Implementation of Standard Operating Procedure in Ophthalmic Practice during Covid 19 Era across Pakistan

Purpose: To analyze the implementation of standard operating procedures (SOP) in different ophthalmic settings of Pakistan during Covid 19. Study Design: Cross sectional online survey. Place and Duration of Study: Baqai Medical University & Karachi Medical and Dental College, from 11th to 25th January 2021. Methods: This online survey included doctors working as consultants, medical officers and trainees in ophthalmology setups. A self-designed questionnaire on Google forms was sent online to see the implementation of standard operating procedures during COVID 19. Results: A total of 400 participants were selected by snowball sampling technique. A response rate was 105 (26.5%). Females were 66 (62.86%). Among all participants, 36.19% responded that they always screened patients for COVID 19 at reception. Doctors who always wore masks were 96.19%. Out of those who responded, 16.19% and 11.43% always wore protective goggles and disposable gowns respectively. Only 55.24% practiced hand sanitization, 18.10% washed hands with soap and 30.48% cleaned slit lamps after seeing each patient. Doctors who always asked for PCR before ocular surgery under general anesthesia were 65 (61.90%) and for local anesthesia were 36 (34.29%). Direct Ophthalmoscopy, tonometry, and gonioscopy were performed when necessary by 56.19%, 80.00%, 80.00% of doctors respectively. Only 69.5% were satisfied with precautionary measures. Conclusion: Clinic management needs improvement in implementing SOPs among patients in an eye OPD. Fifty percent of the ophthalmologists received PPE by their administration. Only 69.5% doctors were satisfied with precautionary measures. Key Words: COVID 19, standard operating procedures, Pakistan, Ophthalmology

2021 Clinical Practice Guidelines for Diabetes Mellitus in Korea

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence from real-world practice among the Korean population. The guidelines are intended for use at sites across the country by all healthcare providers (including physicians, diabetes experts, and certified diabetes educators) who treat diabetes. The recommendations for screening and antihyperglycemic agents have been revised and updated. Continuous glucose monitoring with insulin pump use and screening and treatment for non-alcoholic fatty liver disease were added in the type 2 diabetes sections. The KDA recommends active vaccination for COVID-19 in patients with diabetes. An abridgement that contains practical information for patient education and systematic clinic management was published separately.

Das Team in der Neurorehabilitation

Neurological rehabilitation is rehabilitative therapy that is concerned with neurological patients in a multi-professional team under the leadership of a physician. The members of this interdisciplinary team work together closely with an intense exchange of knowledge and competence. This primary treatment team includes specialists in neuropsychology, speech therapy, occupational therapy and physiotherapy (including physical therapy), along with social workers and co-therapeutic nursing. Other forms of therapy may also be included. A secondary team is defined by the cooperation of the neurologist with other medical fields, e.g., neurosurgery, geriatrics, psychiatry, orthopedics and neuropediatrics. A tertiary team exists in the form of organizational cooperation between the medical und economic clinic management with insurance companies and political decision makers. Every kind of rehabilitation is basically multi-professional from an organizational viewpoint, and it is performed interdisciplinarily applying the methods of all therapeutic disciplines to create synergies. This particularly applies to neurorehabilitation, as in this field – generally following a disease or an injury to the brain as the central regulation organ – several different disorders occur in combination: sensorimotor symptoms and signs like paralysis, spasticity, dysphagia and loss of coordination; cognitive or speech disorders; or finally psychological alterations like depression or anxiety. Therefore it is particularly important that the professional team members match and coordinate their therapeutic procedures to reach common rehabilitative goals. »Multi-professional« in this context means that the representatives of the different therapeutic fields work with the patient on an advanced competency level, and »interdisciplinary« means that the members of the team work together closely with thorough cross-consultation between their disciplines. Transdisciplinary cooperation represents the highest level of team competency and includes regularly adopting the tasks and therapeutic procedures from other disciplines. All kinds of cooperation are performed under the supervision of a physician who assumes full responsibility for the rehabilitative therapy, including the prescription of medication and introduction of acute interventions, e.g., surgical procedures. This paper is only concerned with the primary – therapeutic – team. The secondary and tertiary forms of team cooperation are planned to be published separately.

Decentralizing healthcare in Norway to improve patient-centered outpatient clinic management of rheumatoid arthritis – a conceptual model

A growing population of older adults and improved effective treatments for inflammatory rheumatic diseases will increase the demand for more healthcare resources that already struggle with staggering outpatient clinic waiting times. Transformative delivery care models that provide sustainable healthcare services are urgently needed to meet these challenges. In this mini-review article, a proposed Lifelong Treatment Model for a decentralized follow-up of outpatient clinic patients living with rheumatoid arthritis is presented and discussed.Our conceptual model follows four steps for a transformative care delivery model supported by an Integrated Practice Unit; (1) Diagnosis, (2) Treatment, (3) Patient Empowered Disease Management, and (4) Telehealth. Through an Integrated Practice Unit, a multidisciplinary team could collaborate with patients with rheumatoid arthritis to facilitate high-value care that addresses most important outcomes of the patients; (1) Early Remission, (2) Decentralization, (3) Improved Quality of Life, and (4) Lifelong Sustain Remission.The article also addresses the growing challenges for the healthcare delivery system today for patients with rheumatoid arthritis and proposes how to reduce outpatient clinic visits without compromising quality and safety.

Type 1 diabetes management and hospitalisation in the over 25’s at an Australian outer urban diabetes clinic

AimsTo describe clinic management and referral pathways among adults with type 1 diabetes (T1D) aged >25 years attending a public outpatient diabetes service. MethodsRetrospective cohort study of people with T1D aged >25 years seen by endocrinologists in one Australian urban public outpatient in 2017. Electronic and paper medical records were reviewed using a dataset adapted from the UK National Institute for Health and Care Excellence 2015 guidelines. ResultsAmong the 111 people with T1D (mean age 41 ± 13 years, 55% men, mean body mass index 27.1 ± 5.6 kg/m2), mean HbA1c was 8.1 ± 1.9% (66 ± 19 mmol/mol) (lower than the Australian National Diabetes Audit: 8.5%/69 mmol/mol) with 25.5% meeting the guideline target of <53 mmol/mol (7.0%). Most people had seen a diabetes educator (80.2%) or dietitian (73.0%) and had complication screening. Complication rates were high (nephropathy 20.4%, retinopathy 27.4%, peripheral neuropathy 30.1%, ischaemic heart disease/acute infarction 10.5%). Overall, 27% of referrals occurred following an acute inpatient admission or emergency department presentation and 13% for management of diabetes in pregnancy. ConclusionsA high proportion of people with T1D accessed public specialist care either during pregnancy or after a largely avoidable acute glycaemia-related hospital presentation. Subsequent care was in line with national specialist standards. This area has a “wait for acute event” rather than “complication prevention” model of care, associated with under-referral to the local multidisciplinary specialist service. Understanding how widespread this model of care is, and ways to reduce its prevalence, are urgently required.

The Association of Temperature Variability With Blood Pressure in Southern China: a Series of Cross-sectional Studies in Guangdong Province, China

Background: Numerous studies have found a positive relationship between temperature variability and mortality, but few studies regarding the effects of temperature variability on blood pressure (BP) are available.Objective: To investigate the effects of temperature variability on BP in Guangdong province, southern China.Methods: Data on Meteorology and BP in Guangdong Province from 2004 to 2015 were collected from Guangdong Provincial Center for Disease Control and Prevention. There were 38088 participants aged 18 years and over. The generalized additive model (GAM) was used to estimate the relationship between temperature variability and BP after adjusting for confounding variables.Result: Our study found that there was a significant positively correlation between temperature variability and systolic blood pressure (SBP), and the estimate increase with the increment of exposure days in total population. The highest estimate was found at 7 days lag with increased 0.497 mmHg of SBP (95%CI: 0.335–0.660) for a 1 °C increase of TV0-7. There was insignificant association between temperature variability and diastolic blood pressure (DBP). The effects of temperature variability on BP among subpopulations with different hypertension statuses were various, and the estimates of Temperature variability with different exposure days on SBP were all higher in known hypertensives than that in normotensives.Conclusion: There was a significant association between temperature variability and SBP in Guangdong province with various effects for different populations. Our findings provide evidence that temperature variability is an independent risk factor for SBP changes, and temperature variability should be considered in hypertension clinic management and epidemiological survey.

1254 Virtual Fracture Clinic Management of Little (5th) Metacarpal Neck Fractures; a Safe and Feasible Option?

Aim To determine the safety and efficacy of a Virtual Fracture Clinic (VFC) in managing little metacarpal neck fractures. Method Retrospective review of consecutive little MC neck fractures presenting to the ED June-December 2020 and subsequently referred on to VFC. Patient demographics and clinic outcomes were reviewed using electronic patient records and radiographs. Results Fifty patients were identified (Male:Female 37:13; mean age 26 years, range 3-89 years). Of these, 41/50 were discharged directly following VFC advice, with no adverse event. The remaining 9/50 had a face-to-face Fracture Clinic review due to safeguarding concerns (2), concurrent neck of fourth MC fracture (2), concerns regarding fracture pattern (4), and an unclear indication (1). These 9/50 were discharged after single review, with no adverse events to date. Conclusions Our data suggest that VFC review of patients with little MC neck fractures is a safe and feasible means of patient care which has the potential to reduce the requirement of face-to-face patient contact during the Covid-19 pandemic and reduce fracture clinic attendance. We suggest the routine incorporation of a Virtual Fracture Clinic for these hand injuries. Further work is needed to formally investigate associated patient satisfaction and the application of this approach to other trauma presentations.

539 Post-Covid-19 Smell Clinic - Management of Patients With ‘Long Covid’

Introduction Olfactory dysfunction following COVID-19 infection is a prevalent issue in the post-viral phase of illness. Around 50% of patient’s self-report loss of sense of smell with COVID-19. Approximately 10% of these patients report no recovery in sense of smell at 4-6 weeks after onset. Patients with olfactory dysfunction often describe life as living in 2D, with lasting effects on eating habits and relationships. The aim of this project was to establish a novel ‘Post-Covid-19 smell clinic’ for patients, which monitored any changes relating to olfactory dysfunction and to provide advice on management of the condition for these patients with “Long-Covid”. Method The ‘smell clinic’ was set up based on BRS guidelines. Patients were asked to carry out the ‘UPSIT’ smell test and eODQ questionnaire. Patients were then advised to carry out ‘smell retraining’ for 4 months and pointed to appropriate resources. We analysed patients’ presentations to identify patterns that may identify patients who are likely to suffer long term olfactory dysfunction following Covid-19 infection. Parameters including prevalence of parosmia, cacosmia, dysgeusia, demographics were collected. Results Initial data, from 20 patients, showed 40% experienced parosmia and 40% had associated rhinological symptoms such as rhinorrhoea. The range UPSIT score: 22-34, eODQ score: 42-151. Conclusions Our initial analysis of the clinic identified symptoms range from anosmia, parosmia and loss of flavour. Parosmia patients experienced this in relation to smells such as excrement and coffee. Future implications involve analysing the possible benefits of ‘smell retraining’ after repeating UPSIT and the eODQ score

663 A Multi-centre National Study of the Effectiveness of Virtual Fracture Clinic Management of Orthopaedic Trauma during the COVID-19 Pandemic (MAVCOV): A Cross-sectional Study Protocol

Aim Virtual fracture clinics (VFCs) are advocated by recent British Orthopaedic Association Standards for Trauma and Orthopaedics (BOASTs) to efficiently manage injuries during the COVID-19 pandemic. The primary aim of this national study is to assess the impact of these standards on patient satisfaction and clinical outcome amid the pandemic. The secondary aims are to determine the impact of the pandemic on demographics of injuries presenting to the VFC and to compare outcomes and satisfaction when the BOAST guidelines were first introduced with a subsequent period when local practice would be familiar with these guidelines. Method This is a national cross-sectional cohort study comprising centres with VFC services across the United Kingdom. All consecutive adult patients assessed at VFC pre-lockdown (6 May 2019 to 19 May 2019) and at the peak of the first lockdown (4 May 2020 to 17 May 2020), and a randomly selected sample during the second wave (October 2020) will be eligible for the study. Data comprising local VFC practice, patient and injury characteristics, unplanned re-attendances, and complications will be collected. A telephone questionnaire will be used to determine patient satisfaction and patient-reported outcomes for patients who were discharged following VFC assessment without face-to-face consultation. Results As of 31 October 2020, 51 hospitals with VFC services have been recruited to participate in this study. Conclusions The study results will identify changes in case-mix and numbers of patients managed through VFCs, due to urgent necessity, and whether this is safe and is associated with patient satisfaction to inform future clinical practice.