Usual Practice Research Articles

P-041 3-YEAR RETROSPECTIVE ANALYSIS OF USE OF ONLAY PROPHYLACTIC MESH IN MIDLINE LAPAROTOMY FOR GASTRIC CANCER

Abstract Background Incisional hernias are a frequent complication of abdominal wall incisions, ranging from 12.8% to 69% in long-time series. Recent literature supports the use of prophylactic mesh placement to avoid long-term incisional hernias. Gastric surgery in our center is performed via midline laparotomy and prophylactic mesh placement is carried out as a usual practice. The objective of our study is to evaluate long-term results of prophylactic mesh in midline laparotomies for gastric cancer. Methods Observational retrospective analysis of all patients undergoing gastric cancer sugery via midline incision with use of a polypropliene autoadhesive prophylactic mesh, between the years 2019–2021. Outcome measures included demographics, comorbidities, wound complications, reinterventions, neoplastic recurrences and incisional hernias (diagnosed by CT scan). Results A cohort of 55 patients (80% male). Mean age 68.1 years old (41–86), BMI 25,75 kg/m2 (18.73–33). All patients operated for gastric cancer, abdominal wall closure with small bite technique (monofilament absorbable 2/0 suture) and autoadhesive onlay mesh. 72.7% distal subtotal gastrectomies. 89% elective surgery. Mean albumin in preoperative analytic 40.5 g/L. Postoperative complications: 72% Clavien-Dindo grade II, mean CCI 29 (including 4 reinterventions and 1 exitus). Mean follow-up 24.9 months: 8 (14.5%) neoplastic recurrences, 4 (7.3%) exitus for cancer progression and 3 (5.4%) incisional hernias diagnosed by CT Scan (none of them reoperated). No meshes have been removed. In a comparative study no risk factors for incisional hernia have been found. Conclusions In our setting, the use of polypropylene autoadhesive prophylactic meshes in midline incision for gastric cancer is safe and durable.

OC-106 #SOME4SURGERY

Abstract Aim Digital transformation of society is now a reality, as is the incessant increase in the use of social networks. The aim is to present digital platforms for surgeons, how they are used, what impact they have and their roles in research and communication. Material and methods We carried out a narrative review based on bibliographic searches on the use of social networks in health professionals, as well as studies of impact and repercussion in the field of surgical communication and research. Results There are different social networks that can be used by surgeons, Twitter being preferred for its easy use and speed of diffusion, with the ability to group specific topics and amplify them through the use of hashtags such as #SoMe4Surgery (Social Media for Surgery). It is possible to spread knowledge in specific areas, facilitate conversation, collaboration and support between professionals with common interests anywhere in the world. Conclusions Social networks have been described as a necessary component in the usual practice of surgery and as an obligation for surgeons to know how to recognize their power and potential and to be used in the preparation of guides or expert panels, as well as the dissemination of information and interaction between professionals in the face of the growing difficulty in the resources available to access continuing education programs or attendance at face-to-face events. All this through responsible use (even requiring the publication of a guide for the ethical use of social networks by the American College of Surgeons).

Managing the Increasing Burden of Atrial Fibrillation through Integrated Care in Primary Care: A Cost-Effectiveness Analysis.

Integrated care for patients with atrial fibrillation (AF) in primary care reduced mortality compared to usual care. We assessed the cost-effectiveness of this approach. Dutch primary care practices were randomised to provide integrated care for AF patients or usual care. A cost-effectiveness analysis was performed from a societal perspective with a 2-year time horizon to estimate incremental costs and Quality Adjusted Life Years (QALYs). A sensitivity analysis was performed, imputing missing questionnaires for a large group of usual care patients. 522 patients from 15 intervention practices were compared to 425 patients from 11 usual care practices. No effect on QALYs was seen, while mean costs indicated a cost reduction between €865 (95% percentile interval (PI) -€5730 to €3641) and €1343 (95% PI -€6534 to €3109) per patient per 2 years. The cost-effectiveness probability ranged between 36% and 54%. In the sensitivity analysis, this increased to 95%-99%. Results should be interpreted with caution due to missing information for a large proportion of usual care patients. The higher costs from extra primary care consultations were likely outweighed by cost reductions for other resources, yet this study doesn't give sufficient clarity on the cost-effectiveness of integrated AF care.

Patient's perception of hygiene in the dental practice after COVID-19.

The COVID-19 pandemic has significantly impacted various sectors, including healthcare. The dental profession has faced unprecedented challenges in providing care while minimizing the risk of transmission. The aim of the study is to assess how patient's perception of hygiene in the dental field has changed since COVID-19. In detail, it has been analyzed patient's attention to hygiene and how in his opinion the dental practice changed its procedures after COVID-19. A questionnaire consisting of 10 multiple-choice questions was submitted to 509 subjects, patients of several dental practices. These were related to: 1) change in their perception of hygiene after COVID-19; 2) how the office they usually go to has changed and what hygiene standards it has adopted; 3) vaccination against COVID-19. Descriptive analyses of all variables in the questionnaire were performed, and statistical analyses between variables were carried out by chi-square test and Fisher's Exact Test. Most patients (75.8%) stated that they had changed their perception of hygiene after the onset of COVID-19. They reported that they had experienced changes in hygiene procedures at their usual dental practice (70.7%), including rinsing with chlorhexidine mouthwash, continuous air and water disinfection and use of personal protective equipment (PPE). Vaccination of practitioners was considered to be important by 73.5% of participants. In the present study it was analyzed how emergence of the new Coronavirus has considerably changed the perception of patient hygiene within the dental practice. As a result of the awareness implemented to prevent virus transmission, patients are paying more attention to hygiene and preventive procedures to protect their health.

Changing the Scene: Lessons Learned and Actioned into General Practice from Australian Flood Fire Drought & Heat through Primary Health Networks

Introduction:General Practitioners (GPs) manage the majority of usual healthcare needs in a community. These healthcare needs do not cease in disasters; they increase and expand. However, inclusion of GPs in disaster healthcare systems is only just beginning. Systematic review of the health effects of disasters over days, months, and years, shows the major burden of healthcare needs associated with disasters is within the realm of usual general practice. In Australia, Primary Health Networks (PHNs) represent local GPs in each region. They offer the best option for systematic linkage of GPs to the broader DHM system.Method:A systematic review of the literature on the health effects of disasters and three qualitative studies reviewing the current experiences, barriers and facilitators to GP involvement in DHM systems were undertaken through a PhD at the Australian National University in 2022. A knowledge to action framework was developed and utilized to provide a systematic strategy to guide efforts to diffuse, disseminate, and implement the research as it emerged, with a focus on sustaining those changes through integration of PHNs into Australian DHM systems.Results:Integration of GPs, through PHNs, is evolving, through systematic inclusion in planning and policy in local health districts. Over time, evidence-based knowledge of disaster healthcare needs has been incorporated into GP disaster planning and preparedness, and resource development, and utilized by GPs during the recent 2019 Black Summer Bushfires, and East coast Floods.Conclusion:As our knowledge of the healthcare needs of disasters continues to reflect our increasingly challenging and complex world, the proven benefit of active involvement in holistic, comprehensive continuity of healthcare through General Practice in DHM systems through PHN linkage becomes more urgent.

Pharmacist-Led Interventions to Reduce Drug-Related Problems in Prescribing for Pediatric Outpatients in a Developing Country: A Randomized Controlled Trial.

To evaluate a pharmacist-led intervention's effectiveness in reducing drug-related problems (DRPs ( related to prescriptions for pediatric outpatients. We conducted a randomized controlled trial. We recruited and randomly assigned 31 physicians to control or intervention groups. We collected 775 prescriptions (375 from the control group and 400 from the intervention group) at the start. For 3 weeks, intervention physicians received additional information and meetings with pharmacists in addition to the usual practices of the hospital. We then collected prescriptions at the end of the study. We classified DRPs, based on reliable references (Supplemental Table S1) at baseline and endpoint (a week after the intervention). The primary outcome was the proportion of prescriptions with DRPs, and secondary outcomes were the proportions of prescriptions with specific DRP types. The influence of the intervention on general DRPs and specific DRPs was the study's main finding. The pharmacist-led intervention helped reduce the prescriptions with DRPs proportion in the intervention group to 41.0%, compared with 49.3% in the control group (p < 0.05). The DRPs proportion related to the timing of administration relative to meals, unlike the other DRP types, increased in the control group (from 31.7% to 34.9%) and decreased in the intervention group (from 31.3% to 25.3%), with a significant difference between the 2 groups at endpoint (p < 0.01). Patients aged >2 to ≤6 years (OR, 1.871; 95% CI, 1.340-2.613) and receiving ≥5 drugs (OR, 5.037; 95% CI, 2.472-10.261) were at greater risk of experiencing DRPs related to prescribing. A pharmacist-led intervention improved DRP occurrence related to physicians' prescribing. Pharmacists could be involved in in-depth research with physicians in the prescribing process to provide tailored interventions.

OA20 Differences in management approaches for lupus nephritis within the UK

Abstract Background/Aims Outcomes of current therapy for lupus nephritis (LN) are suboptimal. Guidelines offer varied options for treatment of LN at onset, for refractory disease or relapse. Recent randomised trials have demonstrated the efficacy of newer agents and combination therapies, although these are not all permitted within NICE or NHS England funding. Therefore, treatment strategy may vary between clinicians or regions. We aimed to describe variations in usual practice of UK physicians who treat LN. Methods We conducted an online survey of simulated LN case scenarios for rheumatologists and nephrologists within the UK to identify treatment preferences for proliferative (class IV) and membranous (class V) LN. Results Of 77 respondents who completed the survey 48 (62.3%) were rheumatologists and 29 (37.7%) were nephrologists. 69% of the nephrologists but only 27% of rheumatologists reported having a formal departmental protocol for treating patients with LN (p &amp;lt; 0.001). The first-choice treatment of class IV LN in pre-menopausal female patients differed significantly between nephrologists and rheumatologists (p = 0.026) (see Table 1). For patients who failed to improve on first-line therapy there was no significant difference between nephrologists' and rheumatologists' second-choice therapy (p = 0.50) (see Table 1). However, 55% of nephrologists chose to change to second-choice treatment 3-6 months from the start of first treatment and 34.5% would change after 6-12 months but 81.3% of rheumatologists chose to change after 3-6 months and 10.4% would change in less than 3 months (p = 0.016). For class V LN, MMF was the preferred initial treatment irrespective of whether proteinuria was in nephrotic range or not. For nephrotic range class V LN not responding to first-choice treatment there were significant differences between nephrologists' and rheumatologists' choices for second-line therapy (p = 0.041) (see Table 1). Conclusion There is variation in treatment choices for LN between physicians with different choices reported by nephrologists and rheumatologists. These results suggest that: (i) care may not be well coordinated between rheumatologists and nephrologists; (ii) clearer guidelines are required to ensure use of the best therapies; (iii) access to the most effective therapies needs to be improved. Disclosure S.T. Ibrahim: None. B. Rhodes: None. B. Griffiths: None. C. Gordon: None. C.J. Edwards: None. D. Jayne: None. E.M. Vital: None. L. Lightstone: None. M.R. Ehrenstein: None. P. Hewins: None. Z. Mclaren: None. J.A. Reynolds: None.

Sonidegib as a Locally Advanced Basal Cell Carcinoma Therapy in Real-life Clinical Setting: A National Multicentre Study

BackgroundBasal cell carcinoma (BCC) is the most prevalent cancer. A minority of BCCs have an aggressive behaviour (laBCC) and may require hedgehog pathway inhibitors such as sonidegib as its treatment. ObjectiveTo describe the use of sonidegib in a large number of patients and provide more data on its real-life efficacy and safety profile. MethodsWe conducted a retrospective and multicentric study that included patients treated with sonidegib. Epidemiological, effectiveness and safety data were collected. ResultsA total of 82 patients with a mean age of 73.9 years were included. Ten patients had Gorlin syndrome. Median treatment duration was 6 months. Median follow-up duration was 34.2 months. Globally, 81.7% of the patients showed clinical improvement (52.4% partial response and 29.3% complete response), 12.2% clinical stability and 6.1% disease progression. There was no statistically significant difference in clinical improvement between the 24h and 48h sonidegib posology. After 6 months of treatment, 48.8% of the patients discontinued sonidegib. Prior vismodegib treatment and recurrent primary BCC were associated with a poorer response to sonidegib. At 6 months of treatment, 68.3% of the patients experienced at least one adverse effect. ConclusionSonidegib shows good effectiveness and acceptable safety profile in usual clinical practice.

Autonomic nervous system disorders in multiple sclerosis.

Multiple sclerosis (MS) is a chronic progressive demyelinating disease of the central nervous system (CNS), which also affects the autonomic nervous system (ANS). Manifestations of MS in the ANS include urological, sexual, gastrointestinal, cardiovascular, and thermoregulatory disorders as well as increased fatigue. These problems are common yet are often underestimated due to the non-specificity of the symptoms and the limited evaluation of the ANS in the usual clinical practice. Most of these symptoms seem to be related to localized lesions in the CNS. However, the mechanisms by which these disorders are caused in MS have not been fully investigated, thus preventing any focused etiological treatment. The most common disorders of the ANS in MS represent a challenge for clinicians due to the variability of the clinical picture and our minimal data on their diagnosis and treatment. Early diagnosis and initiation of individualized treatment regimens, often in need of multiple approaches, seem to yield the best results in managing ANS dysfunction in MS patients.

Study protocol for an economic evaluation and budget impact of implementation strategies to support routine provision of antenatal care for gestational weight gain: a stepped-wedge cluster trial

BackgroundAntenatal clinical practice guidelines recommend routine assessment of weight and provision of advice on recommended weight gain during pregnancy and referral to additional services when appropriate. However, there are barriers to clinicians adopting such best-practice guidelines. Effective, cost-effective, and affordable implementation strategies are needed to ensure the intended benefits of guidelines are realised. This paper describes the protocol for evaluating the efficiency and affordability of implementation strategies compared to the usual practice in public antenatal services.MethodThe prospective trial-based economic evaluation will identify, measure, and value key resource and outcome impacts arising from the implementation strategies compared with usual practice. The evaluation will comprise of (i) costing, (ii) cost-consequence analyses, where a scorecard approach will be used to show the costs and benefits given the multiple primary outcomes included in the trial, and (iii) cost-effectiveness analysis, where the primary outcome will be incremental cost per percent increase in participants reporting receipt of antenatal care for gestational weight gain consistent with the guideline recommendations. Affordability will be evaluated using (iv) budget impact assessment and will estimate the financial implications of adoption and diffusion of this implementation strategy from the perspective of relevant fund-holders.DiscussionTogether with the findings from the effectiveness trial, the outcomes of this economic evaluation will inform future healthcare policy, investment allocation, and research regarding the implementation of antenatal care to support healthy gestational weight gain.Trial registrationTrial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819 (22/01/2021) http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380680&isReview=true.

“It helps us say what’s important...” Developing Serious Illness Topics: A clinical visit agenda-setting tool

BackgroundSkillful communication with attention to patient and care partner priorities can help people with serious illnesses. Few patient-facing agenda-setting tools exist to facilitate such communication. ObjectiveTo develop a tool to facilitate prioritization of patient and care partner concerns during serious illness visits. Patient or family involvementTwo family members of seriously ill individuals advised. MethodsWe performed a literature review and developed a prototype agenda-setting tool. We modified the tool based on cognitive interviews with patients, families and clinicians. We piloted the tool with patients, care partners and clinicians to gain an initial impression of its perceived value. ResultsInterviews with eight patients, eight care partners and seven clinicians, resulted in refinements to the initial tool, including supplementation with visual cues. In the pilot test, seven clinicians used the tool with 11 patients and 12 family members. Qualitatively, patients and care partners reported the guide helped them consider and assert their priorities. Clinicians reported the tool complemented usual practice. Most participants reported no distress, disruption or confusion. DiscussionPatients, care partners and clinicians appreciated centering patient priorities in serious illness visits using the agenda-setting tool. More thorough evaluation is required. Practical valueThe agenda-setting tool may operationalize elements of good serious illness care.

Supporting post-stroke access to services and resources for individuals with low income: understanding usual care practices in acute care and rehabilitation settings

Purpose Following stroke, individuals who live in a low-income or are at risk of living in a low-income situation face challenges with timely access to social services and community resources. Understanding the usual care practices of stroke teams, specifically, how they support this access to services and resources, is an important first step in promoting the implementation of practice change. Method A qualitative multiple-case study of acute care, inpatient, and outpatient rehabilitation stroke teams in an urban area of Canada. Semi-structured interviews and questionnaires about the workplace context were conducted with 19 professionals (social workers, occupational therapists, physiotherapists, speech-language pathologists) at four sites. Results In their usual practice, stroke teams prioritized immediate care needs. The stroke team professionals did not address income or resources unless it directly affected discharge. Usual care was influenced by factors such as time constraints, lack of knowledge about services and resources, and social service system limitations. Conclusion To better support post-stroke access to social services and resource for low-income individuals, a multidisciplinary approach, with actions beginning earlier on and extending throughout the continuum of care, is recommended, in addition to system-level advocacy.

The impact of a universal social emotional intervention on students’ mental wellbeing in a secondary public school in Qatar

This paper is based on a study that explored the impact of a practitioner-designed social emotional program on students’ wellbeing based on the results of the WEMWBS scale in a public secondary school in Qatar. This cluster randomized controlled trial study (RCT) involved the assignment of two groups; an intervention group (n = 82) to receive a universal social emotional intervention and a control group (n = 81) to continue with the usual practices without attending or participating in any social emotional interventions. Students in both groups rated their wellbeing levels before the intervention (baseline) and after the intervention (post intervention). The results revealed a significant improvement in students’ wellbeing after participating in the SEL intervention with an adjusted effect size of (EF = 0.76). The paper discusses the results of this study in the light of the program’s design and social context.

Kinship network evolution in Argentina. An exploration based on online data

We present the initial stages of a research project for a big data genealogical study. Consanguineous ties among members of a family form kinship networks. Family is the first social network for actors and historically was the source of education, support, and socialization. Family is still the source of power in the royalty, and family business has commonly been the first stage for future big firms. Nepotism is still a usual practice in politics and civil service. We analyze contributions to population evolution and propose to empirical test theoretical results. For that to be accomplished, we gather online data and present an initial descriptive analysis. In the end, following previous contributions, we also extend data usage for identifying historical lineages from colonial times in Argentina and analyzing if that antecedent portrays different benefits to descendants.

Conceptions and Attitudes of Pre-School and Primary School Teachers towards STEAM Education in Spain

STEAM education postulates integrated problem-solving-based learning of its disciplines. Although positive results are being reported, there are some difficulties with its implementation. The purpose of this research is to analyze the conceptions and attitudes of Early Childhood and Primary School teachers in Spain towards this educational approach, as well as to determine the initial relationship with their training and experience. A multiple case study with 11 teachers was conducted using a reflection protocol, a photo-elicitation, and a semi-structured interview. All teachers presented an integrated profile. Although they explicitly acknowledged cognitive, affective, and logistical obstacles, a positive relationship was detected between their level of training, experience in STEAM education, and conception of STEAM. Based on this evidence, some recommendations are proposed to optimize the conceptions of the STEAM approach and the usual practices of the teaching staff.

Follow-Up Strategies and Detection of Recurrent Breast Cancer in the Modern Era.

Regular history assessments and physical examination with annual breast imaging have been recommended as the standard surveillance protocol for breast cancer patients who underwent curative-intent therapy. Based on randomized studies conducted in the 2000s, surveillance with regular chest or abdominal imaging, chemistry panels, or tumor marker measurements does not improve survival in such patients. Given the remarkable recent improvements of systemic therapy, we hypothesized that more intensive surveillance may lead to early detection and improve treatment outcomes in the modern era. We retrospectively evaluated the follow-up strategies and benefits of investigations used in usual practice. Breast cancer patients who had initial adjuvant therapy were recruited and classified according to the receipt of standard follow-up (history, physical examination, and annual breast imaging) or alternative follow-up (surveillance with at least annual chest or abdominal imaging or biannual liver function testing). The primary outcome was overall survival. Secondary outcomes included disease-free survival and the indicator of recurrence detection. Of 412 recruited patients, 213 (51.7%) and 199 patients (49.3%) were included in the standard follow-up group and alternative follow-up group, respectively. Among 90 patients (21%) with disease recurrence, the most frequent indicators of recurrence were newly reported symptoms or physical examination abnormalities (64%), followed by abnormal breast imaging (23%) and abnormal chest X-ray (10%). After a median follow-up of 85 months, approximately 90% of patients remained alive after 5 years in both groups. The mean overall survival was similar between the standard and alternative follow-up groups (154.5 months vs. 151.9 months, p = 0.54). There was no difference in terms of the proportion of interval visits, specific cancer treatment received, and disease-free survival. Standard follow-up with history assessments, physical examination, and annual breast imaging remains the recommended surveillance strategy in the modern era. Alternative follow-up strategy did not improve oncologic outcomes.

Coordinating smoking cessation treatment with menstrual cycle phase to improve quit outcomes (MC-NRT): study protocol for a randomized controlled trial

BackgroundWomen experience greater difficulty achieving smoking abstinence compared to men. Recent evidence suggests that hormonal fluctuations during different phases of the menstrual cycle can contribute to lower smoking abstinence rates following a quit attempt among women. However, these findings are limited by small sample sizes and variability among targeted smoking quit dates. This clinical trial aims to clarify whether targeting the quit date to the follicular or luteal phase of the menstrual cycle can improve smoking abstinence.MethodsParticipants will enroll in an online smoking cessation program providing nicotine replacement therapy (NRT) and behavioral support. We will randomize 1200 eligible individuals to set a target quit date: (1) during the mid-luteal phase, (2) during the mid-follicular phase, or (3) 15–30 days after enrollment with no regard to the menstrual cycle phase (usual practice). Participants will receive a 6-week supply of combination NRT consisting of a nicotine patch plus their choice of nicotine gum or lozenge. Participants will be instructed to start using NRT on their target quit date. Optional behavioral support will consist of a free downloadable app and brief videos focusing on building a quit plan, coping with cravings, and relapse prevention, delivered via e-mail. Smoking status will be assessed via dried blood spot analysis of cotinine concentration at 7 days, 6 weeks, and 6 months post-target quit date.DiscussionWe aim to overcome the limitations of previous studies by recruiting a large sample of participants and assigning target quit dates to the middle of both the follicular and luteal phases. The results of the trial can further elucidate the effects of the menstrual cycle on smoking cessation outcomes and whether it is beneficial to combine menstrual cycle phase timing strategies with accessible and low-cost NRT.Trial registrationClinicalTrials.gov NCT05515354. Registered on August 23, 2022.

5613475 ADVERSE REACTIONS TO RBC TRANSFUSION: A SINGLE THALASSEMIA AND SICKLE CELL DISEASE DEPARTMENT’S EXPERIENCE

Background: Thalassemia and Sickle Cell Disease patients require regular blood transfusions and iron chelation treatment for the entirety of their lives. Several patients had transfusion-related side effects as a result of frequent and chronic transfusions. Methods: In this study, we analysed the frequency of transfusion reactions and the methods used to address them by reviewing the medical records of 95 patients who received multiple transfusions on a regular basis during a 20-year period. All demographics and charactiristics are in TABLE 1. Table 1: - The Demographics and Characteristics Compared TYPE OF HEMOGLOBINOPATHY β-Thalassemia (51.3%) α-Thalassemia (2.6%) Sickle Cell Disease (12.8%) β-thal/SCD (15.4%) AGE AT THE ONSET OF TRANSFUSIONS < 2 years old (45.7%) > 20 years old (11.4%) > 30 years old (34.3%) occasionally (8.6%) TRANSFUSION FREQUENCY weekly (2.7%) every 15-20 days (54.1%) monthly (34.3%) exchange transfusions (2.7%) Results: Over a 20-year period, 42 percent (42,1%) of the 95 patients who received repeated transfusions reported at least one adverse event during the transfusion (about two per year reported). Our unit’s usual clinical practice is to transfuse patients with Leukoreduced RBC to prevent HLA alloimmunization, CMV transmission, and fever nonhemolytic transfusion reactions.Fever (48.1%), chills (18.5%), anaphylaxis/urticaria (11.2%), swelling (3.7%), hemolysis (11.2%), yersinia enterocolitica (3.7%), and alloimmunization (3.7%) were the most common side effects reported by patients experiencing a transfusion reaction (image 1).In each case, the transfusion was discontinued and the reaction was treated according to local clinical practice. Antibiotic therapy was used to manage infectious complications. Extended blood type matching (ABO, CcDEe, Kell, Duffy, Kidd, MNS,Lewis, Lutheran, etc) has been used in clinical practice as a prophylactic intervention in the case of hemolysis or alloimmunization. Before receiving washed red blood cells in future transfusions, some patients with fever or allergic responses were administered premedication with antihistamines or antipyretics. Nine patients (22.5%) of patients those who had experienced a previously adverse reaction reported a second episode with the following symptoms: allergic reaction/urticaria (44.5%), fever (33.5%), and alloimmunization (22.5%). Patients who developed alloimmunization during the second adverse transfusion event had no history of alloimmunization previously. Conclusions: In the studied population, there was no high prevalence of serious or fatal transfusion adverse effects. Every transfusion requires constant vigilance for the occurrence of transfusion reactions, especially in patients who have received multiple transfusions.

5612994 A ONE-YEAR AUDIT OF PREGNANCY MANAGEMENT AND OUTCOMES IN WOMEN WITH SICKLE DISORDERS AT A SINGLE UK CENTRE

Background: Women with sickle cell disorders (SCD) have increased morbidity and mortality in pregnancy due to increased sickle and pregnancy-related complications and require multidisciplinary team management, including obstetrician and midwife with experience of high-risk antenatal care and haematologist with links to a Specialized Hemoglobinopathy Team1. About 15,000 individuals live with SCD in the UK, with 110-200 pregnancies per annum1. Aims: To determine whether King’s College Hospital followed recently published British Society of Haematology (BSH) guidelines for the management of pregnancy in SCD. Pilot a proposed BSH audit proforma and assess mode of delivery, neonatal birth weight and special care baby unit (SCBU) requirements for this cohort. Methods: Pregnancy management and outcomes were audited using a proforma based on recent BSH guidelines (Appendix 1). Review of electronic patient records (EPR) for all women attending joint obstetric hemoglobinopathy clinics with SCD who completed a pregnancy between 01/10/20 and 01/10/21, including miscarriage and termination of pregnancy (TOP). Results: 23 pregnancies resulted in 19 live births (one twin pregnancy), 3 miscarriages (10/40 + 1, 10/40 + 1, 14/40 + 6); and 2 TOPs (10/40, 10/40). Maternal haemoglobin genotype was 74% HbSS, 23% HbSC, and 4% HbS other. The average maternal age at delivery (excluding miscarriage and TOP) was 33.6 years (24.8-40.8 years). Average gestational age at delivery (excluding miscarriage and TOP) was 37.9 weeks (32/40 + 1 to 40/40 + 1). 13 pregnancies were delivered by Caesarean section (9 emergency) and 5 by vaginal delivery (4 forceps). 14 women who had a live birth underwent transfusion during pregnancy, 1 was transfused postnatally and 3 were not transfused. Maternal complications were recorded in 94% pregnancies (excluding miscarriage and TOP). 47% of women had sickle vaso-occlusive crises, 56% had an infection, 17% had acute kidney injury and 6% required Intensive Therapy Unit care. Neonatal complications were recorded in four neonates. Three had intrauterine growth restriction, and were delivered at 32 + 1, 33 + 6 and 38 + 1 gestation respectively, with one requiring care in SCBU. One neonate had jaundice requiring five days of phototherapy. The average neonatal birth weight was 2770g (960-3715g) with a birthweight centile ranging from 0-0.4 to 75-91. Discussion: Audit barriers included an initial lack of access to information due to separate EPR system (BadgerNet) for maternal notes, rectified by collaboration with the obstetric team and access to BadgerNet. Summary/Conclusion: This pilot audit enabled assessment of collecting required data for a proposed BSH audit proforma; monitoring compliance with newly published BSH guidelines for management of pregnancy in SCD1; and provided insight into pregnancy outcomes in women with SCD who delivered within a 12-month period at a single large centre. The higher-than-expected transfusion rate during pregnancy was likely due to ongoing recruitment to the TAPS2 trial, with eligible women offered randomisation to usual practice or pre-emptive red cell exchange transfusion 6-10 weekly from 6-20 weeks gestation. A high proportion of live births were delivered by Caesarean section, reflecting a high proportion of multiparous women with previous Caesarean sections in this cohort. Although complication rates were high, most complications were relatively minor and non-life threatening. Keywords: Pregnancy, Sickle cell disease Reference 1. Oteng‐Ntim E et al. Br J Haematol 2021;194(6):980-995.

Efficacy of a Relaxation Scenario in Virtual Reality for the Comorbid Symptoms of Anxiety and Asthenia in a General Hospital Setting: A Pilot Comparative Randomized Open-Label Study.

Patients in general hospitals often display concomitant signs of mental maladjustment: low mood, anxiety, apathy, asthenia, all of which can have a negative impact on the course of the underlying disease and the recovery process. One of the non-pharmacological approaches that has gained wider acceptance in medical practice in recent years is the use of procedures based on virtual reality. Assess the efficacy of the new domestic, virtual reality application Flow as relates to symptoms of anxiety and asthenia in patients undergoing inpatient treatment. The study was open-label and had a comparison group; the patients were assigned to the experimental or control group using a randomization table. The patients were assessed using the Spielberger State Anxiety Inventory; the Fatigue Symptom Rating Scale; the Well-being, Activity, Mood questionnaire; the Depression Anxiety Stress Scale; and the Clinical Global Impression Scale. Physical parameters were measured before and after each virtual reality session. The obtained data were statistically processed. The study involved 60 patients. In 40 patients, the treatment program included a course of five daily relaxation sessions in virtual reality; the control group consisted of 20 patients, who were treated in accordance with the usual practice of the institution. The addition of virtual reality sessions to the standard treatment course yielded significant advantage in terms of affective symptoms reduction in patients both after a single session and as a result of undergoing the full course, and several days after its completion. The patients in the experimental group also showed a significant decrease in blood pressure after the sessions, and this was most pronounced in individuals who initially had elevated and high blood pressure. The use of relaxation program courses in the virtual reality application Flow is an effective and promising means of non-pharmacological care for non-psychiatric inpatients showing symptoms of anxiety, apathy, depressive mood, as well as hypertension.