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Background/Aims National Institute for Health and Care Excellence (NICE) impact reports review how NICE recommendations for evidence-based and cost-effective care are being used in priority areas of the health and care system. Musculoskeletal (MSK) conditions, including arthritis, affect over 20 million people in the UK, and represent a significant burden of ill health, both to the individual and the wider healthcare system. This report summarises the progress made by the healthcare system in England towards implementing NICE’s suite of guidance on arthritis. Methods Published data collected from national audits, reports, surveys, journals and indicator frameworks was reviewed to provide insight on the uptake and impact of NICE’s recommendations and quality standards on osteoarthritis, rheumatoid arthritis and spondyloarthritis. Stakeholders were engaged to provide expert advice and an understanding of real-world experiences and working practices. A report was produced, including examples of NICE guidance in practice, patient quotes and outcomes data, alongside uptake data. The report highlights implementation gaps and considers what NICE will do next to support the system to improve uptake in these areas. Results Data were presented, focusing on the following topic areas: diagnosis and management of osteoarthritis, referral and diagnosis of inflammatory arthritis, and management of inflammatory arthritis. The report highlights areas of high uptake: significant progress has been made in reducing the number of unnecessary knee arthroscopies for people with osteoarthritis; Improvements are being made towards achieving rheumatology referral targets for people with suspected inflammatory arthritis, as well as ensuring pharmacological treatment is started promptly. There is an ongoing transition to the use of biosimilar drugs as a cost-saving measure. This has reduced rheumatology drug spend by over £80 million between 2017 and 2019;. There is high provision of education and support for people with arthritis, including access to specialist advice to manage flares. The report also highlights areas where there are gaps in implementation: there is a need for improved data collection on the diagnosis and management of osteoarthritis in primary care. There is a need for the increased provision of pre- and post-surgical physiotherapy and rehabilitation for people having joint surgery. There are severe delays in the referral and diagnosis of axial spondyloarthritis, highlighting the need to raise awareness of the condition in primary care, and in other specialist secondary care areas. There is a need to improve access to psychological services for people living with a long-term physical health condition. Conclusion Arthritis remains one of the most significant causes of disability in the UK. Evaluating the uptake of evidence-based guidance and improving implementation is central to improving outcomes. Throughout this report, we have identified areas of high and low uptake of NICE guidance and will work closely with stakeholders to address gaps in implementation. Disclosure J. Wray: None. J. Beveridge: None. V. Carter: None.

Background Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. Methods In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. Findings Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. Interpretation Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. Funding British Heart Foundation Data Science Centre, led by Health Data Research UK.

Background After receiving intensive medical treatment; individuals with eating disorders often require ongoing care to maintain their recovery, build social networks, and reduce risk of relapse. Methods To address this important transition period, a six-month peer mentoring program was developed and piloted in Melbourne, Australia. Twelve adults with a past history of an eating disorder (mentors) were paired with 14 individuals with a current eating disorder (mentees). Pairs met for thirteen mentoring sessions in community settings. Throughout the program mentees and mentors completed reflective questions online. Upon completion of the program, qualitative interviews were conducted. Both online reflections and interviews explored themes relating to perceived benefits and challenges of participation in the peer mentoring program, and the differences between mentoring and traditional treatment. Results Thematic analysis identified several benefits for mentees; including hope, reconnection with others, and re-engaging with the world. The majority of mentees described their mentor as uniquely supportive due to their past experience of an eating disorder. Mentors reported experiencing benefits such as increased connection with self and others, and indicated that the experience helped them positively reframe their past experience of an eating disorder. Ending the relationship at the completion of the program was a significant challenge for both groups, and managing boundaries was deemed a main challenge by mentors. Conclusions Overall, results indicated that this mode of informal support may be worthy of further investigation as an adjunct to clinical treatment programs for this population. Trial registration Australian and New Zealand Clinical Trials registration number - ACTRN12617001412325 - Date of registration – 05/10/2017 (Retrospectively registered)

Background Eating disorders are serious psychiatric illnesses that are often associated with poor quality of life and low long-term recovery rates. Peer mentor programs have been found to improve psychiatric symptoms and quality of life in other mental illnesses, and a small number of studies have suggested that eating disorder patients may benefit from such programs. The aim of this study is to assess the efficacy of a peer mentor program for individuals with eating disorders in terms of improving symptomatology and quality of life. Methods Up to 30 individuals with a past history of an eating disorder will be recruited to mentor 30 individuals with a current eating disorder. Mentoring will involve 13 sessions (held approximately every 2 weeks), of up to 3 h each, over 6 months. Discussion This pilot proof-of-concept feasibility study will inform the efficacy of a peer mentoring program on improving eating disorder symptomatology and quality of life, and will inform future randomised controlled trials. Trial registration Australian and New Zealand Clinical Trials Registration Number: ACTRN12617001412325. The date of registration (retrospective): 05/10/2017. Electronic supplementary material The online version of this article (10.1186/s40814-018-0268-6) contains supplementary material, which is available to authorized users.

Eating Disorders Victoria (EDV) has been providing information and support to people affected by eating disorders for over 30 years. Feedback has been received regularly from callers to the helpline, participants in support groups and members regarding General Practitioners' (GP) quality of knowledge about eating disorders and sensitivity to issues around disclosure. In 2013, EDV obtained 3 years funding from the William Buckland Foundation to provide an eating disorders education program for primary healthcare professionals. The program, which will be described in more detail, consists of three components: 1. Information brochures in over 880 clinics throughout Victoria in partnership with distributors, InfoMed 2. RACGP accredited ‘Eating Disorders in General Practice’ education sessions, developed and provided in partnership with the Victorian Centre for Excellence in Eating Disorders (CEED) 3. Visits to Victorian GP clinics to provide opportunities for informal and individualised information and support to staff Preliminary outcomes have been positive, with more than 70% of the 430 participants reporting that their learning needs regarding their ability to recognise the signs & symptoms of the different types of eating disorders were entirely met. Other positive outcomes will be presented and implications for future work will be discussed.