Covid-19 Impact on Macular Neovascularization and Retinal Vein Occlusion Treatment: Single-Center Experience

<b><i>Purpose:</i></b> The aim of this study was to evaluate whether the coronavirus disease 19 (COVID-19) pandemic resulted in undertreatment and subsequent loss of visual acuity (VA) in patients with macular neovascularization (MNV) or retinal vein occlusion (RVO) regularly treated with intravitreal antivascular endothelial growth factor injections. <b><i>Methods:</i></b> Single-center, retrospective study of patients scheduled for treatment between March 19 and June 1, 2020, the national mandatory quarantine period. Patients’ demographics, VA, and scheduled treatment during this period were reviewed via medical records. All patients were analyzed regarding treatment attendance rates. The visual impact of COVID-19 was assessed in patients who had been treated and presented a stable VA for &#x3e;6 months before the beginning of the quarantine. <b><i>Results:</i></b> This study included 927 eyes from 769 patients. The attendance rate increased throughout the study timeframe (<i>p</i> &#x3c; 0.001) and correlated negatively with higher patient’s age (<i>r</i> = −0.142; <i>p</i> = 0.005). Patients with age-related macular degeneration (67.6%) had lower attendance rates (<i>p</i> = 0.007) and were older (<i>p</i> &#x3c; 0.001). The visual impact analysis included 400 eyes from 325 patients. The average VA variation throughout this period was −1.7 ± 8.4 ETDRS letters and was similar in different retinal pathologies (<i>p</i> = 0.334). VA variation did not correlate with the number of missed treatments per patient (<i>r</i> = 0.100; <i>p</i> = 0.150). The prevalence of subretinal fluid and intraretinal fluid, as well as central retinal thickness decreased significantly throughout the study period (<i>p</i> values of &#x3c;0.001, &#x3c;0.001, and 0.032, respectively). <b><i>Conclusion:</i></b> The COVID-19 pandemic had a significant impact on the attendance rate of patients with MNV or RVO to their scheduled treatments, which was higher in the first week of mandatory quarantine. Nevertheless, VA did not decrease significantly during this period, with a limited VA variation regardless of primary retinal disorder and morphological parameters even improved in the eyes included in the visual impact analysis.

Evaluating the impact of an enhanced triage process on the performance and diagnostic yield of oesophageal physiology studies post COVID-19

ObjectivesThe COVID-19 pandemic significantly impacted on the provision of oesophageal physiology investigations. During the recovery phase, triaging tools were empirically recommended by national bodies for prioritisation of referrals amidst rising waiting lists and reduced capacity. We evaluated the performance of an enhanced triage process (ETP) consisting of telephone triage combined with the hierarchical ‘traffic light system’ recommended in the UK for prioritising oesophageal physiology referrals.DesignIn a cross-sectional study of patients referred for oesophageal physiology studies at a tertiary centre, data were compared between patients who underwent oesophageal physiology studies 6 months prior to the COVID-19 pandemic and those who were investigated within 6 months after service resumption with implementation of the ETP.Outcome measuresAdjusted time from referral to investigation; non-attendance rates; the detection of Chicago Classification (CC) oesophageal motility disorders on oesophageal manometry and severity of acid reflux on 24 hours pH/impedance monitoring.ResultsFollowing service resumption, the ETP reduced non-attendance rates from 9.1% to 2.8% (p=0.021). Use of the ‘traffic light system’ identified a higher proportion of patients with CC oesophageal motility disorders in the ‘amber’ and ‘red’ triage categories, compared with the ‘green’ category (p=0.011). ETP also reduced the time to test for those who were subsequently found to have a major CC oesophageal motility diagnosis compared with those with minor CC disorders and normal motility (p=0.004). The ETP did not affect the yield or timing of acid reflux studies.ConclusionETPs can effectively prioritise patients with oesophageal motility disorders and may therefore have a role beyond the current pandemic.

Academic Persistence for Students Involved in the Accelerated Education Program in Dadaab Refugee Camp

The academic community has highlighted the lack of research into accelerated education programs (AEPs) in refugee camps. Furthermore, AEPs take different forms in different countries. Generally speaking, however, several AEPs in different parts of the world are known for their low attendance rates. Accordingly, this article presents the key barriers causing absenteeism or preventing students from continuing their education within the program in Dadaab Refugee Camp. Our study shows that humanitarian action itself plays a significant role in pupil academic persistence. Also, flexible schedules are not a solution to absenteeism in AEP.

COVID-19 and delivery of difficult asthma services

The COVID-19 pandemic necessitated an urgent reconfiguration of our difficult asthma (DA) service. We rapidly switched to virtual clinics and rolled out home spirometry based on clinical need. From March to August 2020, 110 patients with DA (68% virtually) were seen in clinic, compared with March–August 2019 when 88 patients were seen face-to-face. There was DA clinic cancellation/non-attendance (16% vs 43%; p<0.0003). In patients with home spirometers, acute hospital admissions (6 vs 26; p<0.01) from March to August 2020 were significantly lower compared with the same period in 2019. There was no difference in the number of courses of oral corticosteroids or antibiotics prescribed (47 vs 53; p=0.81). From April to August 2020, 50 patients with DA performed 253 home spirometry measurements, of which 39 demonstrated >20% decrease in forced expiratory volume in 1 s, resulting in new action plans in 87% of these episodes. In our DA cohort, we demonstrate better attendance rates at virtual multidisciplinary team consultations and reduced hospital admission rates when augmented with home spirometry monitoring.

Hearing Aid Review Appointments: Attendance and Effectiveness

Purpose This study aimed to (a) identify participant factors associated with hearing aid review (HAR) appointment attendance, (b) investigate whether the completion of self-report survey identifying hearing aid–related problems affects HAR appointment attendance, and (c) investigate whether hearing aid problems and hearing aid management deficiencies are adequately addressed during HAR appointments. Method A prospective cohort study of adult hearing aid owners recruited from a single hearing clinic in Western Australia. Potential participants were invited to an annual HAR appointment via postal letter. The invitation included a paper-based self-report survey evaluating either (a) hearing aid problems, (b) hearing aid management skills, or (c) hearing aid outcomes, depending on which intervention/control group the potential participants were assigned to, and a reply paid addressed envelope. Two months later, potential participants were sent all three paper-based self-report surveys, irrespective of whether they had attended or not attended an HAR appointment. Results (a) There was no significant difference in gender or source of funding for hearing services between HAR appointment attendees and nonattendees. HAR nonattendees lived a greater distance from their clinic and were younger than attendees. (b) Survey completion did not influence HAR appointment attendance rates. (c) A significant reduction in individuals' self-reported hearing aid problems was recorded following the attendance at the HAR appointment. No significant changes in hearing aid management skills or overall hearing aid outcomes were detected. Conclusions Long travel distances may be a barrier to attendance at review appointments. HAR appointments appear to be effective in improving hearing aid problems.

Evaluation of the instrumented Timed Up and Go test as a tool to measure exercise intervention effects in nursing home residents: results from a PROCARE substudy

Background and objectives To achieve independence in activities of daily living, a certain level of functional ability is necessary. The instrumented Timed Up and Go (iTUG) test provides guidance for appropriate interventions, for example, when considering the subphases within the TUG. Therefore, we evaluated the iTUG as a tool to measure the effects of a multicomponent exercise intervention on the iTUG subphases in nursing home residents. Methods Fifty long-term nursing home residents (34 women, 82.7 ± 6.46 [65–91] years; 16 men, 78.6 ± 7.0 [62–90] years) performed the iTUG test before and after a 16-week intervention period (2 × 45–60 min/week). According to the attendance rates, participants were divided into three groups. Results The total iTUG duration decreased from baseline to posttest, F(2,46) = 3.50, p = 0.038, η2p = 0.132. We observed significant correlations between the attendance rates and the total iTUG duration (r(50) = 0.328, p = 0.010). However, we did not observe significant group × time interaction effects in the subphases. The Barthel Index moderated the effect between attendance rate and the total duration of the iTUG test, ΔR2 = 8.34%, F(1,44) = 4.69, p = 0.036, 95% CI [0.001, 0.027]. Conclusions We confirmed the effectiveness of the iTUG as a tool to measure exercise intervention effects in nursing home residents, especially when participants exhibit high attendance rates. That said, mobility needs to be considered in a more differentiated way, taking into account parameters in the subphases to detect changes more sensitively and to derive recommendations in a more individualized way.

Determinants of Accident and Emergency Attendances and Emergency Admissions in Infants: Birth Cohort Study

Background: Understanding of drivers in increasing infant accident and emergency (A&E) attendances and emergency hospital admissions across England is limited. We examine variations in use of emergency hospital services among infants by local areas in England and investigate the extent to which infant and socio-economic factors explain these variations.Methods: Birth cohort study using linked administrative Hospital Episode Statistics data in England. Singleton live births between 1 April 2012 and 31 March 2019 were followed up for 1 year; from 1 April 2013 (from the discharge date of their birth admission) until their first birthday, death or 31 March 2019. Mixed effects negative binomial models were used to calculate incidence rate ratios for A&E attendances and emergency admissions and mixed effects logistic regression models estimated odds ratio of conversion (the proportion of infants subsequently admitted after attending A&E). Models were adjusted individual-level factors and included a random effect for local authority (LA).Results: The cohort comprised 3,665,414 births in 150 English LAs. Rates of A&E attendance and emergency admissions were highest amongst: infants born <32 weeks gestation; with presence of congenital anomaly; and to mothers <20-years-old. Area-level deprivation was positively associated with A&E attendance rates, but not associated with conversion probability. A&E attendance rates were highest in the North East (916 per 1000 child-years, 95%CI: 911 to 921) and London (876 per 1000, 95%CI: 874 to 879), yet London had the lowest emergency admission rates (232 per 1000, 95%CI: 231 to 234) and conversion probability (25% vs highest 39% in South West). Adjusting for individual-level factors did not significantly affect variability in A&E attendance and emergency admission rates by local authority.Conclusions: Drivers of A&E attendances and emergency admissions include individual-level factors such being born premature, with congenital anomaly and from socio-economically disadvantaged young parent families. Support for such vulnerable infants and families should be provided alongside preventative health care in primary and community care settings. Substantial geographical variations in rates were not explained by individual-level factors, suggest more detailed understanding of local and underlying service-level factors would provide targets for further research on mechanisms and policy priority.

An Analysis between Patient Demographics and Non-attendances in General Surgery Clinics at an NHS Trust: An Audit

Background: Missed clinic appointments can have bearing on a multitude of factors including patient care, hospital management and resources. Aim: To assess the non-attendance rates to surgical clinics within our trust. Secondary outcomes will be to assess the correlation between travel distances to clinic, time of year, patient demographics, and whether the appointment is a new patient or follow-up, on DNA rate. Methods: Retrospective audit including all patients attending outpatient general surgical appointments at all 5 district general hospitals within the trust between the fiscal years of April 2016 to March 2018. Using case notes and electronic patient records, data on patient demographics, type of appointment, time of year and distance from hospital were collected. Results and Conclusions: There is correlation between DNAs and age, gender, ethnicity, subspecialty, and distance from hospital. The reasons behind DNAs will be multifactorial and efforts should be made to investigate the barriers to attendance.

Mapping out-of-school adolescents and youths in low- and middle-income countries

Education is a human right and a driver of development, but, is still not accessible for a vast number of adolescents and school-age-youths. Out-of-school adolescents and youth rates (SDG 4.3.1) in lower and middle-income countries have been at a virtual halt for almost a decade. Thus, there is an increasing need to understand geographic variation on accessibility and school attendance to aid in reducing inequalities in education. Here, the aim was to estimate physical accessibility and secondary school non-attendance amongst adolescents and school-age youths in Tanzania, Cambodia, and the Dominican Republic. Community cluster survey data were triangulated with the spatial location of secondary schools, non-proprietary geospatial data and fine-scale population maps to estimate accessibility to all levels of secondary school education and the number of out-of-school. School attendance rates for the three countries were derived from nationally representative household survey data, and a Bayesian model-based geostatistical framework was used to estimate school attendance at high resolution. Results show a sub-national variation in accessibility and secondary school attendance rates for the three countries considered. Attendance was associated with distance to the nearest school (R2 > 70%). These findings suggest increasing the number of secondary schools could reduce the long-distance commuted to school in low-income and middle-income countries. Future work could extend these findings to fine-scale optimisation models for school location, intervention planning, and understanding barriers associated with secondary school non-attendance at the household level.

1371 “The Nosebleed Effect”: Advice Given to Epistaxis Patients Discharged from The Emergency Department

Introduction Many patients with epistaxis are seen in the A&E department. A significant number are discharged without need for inpatient admission due to minor bleeds. Many are given limited information on management of further bleeds and even fewer are advised on the prevention of bleeds. Aim To evaluate the advice given to patients with epistaxis who are seen and discharged from A+E, to instigate an improvement in advice and to examine the subsequent effect on re-attendance rates Method Epistaxis patients discharged from A+E were audited over a 6-week period looking at advice given on discharge. A questionnaire was distributed to all A&E and ENT doctors probing current practice. A presentation on the management and prevention of epistaxis and the appropriate verbal/written advice to give was delivered and epistaxis advice sheets were made available. The practice regarding advice and the re-attendance rates were re-audited. Results 53 patients presented to the A&E department with epistaxis. 31 patients presenting with epistaxis were seen and discharged by A&E doctors. The remaining seen by ENT. Only 9 patients received verbal advice and 1 received written advice. There were 13 re-attenders. After re-audit showed a significant increase in the proportion of patients receiving advice by A&E doctors. Verbal and written advice increased from 18% to 61% and 1% to 60% respectively. The number of re-attenders was reduced to 13 to 6.