Search for Rare Decays of D^{0} Mesons into Two Muons

A search for the very rare D^{0}→μ^{+}μ^{-} decay is performed using data collected by the LHCb experiment in proton-proton collisions at sqrt[s]=7, 8, and 13 TeV, corresponding to an integrated luminosity of 9  fb^{-1}. The search is optimized for D^{0} mesons from D^{*+}→D^{0}π^{+} decays but is also sensitive to D^{0} mesons from other sources. No evidence for an excess of events over the expected background is observed. An upper limit on the branching fraction of this decay is set at B(D^{0}→μ^{+}μ^{-})<3.1×10^{-9} at a 90% C.L. This represents the world's most stringent limit, constraining models of physics beyond the standard model.

Observation of a J/ψΛ Resonance Consistent with a Strange Pentaquark Candidate in B^{-}→J/ψΛp[over ¯] Decays

An amplitude analysis of B^{-}→J/ψΛp[over ¯] decays is performed using 4400 signal candidates selected on a data sample of pp collisions recorded at center-of-mass energies of 7, 8, and 13 TeV with the LHCb detector, corresponding to an integrated luminosity of 9  fb^{-1}. A narrow resonance in the J/ψΛ system, consistent with a pentaquark candidate with strangeness, is observed with high significance. The mass and the width of this new state are measured to be 4338.2±0.7±0.4  MeV and 7.0±1.2±1.3  MeV, where the first uncertainty is statistical and the second systematic. The spin is determined to be 1/2 and negative parity is preferred. Because of the small Q-value of the reaction, the most precise single measurement of the B^{-} mass to date, 5279.44±0.05±0.07  MeV, is obtained.

First Measurement of Hard Exclusive π^{-}Δ^{++} Electroproduction Beam-Spin Asymmetries off the Proton

The polarized cross-section ratio σ_{LT^{'}}/σ_{0} from hard exclusive π^{-}Δ^{++} electroproduction off an unpolarized hydrogen target has been extracted based on beam-spin asymmetry measurements using a 10.2  GeV/10.6  GeV incident electron beam and the CLAS12 spectrometer at Jefferson Lab. The study, which provides the first observation of this channel in the deep-inelastic regime, focuses on very forward-pion kinematics in the valence regime, and photon virtualities ranging from 1.5  GeV^{2} up to 7  GeV^{2}. The reaction provides a novel access to the d-quark content of the nucleon and to p→Δ^{++} transition generalized parton distributions. A comparison to existing results for hard exclusive π^{+}n and π^{0}p electroproduction is provided, which shows a clear impact of the excitation mechanism, encoded in transition generalized parton distributions, on the asymmetry.

Reducing radiation exposure and cancer risk for children with scoliosis: EOS the new gold standard

PURPOSE

Children are exposed to significant radiation doses during the investigation and treatment phases of scoliosis. EOS is a new form of low-dose radiation scan which also yields great image quality. However, currently its use is discouraged in the UK due to higher costs. We aimed to quantify the additional radiation dose and cancer risk.

METHODS

We retrospectively reviewed all paediatric cases who received both standing whole spine roentgenograms and EOS scans as part of their investigations for scoliosis during a six-month period. We compared the radiation doses between the two modalities and estimated the additional mean lifetime cancer risk per study.

RESULTS

We identified 206 children (mean age 14.4) who met the criteria of having both scans. Dose area products (dGycm2) were converted to estimated effective doses (mSv). The total mean doses were 0.68 mSv (PA 0.49 + Lat 0.19) for plain films, and 0.13 mSv (PA 0.08 + Lat 0.04) for EOS scans (p < 0.001). Additional lifetime cancer risk of a plain film was 543% greater than EOS for both sexes (1/10727 versus 1/5827 in males, 1/34483 versus 1/6350 in females).

CONCLUSION

There is approximately 5.4-fold increase in risk of cancer for both boys and girls with roentgenograms over EOS, with girls being the most impacted. This carries a significant impact when considering the need for repeat imaging on additional lifetime malignancy risk in children. In our opinion, EOS dual planar scanning is the new gold standard when X-ray of the whole spine is required.

LEVEL OF EVIDENCE

III.

First CLAS12 Measurement of Deeply Virtual Compton Scattering Beam-Spin Asymmetries in the Extended Valence Region

Deeply virtual Compton scattering (DVCS) allows one to probe generalized parton distributions describing the 3D structure of the nucleon. We report the first measurement of the DVCS beam-spin asymmetry using the CLAS12 spectrometer with a 10.2 and 10.6 GeV electron beam scattering from unpolarized protons. The results greatly extend the Q^{2} and Bjorken-x phase space beyond the existing data in the valence region and provide 1600 new data points measured with unprecedented statistical uncertainty, setting new, tight constraints for future phenomenological studies.

Development and evaluation of a novel educational program for providers on the use of polygenic risk scores

PURPOSE

This study aimed to develop an online educational program for using PRS for breast and ovarian cancer risk-assessments and evaluate the impact on genetic healthcare providers' (GHP) attitudes, confidence, knowledge, and preparedness.

METHODS

The educational program comprised of an online module covering theoretical aspects of PRS, and a facilitated virtual workshop with pre-recorded roleplays and case discussions. Data were collected in pre-and post-education surveys. Eligible participants were GHPs working in Australian familial cancer clinics registered to recruit patients for a breast and ovarian cancer PRS clinical trial (n=12).

RESULTS

124 GHPs completed the PRS education, of whom 80 (64%) and 67 (41%) completed the pre-and post-education surveys, respectively. Pre-education, GHPs reported limited experience, confidence and preparedness using PRS, but recognized its potential benefits. Post-education GHPs indicated improved attitudes (p=<0.001), confidence (p=<0.001), knowledge (p=<0.001), and preparedness (p=<0.001) to use PRS. Most GHPs felt the program entirely met their learning needs (73%) and was completely relevant to their clinical practice (88%). GHPs identified PRS implementation barriers, including limited funding models, diversity issues, and need for clinical guidelines.

CONCLUSIONS

Our education program improved GHP attitudes, confidence, knowledge, and preparedness for using PRS/personalized risk and provides a framework for development of future programs.

First Measurement of Λ Electroproduction off Nuclei in the Current and Target Fragmentation Regions

We report results of Λ hyperon production in semi-inclusive deep-inelastic scattering off deuterium, carbon, iron, and lead targets obtained with the CLAS detector and the Continuous Electron Beam Accelerator Facility 5.014 GeV electron beam. These results represent the first measurements of the Λ multiplicity ratio and transverse momentum broadening as a function of the energy fraction (z) in the current and target fragmentation regions. The multiplicity ratio exhibits a strong suppression at high z and an enhancement at low z. The measured transverse momentum broadening is an order of magnitude greater than that seen for light mesons. This indicates that the propagating entity interacts very strongly with the nuclear medium, which suggests that propagation of diquark configurations in the nuclear medium takes place at least part of the time, even at high z. The trends of these results are qualitatively described by the Giessen Boltzmann-Uehling-Uhlenbeck transport model, particularly for the multiplicity ratios. These observations will potentially open a new era of studies of the structure of the nucleon as well as of strange baryons.

Factors affecting turnaround time of SARS-CoV-2 sequencing for inpatient infection prevention and control decision making: analysis of data from the COG-UK HOCI study

BACKGROUND

Barriers to rapid return of sequencing results can affect the utility of sequence data for infection prevention and control decisions.

AIM

To undertake a mixed-methods analysis to identify challenges that sites faced in achieving a rapid turnaround time (TAT) in the COVID-19 Genomics UK Hospital-Onset COVID-19 Infection (COG-UK HOCI) study.

METHODS

For the quantitative analysis, timepoints relating to different stages of the sequencing process were extracted from both the COG-UK HOCI study dataset and surveys of study sites. Qualitative data relating to the barriers and facilitators to achieving rapid TATs were included from thematic analysis.

FINDINGS

The overall TAT, from sample collection to receipt of sequence report by infection control teams, varied between sites (median 5.1 days, range 3.0-29.0 days). Most variation was seen between reporting of a positive COVID-19 polymerase chain reaction (PCR) result to sequence report generation (median 4.0 days, range 2.3-27.0 days). On deeper analysis, most of this variability was accounted for by differences in the delay between the COVID-19 PCR result and arrival of the sample at the sequencing laboratory (median 20.8 h, range 16.0-88.7 h). Qualitative analyses suggest that closer proximity of sequencing laboratories to diagnostic laboratories, increased staff flexibility and regular transport times facilitated a shorter TAT.

CONCLUSION

Integration of pathogen sequencing into diagnostic laboratories may help to improve sequencing TAT to allow sequence data to be of tangible value to infection control practice. Adding a quality control step upstream to increase capacity further down the workflow may also optimize TAT if lower quality samples are removed at an earlier stage.

Propylene Glycol and Hydroxypropyl Guar Nanoemulsion - Safe and Effective Lubricant Eye Drops in the Management of Dry Eye Disease

Dry eye disease (DED) is a chronic condition of the ocular surface characterized by a loss of the tear film homeostasis and accompanied by symptoms such as eye discomfort and visual disturbances. DED is classified as aqueous deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed dry eye etiologies. The mainstay treatment in the management of DED is artificial tear drops or lubricant eye drops that replenish the aqueous and/or lipid layer of the tear film. These are available as both lipid-based and non-lipid-based formulations, with/without preservatives. Lipid-based lubricant eye drops can stabilize the tear film lipid layer, reduce tear evaporation, and improve signs of EDE. In this review, we present the formulation components, mechanism of action, and summary of preclinical and clinical evidence on a lipid-based formulation - propylene glycol-hydroxypropyl guar (PG-HPG) nanoemulsion lubricant eye drops (Systane^TM Complete). These eye drops consist of the demulcent (lubricant), PG (0.6%). HPG forms a soft, thin, cross-linked in situ gel matrix with borate ions, when exposed to the tear film, which prolongs lubricant retention and provides ocular surface protection. Dimyristoyl phosphatidyl glycerol, an anionic phospholipid, helps in replenishing the lipid layer of the tear film. Moreover, the nanoemulsion formulation serves as a depot for delivery of dimyristoyl phosphatidyl glycerol to enhance ocular surface coverage. Preclinical and clinical evidence demonstrate that PG-HPG nanoemulsion lubricant eye drops are safe and effective in providing temporary relief of symptoms of DED, regardless of its subtypes. Specifically, it provides sustained reduction in dry eye symptoms, improves tear film stability/lipid layer grade, and improves ocular surface characteristics.

Evaluation of a prescribing pharmacist-led heart failure (HF) up-titration clinic

Background/Introduction

Pharmacotherapy is considered the cornerstone of treatment for patients with heart failure with reduced ejection fraction (HFrEF). Modulation of the renin-angiotensin-aldosterone (RAAS) and sympathetic nervous system have been shown to improve survival, reduce the risk of heart failure (HF) hospitalisations and improve quality of life. Unless contraindicated or not tolerated, these patients should be prescribed angiotensin-converting enzyme inhibitor (ACEi)/angiotensin-receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker, mineralocorticoid receptor antagonist (MRA) and sodium-glucose co-transporter 2 (SGLT2) inhibitor and up-titrated to guideline directed dosages.1 Despite the availability of effective treatments, patients are often sub-optimally dosed and experience a prolonged optimisation process. Pharmacist-led clinics can complement existing services and increase uptake of guideline directed medical therapies (GDMT).

Purpose

To evaluate the effectiveness of pharmacist-led heart failure clinics in the Princess of Wales Hospital, supported by the Heart Failure team, in optimisation of patients with HFrEF.

Methods

Patients who attended HF pharmacist led clinic between November 2020 and November 2021 were included in the analysis. Baseline demographics, left ventricular ejection fraction (LVEF), biomarkers, vital signs and medications were documented at baseline and after optimisation of GDMT. Number of clinics appointments and rate of hospitalisation and mortality were captured during the study period.

Results

76 patients were reviewed over a total of 318 consultations (34% virtual), averaging 4 consultations per patient. The mean age was 71 years, 36% of patients were female, mean LVEF was 32% and NT-proBNP 3078ng/L with 15% of patients on “quadruple therapy” at baseline. 93% of patients were referred by cardiologists and the average time from referral to first appointment was 42 days. Post-optimisation, 67% of patients were receiving “quadruple therapy”, with increased uptake of ACEi/ARB/ARNI, beta-blocker, MRA and SGLT2i from baseline (100%, 77%, 93% and 90% respectively). Mean LVEF increased to 42% and mean NT-proBNP reduced to 1695ng/L. No significant changes in creatinine clearance, blood pressure, heart rate or serum potassium (sK+) were recorded. The hospitalisation rate was 11% for heart failure, 6% for other cardiovascular causes and the mortality rate was 7%.

Conclusions

The pharmacist-led HF clinic demonstrated a high uptake of optimally dosed GDMT and improvements in NT-proBNP and LVEF. Pharmacist-led clinics can enhance the provision of existing heart failure services to improve patient outcomes and heart failure care.

Funding Acknowledgement

Type of funding sources: None.

First Measurement of the Z→μ^{+}μ^{-} Angular Coefficients in the Forward Region of pp Collisions at sqrt[s]=13 TeV

The first study of the angular distribution of μ^{+}μ^{-} pairs produced in the forward rapidity region via the Drell-Yan reaction pp→γ^{*}/Z+X→ℓ^{+}ℓ^{-}+X is presented, using data collected with the LHCb detector at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 5.1  fb^{-1}. The coefficients of the five leading terms in the angular distribution are determined as a function of the dimuon transverse momentum and rapidity. The results are compared to various theoretical predictions of the Z-boson production mechanism and can also be used to probe transverse-momentum-dependent parton distributions within the proton.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

POS1554-HPR HEALTH PROFESSIONALS’ PERSPECTIVES ON THE USE OF JANUS KINASE INHIBITORS TO TREAT PATIENTS WITH INFLAMMATORY ARTHRITIS

Background

Janus kinase inhibitors (JAKi) are relatively new to the field of rheumatology and provide health professionals in rheumatology (HPRs) with more therapeutic options for treating inflammatory arthritis (IA), specifically rheumatoid arthritis (RA) and psoriatic arthritis (PsA) [1]. Aside from a different target, JAKi differ from often currently prescribed biologics by being administered orally. To date, there is a lack of evidence on what HPRs think about their real-world use and how the COVID-19 pandemic affects JAKi prescription.

Objectives

To explore UK-based HPRs’ perspectives towards JAKi use in IA patients, and in the context also of the COVID-19 pandemic.

Methods

A 15-item anonymous online survey, with both closed and open-ended questions, was designed and piloted on 5 HPRs with amendments made based on their feedback. The survey was advertised on Twitter and shared by email in September 2021. Data were exported from the online survey platform and analysed descriptively with the assistance of statistical software.

Results

Fifty-one HPRs responded to the survey: 37 Consultants, 7 Registrars, 5 Clinical Nurse Specialists, 1 Clinical Fellow and 1 ‘other rheumatology role’ (not stated). Responses were received from 11/12 UK regions. Most represented was Greater London (18%) and North-West England (16%). 69% of respondents worked in secondary care, with the remaining 31% in tertiary care. The majority (40%) spent 1-25% of their job role doing research, followed by 27% who were not research active.

60% of HPRs indicated that 1-5% of their RA and/or PsA patients take a JAKi (no HPRs had more than 15% of their RA/PsA patients on a JAKi). 96% of HPRs indicated that they prescribe JAKi in their clinical practice, with 91% of those who prescribe following their local guidelines. 72% of respondents who prescribe JAKi, prescribed them ‘frequently’ as a monotherapy. Figure 1 shows responses chosen for when JAKi therapy is usually started and for feeling less confident with JAKi prescription.

Of those HPRs who prescribe, 17% have continued JAKi in their patients. When discontinuation occurred, the most common reasons chosen (multiple responses allowed) were ‘due to inefficacy’ (60%), ‘due to other adverse events’ i.e., non-major adverse cardiovascular events (32%) and ‘due to herpes zoster infection’ (28%). 55% of HPRs would consider switching patients to another JAKi after initial failure.

Across prescribers, 49% indicated no impact of the COVID-19 pandemic on their prescribing of JAKi. Common reasons chosen for a change in prescribing patterns for JAKi as a result of the pandemic (multiple responses allowed) included: prescribing them more as ‘an alternative to infusions, in order to reduce hospital visits’ (23%) and as ‘an alternative to injections, in order to reduce at-home training visits’ (21%). This was followed by ‘other reason’ (15%) with the free text from all 7 respondents highlighting the benefits of the shorter half-life of JAKi e.g., “Prescribed more as quick on and quick off so can be discontinued quickly in event of severe infection” (Registrar, Greater London).

Safety concerns around the use of JAKi were raised in 13/14 free text comments left at the end of the survey e.g., “I am concerned about recent reports of increased VTE [venous thromboembolism] and malignancies” (Consultant, Yorkshire and the Humber) and “Concerns about cardiovascular safety” (Clinical Fellow, Scotland).

Conclusion

A large proportion of HPRs indicate confidence in prescribing JAKi to their patients with IA, adhering to local guidelines. JAKi are largely prescribed as monotherapy, with the most frequent reason for discontinuation being inefficacy. The COVID-19 pandemic seems to have positively impacted JAKi prescription, however, safety concerns over JAKi use remain for some HPRs.

References

[1]Bechman, K. et al. Pharmacol. Res. (2019) 147, 104392.

Acknowledgements

Thank you to all health professionals who piloted, completed and shared the survey. This study received funding from the Pfizer Inflammation ASPIRE 2020 Rheumatology International Developed Markets Competitive Grant Programme.

Disclosure of Interests

Savia de Souza: None declared, Andrew Bassett: None declared, Ruth Williams: None declared, Elena Nikiphorou Speakers bureau: Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly, Grant/research support from: Pfizer and Lilly.

Antimicrobial stewardship using electronic prescribing systems in hospital settings: a scoping review of interventions and outcome measures

Objectives

To identify interventions implemented in hospital electronic prescribing systems and the outcome measures used to monitor their impact.

Methods

We systematically searched CINAHL, EMBASE, Google Scholar and Medline using keywords in three strands: (i) population: hospital inpatient or emergency department; (ii) intervention: electronic prescribing functionality; and (iii) outcome: antimicrobial stewardship. The interventions were grouped into six themes: alerts, order sets, restriction of access, mandated documentation, embedded guidelines and automatic prescription stop. The outcome measures were organized into those that measure the quality or quantity of prescribing or clinical decision support (CDS) activity. The impact of each intervention reported was grouped into a positive, negative or no change.

Results

A total of 28 studies were eligible for inclusion. There were 28 different interventions grouped into the six themes. Alerts visible to the practitioner in the electronic health record (EHR) were most frequently implemented (n = 11/28). Twenty different outcome measures were identified, divided into quality (n = 13/20) and quantity outcomes (n = 4/20) and CDS activity (n = 3/20). One-third of outcomes reported across the 28 studies showed positive change (34.4%, n = 42/122) and 61.4% (n = 75/122) showed no change.

Conclusions

The most frequently implemented interventions were alerts, the majority of which were to influence behaviour or decision-making of the practitioner within the EHR. Quality outcomes were most frequently selected by researchers. The review supports previous research that larger well-designed randomized studies are needed to investigate the impact of interventions on AMS and outcome measures to be standardized.

193 ARE OLDER PATIENTS IN IRELAND BEING ADEQUATELY SCREENED FOR DELIRIUM? RESULTS FROM AN IRISH PERIPHERAL HOSPITAL

Background

Delirium is associated with increased morbidity and mortality in the older person and still remains poorly detected. The Health Service Executive (HSE) has clear algorithms and guidelines which suggest that any person over the age of 65, especially so for patients with pre-existing dementia, presenting to the Emergency Department (ED) or Acute Medical Assessment Unit (AMAU) should be screened for delirium using the 4AT test. An earlier retrospective audit carried out by the authors in the same hospital showed that only 9% of patients with diagnosed delirium had a 4AT test at any point during inpatient stay and 0% had one on admission. We designed a prospective audit to assess what proportion of patients over 65 coming through the Acute Medical Assessment Unit (AMAU) had a delirium screening test performed on admission.

Methods

We reviewed the admission notes of all patients over 65 admitted through the AMAU over a continuous 14 day period from 10/11/20 to 24/11/2020. The admission notes were reviewed within 24 hours of admission. Exclusion criteria included patients presenting delirium tremens and patients presenting with a stroke.

Results

119 patients were identified. The mean age was 78.1 years. 20 (16.8%) had previously diagnosed dementia. 0 patients had a delirium screening test conducted by AMAU/ED staff on admission. 2 (1.7%) had 4AT tests done by members of the Geriatric Emergency Medical Services (GEMS) team within 24 hours. The GEMS team only sees patients who fulfill certain criteria on admission. 10 (8.4%) had ‘delirium’ listed on their differential diagnoses.

Conclusion

Our results show that the older patient being admitted through the AMAU in this hospital in Ireland is not being adequately screened for delirium. Additionally, even when delirium was suspected, delirium screening tools were not being implemented for further assessment. More needs to be done to ensure patients over 65 are assessed as per guidelines.

1560 Unusual Sites of Colorectal Cancer Metastases – A Complete Systematic Review

Background

While colorectal cancer (CRC) usually metastasizes to liver, lungs, and central nervous system, spread to more unusual sites is rarely reported in literature. We aimed to investigate unusual colorectal metastases (UCRM), their clinical course and disease progression.

Method

MEDLINE, EMBASE and Cochrane Library were searched by independent reviewers to identify clinical studies to date that reported UCRM and relevant demographic/clinical data were extracted.

Results

We identified 349 patients, involving 28 sites (bone, musculo-skeletal, skin, brain/spinal cord, head, eye, oral mucosa, thyroid, mediastinum, heart, bronchus, breast, biliary/GI tract, stomach, pancreas, spleen, adrenal, urinary tract, inguinal canal, ovaries, vagina, vulva, testes, spermatic cord, prostate, penis) with male preponderance and median age of 59 years (IQR=54.5-65). These were diagnosed at a median interval of 18 months (IQR=6-36)) after a median follow-up of 12 months (IQR=6-22.5). More were metachronous (n = 210) with recurrence rate of 15.75%. Primary CRC staging revealed T3 in 61% (28%-T4), equal distribution of N0/N1 (38%/37%) and M0 in 85%. 74% of primaries were surgically resected (96%=adenocarcinomas) and 54% underwent adjuvant therapy. UCRM were resected in 45% of cases and showed same histology as primary. 30% had chemotherapy. Only 8% were palliated. Overall morality was 35.24%.

Conclusions

This is the first comprehensive review looking at clinical course and outcomes of patients with UCRM. Most of these developed in patients with primary T3/N0 staging. Outlook of these patients is comparable to those with usual metastatic disease. Judicious and rigorous surveillance is the key to early detection and timely management.

OP0264-HPR “I LITERALLY CONVINCED MYSELF I WAS GOING TO CATCH IT AND DIE”: LIVED EXPERIENCES OF THE COVID-19 PANDEMIC BY PEOPLE WITH RHEUMATIC DISEASES FROM FOUR EUROPEAN COUNTRIES

Background:

The COVID-19 pandemic has resulted in unforeseen challenges for humanity, taking a significant toll, especially the immune-suppressed individuals. In this regard, the health and general well-being of people with rheumatic diseases, the great majority users of immunosuppressives, have been at stake.

Objectives:

To explore the impact of the COVID-19 pandemic on people with rheumatic diseases on immunosuppression during the first wave, concerning a) (self-)management of their disease; b) interaction with the health care team; c) emotional well-being and d) overall health.

Methods:

A qualitative study was conducted following a phenomenological approach. Adults (>18 years) with a rheumatic disease from four European countries (Cyprus, England, Greece, Portugal). Patients were recruited through patient’s associations and social media and were invited to participate in semi-structured, audio-recorded interview or focus groups, between July - August 2020. Following a pilot study the information provided was transcribed verbatim, anonymized and translated into English where necessary. An inductive approach was adopted to carry out a thematic framework analysis with the assistance of ATLAS.ti to identify key themes and subthemes. Data validation strategies were employed, and Ethical approval and informed consent were obtained.

Results:

Participants were 24 patients (21 women, age range 33 to 74 years) divided by 7 focus-groups and 1 individual interview. Most frequent diagnoses were rheumatoid arthritis (n=7), lupus (n=4), juvenile idiopathic arthritis (n=3).

Three key themes with 3-7 subthemes were identified within the analytical framework, centred around the impact of the Covid-19 on patients’ lives (Figure 1): i) individual person (e.g. fear for myself and family, social isolation and lack of personal freedom, more time with family) ii) health settings (e.g. (un)clear information about risks of contamination, fear or risk of shortages of medication, remote consultations), and iii) work and community (e.g. persistent stress due to mass media exposure, lack of awareness by others about patients’ rheumatic disease and its disclosure, hope and suspicion about new vaccine development: “I hear that they will ask vulnerable groups to have the vaccine first (...) Why is that? we will be again the innocent victims”). Findings were similar across countries, except for spirituality (i.e. the pandemic as “the hand of God”), a coping subtheme particular to Portugal. These main themes resonated well with the social ecological model and Walsh’s Family Resilience Process [1,2].

Conclusion:

When experiencing a significant life-event people require some time to process the different lived experiences. This study provides insights on how patients from four countries coped with the new challenges. Such insights are invaluable for health care providers and policy makers, in guiding more meaningful support tailored to individual needs, especially at times of crisis. The study highlights the impact of COVID-19 on the lives of people with rheumatic disease. A follow-up study is currently underway to examine the effect of subsequent waves of the pandemic.

References:

[1]Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav. 2012;39(3):364-72. doi: 10.1177/1090198111418634.

[2]Walsh F. Family resilience: a framework for clinical practice. Fam Process. 2003;42(1):1-18. doi: 10.1111/j.1545-5300.2003.00001.

Acknowledgements:

We thank the participants of this study.

Disclosure of Interests:

None declared