Initial impact of COVID-19 on paediatric spinal services in Scotland

COVID-19 has affected many National Health Service Scotland services. Our aim is to describe this impact on the Scottish National Spine Deformity Service (SNSDS). All referrals to the SNSDS from 1 January 2020 to 30 June 2020 were analysed and compared with the same period in 2019. There was a 64.3% decline in referrals during the pandemic to the SNSDS. The mean waiting time to be seen in first clinical appointment for a new referral was 6.5 weeks in 2020 compared with 10.9 in 2019. There were 60 patients still waiting to be seen at the end of the study period.

P101 ‘Best Foot Forward Workshops’: a novel supported self-management approach for foot health

Background Rheumatic foot health challenges can be multiple and wide-ranging, leading to reduced mobility or quality of life. However, the provision of foot health services is disparate. There is a need to innovate new approaches to personalised foot health care outside of traditional clinical models of service delivery. A new healthcare model was co-designed by patients, academics and clinicians from secondary and primary care Trusts, to support self-management. Part of this model included the development of ‘best foot forward’ workshops. There is a need to: minimise the impact of the demonstrated gap between what service users need or want and what services are providing; reduce waiting times; empower self-management; improve MDT availability for those in need; reduce the number of appointments needed to get resolution; reduce service costs; maintain patient satisfaction. Methods The team co-designed a series of foot health workshops, at 8-week intervals. The novel workshop design extended beyond a traditional patient education session and consisted of: 1. an education session about anatomy and physiology for the lower limb, 2. social networking time, 3. a themed education session, 4. opportunity for group discussion, 5. opportunity for individual question and answer with a health professional, 6. Access to direct request for follow-up appointment. Electronic invitations were sent to all patients registered within a single rheumatology department enrolled on the electronic notification system. Posters advertising the workshops were displayed in waiting areas. After three workshops data regarding patient attendance, satisfaction, and health service use up to four weeks after the workshop was collected. Results Nineteen, 22 and 30 patients attended the workshops respectively. Seven people attended multiple workshops. All patients reported having an unmet foot health need and would have otherwise sought a clinical appointment. Allowing for session preparation time (approx. 3 hours per session) 20 hours of clinical time was saved; the clinical waiting list was reduced by 12 sessions (6 weeks). Three patients (4%) requested one follow-up clinical appointment immediately after the workshop. No patients requested additional appointments in the four weeks after each workshop; enabling patient led review saved 71 further appointments. Patients reported content, venue and satisfactions scores of 9.6, 8.7 and 9.6/10 respectively. Conclusion Further research is needed to confirm that patients’ needs are being fully met, in addition to enabling supported self-management and improving clinical outcomes. There is potential for these workshops to be co-ordinated and facilitated by expert patient partners. The role of group interaction as a therapeutic mechanism to aid supported self-management is worthy of further study. Best foot forward workshops could represent a viable supported self-management alternative to traditional clinical models for people with rheumatic conditions. Disclosures S. Connett None. C. Beevor None. S. Ward None. E. Wong None. L. Cherry None.

Impact of catastrophizing on pain during orthodontic treatment

ABSTRACT Objective: This study proposed to investigate the influence of catastrophizing and others factors related to pain during orthodontic treatment. Methods: 27 patients with 0.022 x 0.028-in Straight-wire brackets were evaluated during alignment and leveling phase with nickel-titanium wires. Visual Analog Scales measured the intensity of orthodontic pain at six moments after a clinical appointment: 6 first hours; 1, 2, 3, 5, and 7 days. Multiple linear regression and stepwise approach assessed the influence of the following variables on pain: catastrophizing, sex, age, duration of treatment, clinical appointment time (morning or afternoon), and wire diameter. Results: The highest pain intensity was reported 24 hours after activation. These data were used to analyze factors associated with pain level. Age (r = 0.062, p= 0.7586), sex (p= 0.28), catastrophizing (r = -0.268, p= 0.1765), and orthodontic wire diameter (r = 0.0245, p= 0.2181) were not correlated with orthodontic pain in the univariate statistics. Catastrophizing was included in the multiple regression model because it was of great interest. Duration of orthodontic treatment (r = 0.6045, p= 0.0008) and the time when orthodontic appliance was activated (p= 0.0106) showed statistical significant associations with pain, and were also included in the multivariate regression, which showed that about 32% of orthodontic pain could be explained by the duration of treatment (R2= 0.32, p= 0.0475). Catastrophizing (R2= 0.0006, p= 0.8881) and clinical appointment time were not significantly associated with pain (R2= 0.037, p= 0.2710). Conclusions: Pain after activation of fixed orthodontic appliance is not associated with catastrophizing as well as age, sex, orthodontic wire diameter, and period of activation.

Pengaruh Supervisi Klinis Terhadap Implementasi Kompetensi Sesuai Clinical Appointment pada Perawat Klinis II di RSUD KRT Setjonegoro Wonosobo

Implementasi praktik keperawatan sesuai clinical appointment dilaksanakan agar tidak membahayakan keselamatan pasien, tidak terlalu lama dalam perawatan klien dan mendukung program pelaksanaan perawatan ada suatu metode yang dilakukan yaitu supervisi klinis. Penelitian ini adalah untuk mengetahui adanya pengaruh supervisi klinis terhadap implementasi kompetensi perawat sesuai clinical appointment. Penelitian ini menggunakan desain quasy eksperimen dengan one group pre post test design dengan sampel sejumlah 57 Perawat Klinis II sebagai responden penelitian. Dari penelitian ini didapatkan jumlah perawat yang tidak melakukan implementasi kompetensi sesuai clinical appointment ada 50 perawat yang belum sesuai dan hasil post test didapatkan adanya perbedaan yang signifikan dengan pre test. Supervisi klinis efektif untuk mengontrol implementasi kompetensi perawat sesuai clinical appointment.

A multicentre Study of Nutrition Risk Assessment in Adult Patients with Inflammatory Bowel Disease Attending Outpatient Clinics

Background: Overnutrition and undernutrition can affect patients with inflammatory bowel disease (IBD). Although all IBD outpatients should be screened for nutrition risk, screening is not routinely performed, potentially leading to reduced identification and treatment. This study aimed to estimate the prevalence of nutrition risk in adult IBD outpatients and the proportion of cases who discussed diet and/or nutrition during their routine clinical appointment. Methods: Adults with IBD attending outpatient clinics at 4 hospitals in Greece and in UK were recruited. Demographic and anthropometric data were collected using face-to-face patient interviews and clinical records. Patients were classified as high (i.e., body mass index [BMI] < 18.5 or 18.5–20 kg/m2 and weight loss > 5%), moderate (i.e., BMI 20–25 kg/m2 and weight loss > 5%) or low risk of undernutrition and high risk of obesity (i.e., BMI 25–30% and weight gain > 5%). The proportion of patients who discussed diet and/or nutrition during their clinical appointment was calculated. Results: In total, 390 IBD patients participated. Sixteen (4%) patients were underweight, 113 (29%) were overweight and 71 (18%) were obese. Twenty-one (5%) patients were at high risk of undernutrition; of these 4 (19%) were under dietetic care. Of those at high risk of undernutrition, 11 (52%) had discussed diet and/or nutrition during their routine clinical appointment. Fifty-six (14%) patients had gained more than 5% weight since their last recorded/reported weight and 19 (5%) were at high risk of obesity. Conclusions: Few patients were identified to be at high risk of undernutrition and less than a fifth of these were under dietetic care. Overnutrition is a growing problem in IBD with almost half of adult patients being overweight or obese. Diet and/or nutrition were not routinely discussed in this group of IBD outpatients.

DESKRIPSI IMPLEMENTASI KOMPETENSI PERAWAT SESUAI CLINICAL APPOINTMENT DI RSUD KRT SETJONEGORO WONOSOBO

Praktik keperawatan profesional berbasis kompetensi adal ah integrasi dari pengetahuan, skill, tanggungjawab dan akuntabilitas. Implementasi dari kompetensi berdasarkan kewenangan klinis dapat berdampak pada kepuasan pasien dan kejadian patient safety. Tujuan penelitian ini adalah mengetahui deskripsi implementasi kompetensi perawat klinis I di RSUD KRT Setjonegoro dengan metode kualitatif dengan pendekatan fenomenologis dengan metode indepth interview pada 5 perawat klinis I, 5 partisipan triangulasi untuk membedakan aplikasi implementasi kompetensi berdasarkan penugasan klinis. Observasi dilakukan pada perawat klinis I. Kebijakan dan peraturan dari penugasan klinis merupakan bagian dari sistem pelayanan kesehatan dan proses yang meliputi sosialisasi kredensial, kredensial dan penerbitan penugasan klinis. Implementasi kompetensi yang kurang sesuai dengan penugasan klinis dapat menyebabkan komplain dari pasien dan adanya kejadian yang tidak diharapkan. Dukungan dari semua pihak diperlukan untuk implementasi kompetensi perawat berdasarkan penugasan klinis.

Diagnoses and referral pattern at a first seizure clinic in London

Summary Background. Epilepsy is among the most frequent neurological conditions and it is estimated that approximately 8% of the population experience a seizure at some time in their lives. Aim. To examine the characteristics of patients referred to a First Seizure Clinic (FSC) at a University Hospital in South-West London. Methods. All subjects referred to the FSC at St George’s University Hospitals between January and December 2015 were included in this audit. Results. From a total of 257 patients, males 49.5%, age range 16–90, 30% referred by General Practices (GPs), 59.1% by the Accident & Emergency Department (A&E) and 10.9% by other hospital wards, 24.5% did not attend (DNA) the clinical appointment. Females who did not attend were significantly older than males (49.8 years old vs 39.7; p = 0.007). Among those who attended the clinical appointment, 17% were diagnosed first unprovoked seizure, 12.4% acute symptomatic seizure and 28.9% epilepsy. These patients were referred mainly by A&E while GPs referred seizure mimics especially non-epileptic attack disorder (NEAD) and syncope. Patients with NEAD were significantly younger than those with seizures (29.4 years old vs 44.2; p < 0.001) and had a previous psychiatric history (72.7% vs 16.8%; p < 0.001). The proportion of seizure mimics was similar in the older sample group (> 65 years). Regarding acute symptomatic seizures, 33.3% were alcohol-related, 20.8% acute brain insults and 12.5% drug-related (always overdose). Conclusions. 1 in 4 patients referred to a FSC does not attend the clinical appointment, especially older females. More than 1 in 3 cases represent seizure mimics and are referred mainly by GPs.