Routine Clinic Appointments Research Articles

Association of Unmet Social Needs With Disease-Related Outcomes in Pediatric Patients With Sickle Cell Disease.

Social determinants of health (SDoH) are socioeconomic factors that influence health and well-being, though when unmetcan greatly contribute to health disparities. Individuals with sickle cell disease (SCD) are at increased risk of mortality, disability, and healthcare utilization. However, there are limited data linking specific social needs with disease outcomes in this population. Therefore, we sought to identify the unmet needs in one institution and their association with healthcare utilization. Children with SCD and their guardians answered demographic and SDoH questionnaires during routine Sickle Cell Clinic appointments. We defined an unmet social need as any positive answer to the SDoH questionnaire. Disease outcome variables were electronic health record (EHR)-documented emergency department (ED) visits, hospitalizations, clinic appointment attendance, and guardian-reported acute SCD events in the previous year. A total of 114 parent-guardian dyads participated, with 103 having complete data to analyze. In all, 52% of subjects reported at least one unmet social need with food insecurity (36%), trouble paying utility bills (28%), and unemployment (16%) being the most prevalent. Subjects with at least one unmet need had two times the rate of ED visits and/or hospitalizations and were 1.15 times more likely to have an SCD event in the past year. However, only the association with ED visits was statistically significant (p = 0.03). Over half of subjects reported at least one unmet need; the most common being reliable access to food, which has the potential to impact health outcomes of sickle cell patients. Furthermore, unmet social needs are linked to healthcare utilization and SCD-related complications, supporting routine screening for SDoH in this population.

Assessing disease control in inflammatory bowel disease: a real world cross-sectional study in the UK (PODCAST-IBD)

Objective Proportion Of suboptimal Disease Control And Strategy of Treatment in IBD (PODCAST-IBD) was an international real-world study which aimed to quantify disease control in IBD using STRIDE-II recommendations. Design/Method Cross-sectional assessment of IBD patients attending routine clinic appointments in four UK centers October 2022 to January 2023. Clinician-reported outcomes, patient-reported outcomes and retrospective data from medical chart review were used to assess IBD control against red flags aligned to STRIDE-II. Results Data were available from 198 UK patients. IBD was suboptimally controlled in 52.4% (54/103) of patients with Crohn’s disease (CD) and 45.3% (43/95) with ulcerative colitis (UC). Impaired quality of life (QOL), defined as Short inflammatory bowel disease questionnaire (SIBDQ) score <50, was the main contributor to suboptimal disease control. Suboptimal disease control has a detrimental impact on fatigue and disability with significantly lower mean Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) score in suboptimally controlled disease (CD: 81.5 vs 125, UC: 87.4 vs 122.8) and IBD Disk. Suboptimal disease control results in higher health care resource use (HCRU) (CD: £4,746 vs £1,924; UC: £2,428 vs £1,121) and higher rates of work productivity loss (CD: 41.7% vs 11.9%, UC: 38.0% vs 22.6%). Conclusion IBD was suboptimally controlled in around one-half of patients. Impaired QOL was the most common contributor (64%, 62/97) to suboptimal control. Suboptimal control had a considerable economic impact; HCRU more than doubled and productivity fell. Physicians could consider regular QOL assessments to prompt timely disease monitoring to enable identification of early active disease and appropriate treatment.

ThP3.7 - Evaluating the Effectiveness of Internal Vetting for General Practitioners Referrals with Urgent Suspicion of Oesophago-Gastric Cancer

Abstract Aim The NHS faces substantial pressure on surgical clinic waiting times especially for urgent suspicion of cancer (USOC). This study audits the effectiveness of internal vetting process and the clinic waiting time for patients referred as USOC for oesophago-gastric cancer. Methods This was a retrospective cohort study of all consecutive USOC referrals with suspected oesophago-gastric cancer who had clinic appointment in a single surgical unit between April to September 2022. All patients who fulfilled the Scottish referral criteria for USOC were included. Patients demographics, the urgency of clinic slot utilised and waiting time to clinic were analysed. This study was registered with Clinical Quality Project (LanQIP 14749). Results 275 patients were included; median age was 63 years (IQR 52-73) and 153 (55.6%) were female. 94 (34.2%) patients were appointed as USOC, 120 (43.6%) as urgent and 61 (22.2%) as routine clinic slot. Overall, the median time for clinic appointment was 42 days (IQR 31-63). The median time to clinic was 47, 42 and 21 days for USOC, urgent and routine clinic appointments, respectively. 21 (7.6%) patients did not attend clinic. Of the patients who attended the clinic, 200 (78.7%) had endoscopy requested. Conclusions Although General Practitioners made appropriate referrals, a noteworthy portion of patients were reassigned to urgent or routine clinic slots. Nevertheless, those downgraded in urgency received prompt clinic reviews. This can be attributed to the strategic use of less urgent slots, ensuring timely assessments for patients with urgent suspicion of oesophago-gastric cancer.

Active implementation of low disease activity state as a treatment endpoint in childhood-onset systemic lupus erythematosus in routine practice is both feasible and associated with better outcomes

IntroductionTreat-to-target (T2T) strategies aim to facilitate tight disease control to improve outcomes. No previous studies evaluated prospectively the feasibility and impact of the T2T strategy in routine practice in childhood-onset SLE (cSLE).MethodsAdolescents and young adults (AYA) with cSLE were recruited for T2T implementation from a large tertiary centre over a period of 6 months and followed up at least twice over a prospective period of 12 months.ResultsDuring Oct 2022–April 2023, 135/162 (83.3%) AYA with cSLE had disease scores evaluated at their routine appointment to enable inclusion in the study, and 122/135 (91.2%) had their disease assessed, and a suitable treatment target agreed and documented at each routine clinical appointment over the 12 months prospective follow-up. T2T strategy led to improved disease control at 12 months: more AYA with cSLE achieved clinical remission off steroids (4.1% vs. 10.7%, P = 0.048), or minimum childhood-lupus low disease activity (cLLDAS) (81.9% vs. 91.8%, P = 0.022). Achieving minimum cLLDAS for longer than 3 months was associated with reduced damage accrual (HR = 1.7; 95%CI = 1.1–2.5; P < 0.0001) at 12 months.ConclusionT2T strategy implementation was achievable and associated with improved cSLE control. Spending at least 3/12 months in cLLDAS led to less damage accumulation.Key Points• This is the first large prospective study in AYA with cSLE to evaluate the impact of active T2T implementation in routine practice.• T2T strategies were feasible to implement in 122/135 (91.2%) AYA with cSLE in routine practice.• The T2T approach was associated with improved disease control and decreased damage accrual at 12 months.

Robotic Heller's cardiomyotomy for achalasia: early outcomes for a high-volume UK centre.

Heller's cardiomyotomy (HCM) is the gold standard treatment for achalasia. Laparoscopic HCM has been shown to be effective with low rates of symptom recurrence, though oesophageal mucosal perforation rates remain high. The aim of this prospective case series is to assess the short-term complication rates and perioperative outcomes for the first cohort of patients undergoing robotic-assisted HCM for achalasia in a single high-volume UK centre. Data were collected from a prospective cohort of patients who underwent robotic HCM at a single high-volume UK centre. Outcomes were assessed using the Eckhard score, which was calculated after their routine postoperative clinic appointments. Thirteen patients underwent robotic HCM during the study period; this is the second largest reported case series in the European literature. There were no intraoperative oesophageal perforations. Six patients were discharged as day cases, six patients were discharged on the first postoperative day and one patient's hospital stay was two nights. There was a single perioperative complication of urinary retention. All patients reported improvement of symptoms following their operation, and all had a postoperative Eckhard score of less than 3, indicating their achalasia was in remission. This cohort has demonstrated that robotic HCM has an exceptional safety profile and results in high levels of symptom resolution, even early in the learning curve. The robotic approach may be superior to laparoscopy as it allows more precise identification and dissection of the oesophageal muscle fibres, which likely reduces the risk of inadvertent mucosal damage or incomplete myotomy.

Primary headache disorders among people living with HIV in Lusaka, Zambia

ObjectiveWe completed a cross-sectional survey study to determine headache prevalence and its association with HIV characteristics among people living with HIV (PLHIV) in Lusaka, Zambia. BackgroundHeadaches are common but their association with HIV status is unknown. MethodsThe HARDSHIP survey, a headache epidemiology questionnaire previously validated in Zambia, was distributed during a 3-month period to 3666 consecutive adult PLHIV attending routine clinic appointments at the Adult Infectious Diseases Centre at the University Teaching Hospital in Lusaka, Zambia. HIV disease characteristics were abstracted from their charts. Results1015 (27.7%) participants responded to the survey. Adjusted for age, 64% reported having a headache within the last year unrelated to another illness. Among participants, 201 met criteria for migraine (20%), 259 for tension-type headache (26%), 18 for probable medication-overuse headache (2%), and 121 for undetermined headache (12%). Prevalence for tension-type headache was significantly higher than that of migraine (P < 0.001). After adjusting for age and sex, higher CD4 counts were associated with migraine. No other associations were observed between overall headache or headache type with HIV disease characteristics including CD4 count, viral load, antiretroviral regimen, and time since HIV diagnosis. ConclusionsHeadaches are highly prevalent among this cohort of PLHIV in Zambia. Optimizing headache treatment and integrating it into routine HIV care may improve quality of life for a substantial proportion of PLHIV in Zambia.

Machine learning approaches to enhance diagnosis and staging of patients with MASLD using routinely available clinical information.

Metabolic dysfunction Associated Steatotic Liver Disease (MASLD) outcomes such as MASH (metabolic dysfunction associated steatohepatitis), fibrosis and cirrhosis are ordinarily determined by resource-intensive and invasive biopsies. We aim to show that routine clinical tests offer sufficient information to predict these endpoints. Using the LITMUS Metacohort derived from the European NAFLD Registry, the largest MASLD dataset in Europe, we create three combinations of features which vary in degree of procurement including a 19-variable feature set that are attained through a routine clinical appointment or blood test. This data was used to train predictive models using supervised machine learning (ML) algorithm XGBoost, alongside missing imputation technique MICE and class balancing algorithm SMOTE. Shapley Additive exPlanations (SHAP) were added to determine relative importance for each clinical variable. Analysing nine biopsy-derived MASLD outcomes of cohort size ranging between 5385 and 6673 subjects, we were able to predict individuals at training set AUCs ranging from 0.719-0.994, including classifying individuals who are At-Risk MASH at an AUC = 0.899. Using two further feature combinations of 26-variables and 35-variables, which included composite scores known to be good indicators for MASLD endpoints and advanced specialist tests, we found predictive performance did not sufficiently improve. We are also able to present local and global explanations for each ML model, offering clinicians interpretability without the expense of worsening predictive performance. This study developed a series of ML models of accuracy ranging from 71.9-99.4% using only easily extractable and readily available information in predicting MASLD outcomes which are usually determined through highly invasive means.

P1145 Assessing disease control in inflammatory bowel disease (IBD) – a real world cross-sectional study in the UK

Abstract Background There is a paucity of data on disease control in patients with inflammatory bowel disease (IBD) in clinical practice. The Proportion Of suboptimal Disease Control And Strategy of Treatment in IBD (PODCAST-IBD) multicentre, non-interventional study aimed to quantify real-world rates of disease control using the STRIDE-II recommendations, explore contributors to, and the economic burden of, suboptimal disease control. Methods Cross sectional assessment of patients with IBD attending routine clinic appointments was carried out in four UK centres between Oct 2022 and Jan 2023. Clinician-reported outcomes, patient-reported outcomes and retrospective data from medical chart review were used to assess IBD control against red flags aligned to the STRIDE-II recommendations (Table). Health care resource utilisation (HCRU) was calculated using NHS reference costs. Results Data was available from 198 patients (Crohn's disease [CD]: 103, ulcerative colitis [UC]: 95) and most were currently receiving long-term IBD-specific treatment (CD: 85%, UC: 78%). IBD was suboptimally controlled in 52.4% (54/103) of patients with CD and 45.3% (49/95) with UC. Impaired quality of life (QOL), defined as Short inflammatory bowel disease questionnaire (SIBDQ) score &amp;lt;50, was the most frequent contributor to suboptimal disease control for both UC and CD. Other frequent contributors were systemic steroid overuse, extraintestinal manifestations (EIM), failure to achieve clinical improvement and perianal disease (Figure). Suboptimal disease control has a detrimental impact on fatigue and disability, demonstrated by lower (indicating more fatigue) mean total FACIT-F score in suboptimally controlled disease (CD: 81.5 vs 125, UC: 87.4 vs 122.8) and IBD Disk, a 10-item self-questionnaire used to assess IBD-related disability. HCRU more than doubled in patients with suboptimal vs optimal control (CD: £4,746 vs £1,924; UC: £2,428 vs £1,121), driven by more hospital admissions and emergency room visits in patients with suboptimal disease control. Patients with suboptimal disease control had higher rates of work productivity loss than those with optimal control (CD: 41.7% vs 11.9%, UC: 38.0% vs 22.6%). Conclusion This UK cross-sectional study found that IBD was suboptimally controlled in around one-half of patients based on STRIDE-II recommendations. Of those with suboptimally controlled disease one-third had impaired QOL making it the most common contributor. Suboptimal control of IBD had a considerable economic impact; HCRU more than doubled and productivity fell. Physicians could consider regular QOL assessments to prompt timely disease monitoring to enable identification of early active disease and ensure appropriate treatment.

Sexual network characteristics and partnership types among men who have sex with men diagnosed with syphilis, gonorrhoea and/or chlamydia in Lima, Peru

ObjectivesSexual networks are known to structure sexually transmitted infection (STI) transmission among men who have sex with men (MSM). We sought to estimate the risks of STI diagnosis for various...

Using "Real-World Data" to Study Cleft Lip/Palate Care: An Exploration of Speech Outcomes from a Multi-Center US Learning Health Network.

To assess the ability of a cleft-specific multi-site learning health network registry to describe variations in cleft outcomes by cleft phenotypes, ages, and treatment centers. Observed variations were assessed for coherence with prior study findings. Cross-sectional analysis of prospectively collected data from 2019-2022. Six cleft treatment centers collected data systematically during routine clinic appointments according to a standardized protocol. 714 English-speaking children and adolescents with non-syndromic cleft lip/palate. Routine multidisciplinary care and systematic outcomes measurement by cleft teams. Speech outcomes included articulatory accuracy measured by Percent Consonants Correct (PCC), velopharyngeal function measured by Velopharyngeal Competence (VPC) Rating Scale (VPC-R), intelligibility measured by caregiver-reported Intelligibility in Context Scale (ICS), and two CLEFT-Q™ surveys, in which patients rate their own speech function and level of speech distress. 12year-olds exhibited high median PCC scores (91-100%), high frequency of velopharyngeal competency (62.50-100%), and high median Speech Function (80-91) relative to younger peers parsed by phenotype. Patients with bilateral cleft lip, alveolus, and palate reported low PCC scores (51-91%) relative to peers at some ages and low frequency of velopharyngeal competency (26.67%) at 5 years. ICS scores ranged from 3.93-5.0 for all ages and phenotypes. Speech Function and Speech Distress were similar across phenotypes. This exploration of speech outcomes demonstrates the current ability of the cleft-specific registry to support cleft research efforts as a source of "real-world" data. Further work is focused on developing robust methodology for hypothesis-driven research and causal inference.

Improving data quality from routine clinical appointments-Development of a minimum dataset for traumatic dental injuries in children and adolescents.

It is currently difficult to evaluate the success or not of treatment for dental injuries due to poor recording of diagnostic and treatment codes in clinical dentistry. A minimum dataset comprises a standardised minimum set of outcomes along with a specified outcome measurement instrument, to allow aggregated use of data from routine clinical care appointments. This study aimed to determine which outcomes should be included in a minimum dataset for traumatic dental injuries (TDI). This is a three-stage sequential, mixed-methods study, using evidence-based best practice for dataset development. Normalisation process theory informed the development of the study protocols. In Stage 1, semi-structured interviews with patients and their parent or guardian were undertaken to identify outcomes of importance to patients. In Stage 2, an online Delphi survey was undertaken to identify outcomes of importance to clinicians. In Stage 3, a National Consensus Meeting was undertaken involving patient representatives, clinicians and other stakeholders, to agree which outcomes should be included in the minimum dataset. Stage 1: Eleven participants were recruited, five children and six parents. Two key themes emerged from the analysis-communication and aesthetics. In Stage 2, 34 dentists were recruited, and 32 completed both rounds of the survey (97% retention). Most outcomes were deemed by participants to be of 'critical importance', with three outcomes deemed 'important' and none to be 'of limited importance'. In Stage 3, 15 participants took part in the consensus meeting. Participants agreed that the dataset should comprise a list of clinician-important outcomes (pulp healing, periodontal healing, discolouration, tooth loss) and a list of patient-important outcomes (communication, aesthetics, pain, quality of life). A Minimum Dataset for TDI has been developed using a robust and transparent methodology.

Drug-induced liver injury secondary to increased levonorgestrel exposure in a patient taking ritonavir.

We report the first published case of a drug induced liver injury (DILI) presumed secondary to a drug-drug interaction between ritonavir and levonorgestrel progestogen-only emergency contraception (POEC). Our patient is a 25-year-old female living with human immunodeficiency virus (HIV), taking antiretroviral therapy (ART) containing tenofovir alafenamide/emtricitabine and darunavir/ritonavir. She was found to have elevated transaminases at a routine clinic appointment consistent with hepatocellular DILI. Further investigation found the most likely cause of this was a drug-drug interaction (DDI) between the ritonavir component of her ART and recent use of levonorgestrel POEC 3days earlier. Evidence suggests that ritonavir increases levonorgestrel exposure, yet our patient received double the usual dose as per dispensing guidance at the time. We review the pharmacokinetics of ritonavir-levonorgestrel DDIs and highlight the need for consistent guidelines on this topic.

In-Person Clinic Visits After Laparoscopic Cholecystectomy: Lessons Learned From COVID-19 Pandemic

IntroductionThe utility of routine in-person clinic appointments after laparoscopic cholecystectomy (LC) is uncertain, especially after the increase of telehealth visits during the COVID-19 pandemic. The purpose of this study was to evaluate the utility of routine in-person follow-up for patients undergoing LC prior to changes implemented during the pandemic and to determine whether a return to routine in-person follow-up is warranted. MethodsWe retrospectively reviewed follow-up encounters for all patients undergoing LC from April 2018 to February 2020. All patients were routinely scheduled for in-person postoperative clinic follow-up 2-4 wk after discharge. Follow-up was considered nonroutine if new studies or medications were ordered, the patient was referred to the emergency department or readmitted, or malignancy was identified on pathology review. ResultsOf 661 patients undergoing LC, 449 (68%) attended their scheduled in-person postoperative appointment and 212 (32%) did not. The postoperative appointment was nonroutine for 39 patients (9% of clinic attenders). Readmission occurred in 42 patients, with no differences between clinic attenders and nonattenders (P = 0.12). Furthermore, attending a postoperative clinic visit did not affect odds of readmission (odds ratio: 0.705, 95% confidence interval: 0.368, 1.351; P = 0.29). Readmission occurred on median day 9 after discharge in both groups. ConclusionsThe incidence of nonroutine follow-up after LC is low, and attendance at follow-up clinic was not associated with reduced readmissions. A return to routinely scheduling in-person follow-up 2-4 wk after discharge may not be warranted. Telehealth visits within 1 wk of discharge after LC should be considered.

Psychosocial well-being among patients with malignant pleural mesothelioma.

The investigators conducted a psychosocial needs assessment of mesothelioma patients through self-report measures of quality of life (QOL), coping, depression, and social support. Patients with malignant pleural mesothelioma (MPM) (N=67) completed a battery of assessments at a single timepoint after being approached during routine medical oncology clinic appointments or by letter. Participants were predominately male (70.0%; n=47) and ranged in age from 35 to 83years old (M=65.61, SD=9.71). Most participants were white (88.0%; n=59), and 10.0% (n=7) were identified as Hispanic. The majority were married or living with a partner (93.0%; n=62) and had some college or more education (64.0%; n=43). Fourteen percent of participants (n=11) endorsed significantly elevated depression symptoms. No significant demographic or clinical differences in depressed compared to nondepressed participants were observed, with a trend toward those identifying as Hispanic and those who were divorced as being more likely to be depressed. For the total sample, the most frequently endorsed coping strategies were active coping, emotional support, and acceptance. The present study did not identify any clear correlates of depression or QOL among patients with MPM. This research contributes to the small literature on psychosocial functioning in patients with MPM and provides putative directions for future larger studies and the development of interventions to provide appropriate support to diverse patients with MPM.

The Utility of the Central Sensitivity Score as a Predictor of Disease Activity in a Cohort of Stable Rheumatoid Arthritis

Objective: To assess the impact of central sensitisation as measured by the ‘Central Sensitivity Score’ on rheumatoid arthritis disease activity change. Methods: This was a prospective cohort study of rheumatoid arthritis patients receiving routine clinical care. At baseline, participants had assessment of rheumatoid arthritis disease activity from a 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate, symptoms of central sensitisation (from central sensitivity score, the numerical score derived from the 2016 American College of Rheumatology Fibromyalgia diagnostic criteria), demographic and clinical variables. A follow up 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate was collected on the next routine clinic appointment (median 3 months). The association of central sensitivity score and change in rheumatoid arthritis disease activity was assessed using a multivariate linear regression analysis. Results: Data were obtained from 82 participants. The median baseline 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate across the cohort was 2.44. On multivariate linear regression a higher baseline central sensitivity score independently predicted improvement in 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate (regression coefficient=-0.02, 95% CI [-0.08 to -0.01]). A higher C-Reactive Protein was also an independent predictor of improvement in 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate (regression coefficient -0.02, 95% CI [-0.04 to 0.01]). Exposure to a higher number of biologics predicted worsening in 3-variable Disease Activity Score with 28 Joint Count Erythrocyte Sedimentation Rate (regression coefficient=0.28, 95% CI [0.08 to 0.48]). Conclusion: In this closely monitored cohort with relatively well controlled disease, a higher baseline central sensitivity score was predictive of a small but not clinically meaningful change in objective rheumatoid arthritis disease activity.

OGC P36 Unmet needs in survivorship: Increased anxiety post oesophago-gastric cancer surgery

Abstract Background Oesophago-Gastric (OG) cancer is an aggressive malignant disease, and patients are offered extensive surgical treatment often in combination with neoadjuvant and adjuvant oncological intervention. The treatment process is emotionally demanding and affects treatment outcomes (Fangand, &amp; Schnoll, 2002). However, the available research is concentrated on generalised anxiety and depression (Hellstadius et al, 2017), despite the unique concerns of this cohort. This study examines the trajectory of patients’ unique OG symptoms related anxiety through utilising a specialist measure. Methods The Oesophageal Anxiety and Hypervigilence Scale (EHAS) is a newly validated self-report questionnaire that detects oesophageal anxiety in patience with GI disorders. It has been shown to demonstrate good internal consistency and validity (Taft et al, 2018). Patients with oesophageal cancer were recruited from at Guy's and St Thomas’ Hospital, London. As part of their routine clinic appointments between September 2021-February 2022, patients completed the EHAS measure across four key time points within their treatment trajectory; diagnosis (Time 1), pre-operatively (Time 2), two weeks post operatively (Time 3), and 6–12 months post operatively, often termed ‘survivorship’ (Time 4). Results A total of 106 EHAS measures were completed by 83 patients (79% male, 20% female, mean age = 64) at different stages within their treatment trajectory, representing a between-subjects design. 61% of patients underwent oesophagectomy, 22% total gastrectomy, 10% subtotal gastrectomy and 7% underwent other surgeries including sigmoid colectomy, and jejunal resection. Pooling the sample z-score, the cut off score for clinical significance was calculated at 33. The EHAS outcomes revealed high anxiety at Time 1 (T1 mean = 28/33) which decreased by 32% from to Time 2 (T2 mean = 19/33). Anxiety remained low in the period between Time 2 to Time 3 (T3 mean = 21/33). Surprisingly, anxiety scores increased by 42% from Time 3 to Time 4 (T4 mean = 29/33), matching the elevated levels observed at Time 1. Other important findings related to the proportion of patients that scored above clinical cut off. Whilst 12% of patients scored above cut off at Time 1, this rose to 32% at Time 4, indicating marked anxiety during the phase of recovery greater than that experienced at diagnosis. At this level of analysis there is no evidence to indicate a relationship between type of surgery and elevated anxiety. Conclusions With the use of a specialist anxiety measure, we demonstrate that oesophageal anxiety is common among OG cancer patient cohort. The trajectory of anxiety observed in this study has clinical implications for the timing of support and enhanced recovery programme; this study revealed that OG anxiety fluctuated across the treatment pathway, and peaked at two distinct time points; diagnosis and survivorship. This challenges the often held assumption that patients anxiety increases pre-operatively (Hellstadius et al, 2017), and instead refocuses the need for input at both the diagnosis and survivorship periods. The high anxiety observed at the survivorship stage may also affect patients’ ability to process and adhere to treatment advice, further exacerbating their symptoms and jeopardising their physical recovery. Patients are monitored less during their survivorship period as the intensity of treatment cease, however the results indicate need for continued input.

QOL-20. PATTERNS AND PREDICTORS OF ANXIETY AND DEPRESSION SYMPTOM TRAJECTORIES IN PATIENTS DIAGNOSED WITH PRIMARY BRAIN TUMORS

Abstract BACKGROUND Patients diagnosed with primary brain tumors (pPBTs) exhibit high psychological distress. This study assessed how symptoms of anxiety and depression change over time in pPBTs and identified factors that may predict patients’ symptom trajectories. METHODS Ninety-nine adult pPBTs completed psychosocial assessments at routine neuro-oncology clinical appointments over 6 to 18 months, with a minimum 8-week interval between assessments. Symptoms of anxiety and depression were assessed with the PROMIS Anxiety and Depression Short-Forms. The prevalence and incidence of patients with clinically elevated anxiety and depression symptoms throughout follow-up were examined, along with the prevalence of patients that experienced clinically meaningful changes in symptoms between follow-ups. Linear mixed-effects models evaluated changes in symptoms over time at the group level and latent class growth analysis (LCGA) evaluated changes in symptoms over time at the individual level. RESULTS At baseline, 51.5% and 32.3% of patients exhibited clinically elevated levels of anxiety and depression, respectively. Of patients with any follow-up data (N = 74), 54.1% and 50% experienced clinically meaningful increases in anxiety and depression scores, respectively. The incidence of moderate to severe anxiety and depression was 15.6% and 8.3%, respectively. There was no significant change in symptoms over time at the group level, but better physical, functional, and brain-cancer well-being predicted significantly lower anxiety and depression symptoms (p&amp;lt; .001). Results from LCGA showcased 5-unique subgroups of patients with distinct anxiety and depression symptom trajectories. CONCLUSION pPBTs commonly experience elevated anxiety and depression. Symptoms of anxiety and depression change in clinically meaningful manners throughout the disease, even in the absence of significant group-level time effects. Routine screening for elevated symptoms is needed to capture clinically meaningful changes in symptoms and identify factors affecting symptoms to intervene.

COVID-19 vaccination uptake in 441 socially and ethnically diverse pregnant women.

To explore COVID-19 vaccination uptake, facilitators and barriers in ethnically-diverse pregnant women. An anonymous quality improvement questionnaire survey exploring COVID-19 vaccination uptake, causes of vaccine hesitancy and trusted sources of information among pregnant women in two acute district general hospitals in England (Berkshire and Surrey) between 1.9.21 and 28.2.22. 441 pregnant women attending routine antenatal clinic appointments. Consented pregnant women completed the survey either electronically using a QR code or on paper. Descriptive data were summarised and free text responses were thematically analysed. 441 pregnant women, mean age 32 years (range 17-44), completed the survey. Twenty-six percent were from ethnic minority groups, and 31% had a co-morbid health condition. Most respondents (66.2%) had been vaccinated against COVID-19 with at least one dose (White British 71.9%, Asian 67.9%, White-other 63.6%, Black 33%). The most common reasons for not being vaccinated were concerns about effects on the unborn baby and future pregnancies, anxiety about possible adverse impact on the mother, not enough known about the vaccine, and lack of trust in vaccines. Comments included: "I'd rather not risk injecting the unknown into my body", and "I don't trust it." Although 23% used social media for information on COVID-19 vaccination, the most trusted sources were the patient's GP and midwife (43%) and official health-related websites such as NHS (39%). A third of these pregnant women had not been vaccinated against COVID-19. Trusted health professionals like midwives and GPs could have a crucial role in increasing vaccination uptake.

Remote capillary blood collection for HbA1c measurement during the COVID-19 pandemic: A laboratory and patient perspective.

AimsThe purpose of this study was to assess the clinical performance and user acceptance of capillary blood samples prepared remotely using the MiniCollect® capillary blood collection device as an alternative to blood collection by venepuncture for glycated haemoglobin (HbA1c) analysis.MethodsFollowing written informed consent, a cross‐sectional study was conducted in individuals aged ≥18 years with any type of diabetes who routinely self‐monitor their blood glucose. Eligible participants recruited whilst attending their routine clinical appointments were required to provide a venous blood sample, prepare a capillary blood sample at home (remotely) and complete a bespoke questionnaire. HbA1c in whole blood collected in ethylenediaminetetraacetic acid was determined by capillary electrophoresis on the Sebia Capillary's 3 Tera analyser following standard operating procedure.ResultsHbA1c results from both venous and capillary collection demonstrated good agreement. Passing‐Bablok regression: y = 0 + 1x (p = 0.18), Spearman correlation r = 0.986, p < 0.0001. The Bland–Altman difference plot provided a mean difference of 0.3 mmol/mol (2.2%). Over half of the participants found the MiniCollect device easy to use. The majority of participants were in favour of the remote capillary blood collection service and would use it if routinely available.ConclusionThe home collection of capillary blood for HbA1c determination is a valuable and convenient alternative to standard venous blood collection as it provides an opportunity to support routine HbA1c monitoring, whilst mitigating the transmission of SARS‐CoV‐2. This service would additionally allow individuals to attend clinic visits with a HbA1c value, ensuring optimal continuance of patient care for individuals with diabetes.

Feasibility and acceptability of measuring psychosocial outcomes for primary brain tumor patients and caregivers in a neuro-oncology clinical setting.

e24131 Background: A primary brain tumor (PBT) is a distressing diagnosis that impacts the psychosocial well-being of patients and caregivers. Validated questionnaires are useful to assess PBT patient and caregiver psychosocial outcomes. However, it is unknown whether it is feasible to assess these outcomes in a routine clinical setting. This study evaluated the feasibility of assessing psychosocial outcomes for PBT patients and caregivers at the UF Health Neuro-Oncology clinic. Methods: 171 participants (100 PBT patients, 75 with malignant glioma; 71 caregivers) completed a battery of questionnaires to assess psychosocial outcomes during routine clinical appointments. At the end of the battery, a Participant Experience Form (PEF) assessed participant perceptions about the overall experience of completing the battery on a 7-point Likert Scale. Based on criteria from Bowen and colleagues (2009), feasibility and acceptability of assessment procedures were conceptualized and operationalized by assessing: Acceptability (80% of participants will have an average score ≥ 4 on the PEF); Practicality (average time of completion will be &lt; 35 minutes); and Implementation (80% of participants will complete the entire battery). Descriptive statistics were used to assess these outcomes. Results: Patient and caregiver scores of feasibility and acceptability outcomes were as follows: Acceptability (Average PEF score: patients = 5.75 [ SD= 0.95]; caregivers = 5.96 [ SD= 0.83]); Practicality (Average time to complete (minutes): patients = 28.7 [ SD= 11.68]; caregivers = 26.0 [ SD= 12.01]); Implementation (% of participants that completed entire battery: patients = 88.0; caregivers = 84.5). Conclusions: The results indicate that assessing psychosocial outcomes in a routine clinical setting for PBT patients and caregivers was feasible, acceptable, and practical. Future research will use this battery to evaluate longitudinal psychosocial outcomes for this population in a clinical setting.