practice.