O23 Testing the waters: COVID-19 first wave and shielding among Black, Asian and Minority Ethnic patients with rheumatological conditions in the UK

Abstract Background/Aims  COVID-19 has created numerous challenges for people globally. In the UK, few studies have reported poorer outcomes for certain ethnic populations. UK government introduced shielding guidance to protect the most vulnerable patients and this was in force for a number of months. However, shielding guidance was initially released only in English, which resulted in further disenfranchisement of the Black, Asian and Minority Ethnic community (BAME). We undertook an audit to understand experiences of shielding particularly in rheumatological BAME patients in multi-ethnic communities in 3 centres - Wolverhampton, Leicester and Oxford. Methods  This study was approved in all three sites as an audit. Patients contacting rheumatology helpline or having routine consultations were included. Each centre aimed to recruit at least 20 patients. A questionnaire was developed to capture important data on shielding. The study was conducted between May and June 2020 during the peak of the first wave of Covid 19. Results  We recruited 79 patients into this audit, of these 54 were of BAME and 25 of Caucasian ethnicity with 17 males and 62 females. Rheumatoid Arthritis (RA) was the commonest diagnosis in 49 of these patients (62%) and these patients were older (median ages 56 vs. 46 years, p = 0.14). BSR risk scoring algorithm was used to determine need for shielding (BSR score of 3 or more) - 38 patients fell into this category. The remaining patients had scored lower and had the option of shielding or enhanced social distancing. Of the 13 Caucasian patients who should have been shielding, 11 were (85%). Of the 25 BAME patients who should have been shielding: 17 were, and 8 were not (68%, p = 0.26; 65% looking at South Asian patients alone). Understanding of reasons for shielding was clear for 21 out of 25 Caucasian patients (84%). In contrast, 33 of 54 patients from BAME backgrounds (61%) were clear on this (p = 0.10). Within Wolverhampton and Leicester, the numbers are starker with 20 out of 37 (54%) being clear on this. Very few Caucasian patients made changes to their existing medications with 84% carrying on their medications as they were before the onset of COVID 19. However, of 54 BAME patients, 14 patients had stopped medications - either by themselves or as per advice of health professionals (74%, p = 0.16). There was a significant difference between centres in patients stopping medications with patients from Leicester much more likely (p &amp;lt; 0.001). Conclusion  Despite the small numbers, the data clearly suggest that BAME patients were less likely to understand the reasons for shielding, to follow shielding advice, and more likely to change their medications, thereby risking a flare. Addressing culturally competent educational needs and health equality for BAME rheumatology patients continues to remain a challenge. Disclosure  S. Dubey: None. K. Kumar: None. H. Bunting: None. T. Sheeran: None. B. Douglas: None. J. Sabu: None. M. Attwal: None. A. Moorthy: Honoraria; UCB, MSD, AbbVie.</jats:p

Randomised Controlled Trial of Ankle Block Versus Metatarsal Block for First Ray Surgery

Category: Bunion Introduction/Purpose: First ray arthrodesis or osteotomy is a day surgery procedure performed commonly under general anaesthetic. One of the aims with such procedures is to ensure our patients are discharged on the day of surgery and are relatively pain free on discharge. This is often achieved by the use of local anaesthetic blockades, either as an ankle block or as a metatarsal block. There are studies published on the effectiveness of ankle block for first ray surgery but there is a dearth of studies on metatarsal block. Therefore the aim of this study is to compare the effectiveness of ankle block versus metatarsal block in conjunction to general anaesthetic for first ray surgery. Methods: Both local trust board approval and National Research Ethics Committee approval were granted for the study. Statistical analysis to ensure an adequately powered study was performed. Fifty patients undergoing arthrodesis or osteotomy of the first ray were recruited into this study and randomly allocated to the cohort to receive either a metatarsal block or an ankle block. All patients had general anaesthesia. Those patients randomized to ankle block had this performed after induction of general anaesthesia using ultrasonography. Those patients randomized to metatarsal block had this performed at the end of the operative procedure. Patients scored their pain level using a visual analogue scale (0-10) at 2, 6 and 24 hours. A physiotherapist, who was blinded to their treatment arm, assessed patients at hourly intervals from two hours. Patients were contacted by telephone by a research nurse, who was also blinded to their treatment arm, over 24 hours from discharge. Results: Forty-eight patients completed the study: 25 in the ankle block treatment arm and 23 in the metatarsal block arm. The majority of the patients were female (44 patients) with an average age of 53 years (range 31-76 years). Analysis of pain scores showed that there was no statistically significant difference between the two groups at any of the measured time periods. Analysis of their analgesic requirement in the first 24 hours after surgery again revealed no striking difference between the two cohorts. Similarly analysis of the time taken to safely mobilise revealed that there was no difference between the two groups. However analysis of the time taken to perform the anaesthesia highlighted a mean addition of eleven minutes when an ultrasound guided ankle block was performed. Conclusion: This prospective randomised blinded study demonstrates that metatarsal blocks are just as effective in giving post- operative analgesia as ultrasound guided ankle blocks in patients undergoing first ray surgery under general anaesthetic