Follow-up Arrangements Research Articles

Mírové smlouvy v mezinárodních vztazích. (K problematice kritérií a systematizace)

The subject of this study is the issue of peace treaties, which are among the most important diplomatic acts and documents in international relations. Peace treaties represent one of the most important types of international treaties. They are an integral part of the couple relationship of peace and war. Their basic specificity is the fact that, on the one hand, they confirm the end of the war conflict and, on the other hand, establish measures and rules for the subsequent relations between the participants in the conflict. In contrast to the prevailing approach, which deals with this issue from the point of view of international law, the author approached the issue on the basis of historical analysis and comparison. His goal was to establish criteria and, based on this, systematize the most important peace treaties concluded in the course of the history of international relations. The author came to determine a total of six intertwining main models of peace treaties: 1. victory of one side over the other, 2. parties exhausted each other and none won, 3. only one of the stages of the war was ended, 4. participation in the conflict ended with a peace treaty only some parties, 5. number of parties involved, 6. content aspect of the treaty. Following this, the author also paid attention to other related problems. Specifically, these are the ratification and observance of peace treaties, accompanying and follow-up contractual arrangements, the extent and degree of punishment of the defeated party, and treaties intended to prevent conflict. The purpose of the study was to create a conceptual and systematically anchored framework for further research on this important part of international relations and diplomacy.

Organizing mentoring and induction practices: understood through the eyes of newly qualified teachers

ABSTRACT Measures aimed at newly qualified teachers (NQTs) in Norway are characterized by ambitious policy expectations, though with leeway for practitioners. This article investigates how NQTs perceive practices enacted to include them in the teaching profession while identifying the actors of such practices. We use practice architectures theory and the notion of ecology of educational practices to analyze conditions associated with mentoring and induction practice. Findings show that NQTs in Norway perceive mentoring and follow-up arrangements as limited and poorly adapted to their needs. We emphasize the need to take seriously tensions linked to mentoring practices, which become evident when NQTs problematize issues such as long-term temporary employment and school leaders as mentors. We argue for prioritizing mentoring practices and the closer follow-up of new teachers; the study illustrates how this may happen through better coupling between mentoring practices and other educational practices.

Barriers and enablers of post-COVID-19 acute care follow-up in Nigeria from service providers' perspective: a nominal group technique.

Despite modest efforts to study and document the complications that arise after acute treatment of patients with coronavirus disease, its ramifications and regional variations are yet to be clearly understood. Progress in sub-Saharan Africa, notably Nigeria, has been impeded by patient disengagement from care and insufficient or non-existent follow-up arrangements. The aim of this study was to describe the barriers and enablers for follow-up services after discharge from COVID-19 care pathway in Nigeria. Seventeen experts involved directly in the care of patients with COVID-19 participated in brainstorming using the nominal group technique during a national workshop to review the new guidelines for COVID-19 case management in Nigeria. Participants discussed the barriers and facilitators of post-acute care follow-up of patients discharged from COVID-19 pathway and ranked their recommendations to arrive at three major factors per question. Participants were mostly middle aged and predominantly clinicians. The top three barriers were patients' perception of their symptom severity, lack of organizational clarity/structure/policies on follow-up care after discharge, and financial constraints. Similarly, participants identified providers' initiated education on the reasons for follow-up at discharge, written organizational policies/structure and clarity and free follow-up services as the top three facilitators. This study has enumerated barriers to follow-up care after discharge patients with coronavirus disease and highlighted providers, institutional and governmental responses that will facilitator follow-up care after discharge of patients with COVID-19. The implication is that, there is need for clear institutional guidelines for tracking and documenting post-COVID condition. In the future, it would be necessary to assess the achievements and shortcomings of post-COVID condition tracking in Nigeria through the use of implementation science outcomes.

Etiology and outcome of hypoglycemia in young children: A retrospective cohort study

Objectives: Hypoglycemia is one of the most common presenting complaints at a pediatric emergency department. There are many distinct causes of hypoglycemia, ranging from nutritional insufficiency to infectious origins to metabolic disorders. Full clinical assessment and appropriate investigations can help differentiate the cause of hypoglycemia with subsequent tailored management. All patients with hypoglycemia should have a full clinical assessment together with a hypoglycemia screen if appropriate. This clinical review aims to determine the investigation of hypoglycemia in young children (<6 years) and whether these patients received a subsequent diagnosis and adequate follow-up plans. Material and Methods: The laboratory database searched for all children from 0 to 6 years old, with hypoglycemia defined as plasma glucose (PG) <54.0 mg/dL (or <3.0 mmol/L) from 2013 to 2021 at the Royal Hospital of Children, Glasgow. Cases were reviewed for the biochemistry investigations to determine if they had hypoglycemia screening requested and/or performed the presenting complaint, clinical diagnosis, and subsequent follow-up arrangements. Results: Five hundred and one children were identified with hypoglycemia (PG <54.0 mg/dL) over a 9-year period. Of these patients, 28% (142/501) had a full hypoglycemia screen, 38% had a partial screen, and 34% (166/501) had no additional blood tests related to hypoglycemia screening other than a PG. The cause of hypoglycemia was identified in 15% (77/501), with gastroenteritis being the most common cause. Of those who were hypoglycemic, 48% (240/501) had an ongoing follow-up. Among those with severe hypoglycemia (PG ≤27.0 mg/dL) (86/501), causes were identified in 72% (62/86) and 63% (54/86) of this cohort which was followed up after the first presentation. Conclusion: Screening was not consistently performed for all patients presenting with hypoglycemia. A great portion of patients were not fully investigated or followed up. This could be a result of clinical judgment in the assessment of further investigation for hypoglycemia. However, moderate and severe hypoglycemia still require further investigations, which can potentially lead to long-term consequences if not managed appropriately.

Healthcare providers' knowledge, attitudes and practices on smoking cessation intervention in the Northern Cape.

Clinicians are crucial in encouraging smokers to quit through behavioural or pharmacological smoking cessation interventions. Smokers quit better with professional help. The level of healthcare providers' (HCPs) knowledge, attitudes and counselling skills related to effective smoking cessation support in the study area remains uncertain. The study aimed to determine HCPs' knowledge, attitudes and practices (KAP) on smoking cessation intervention strategies in the Sol Plaatje district, Northern Cape. Sol Plaatje's 13 district municipality clinics, Kimberley, Northern Cape. A descriptive, cross-sectional analytical study involving healthcare workers in the above setting. A total of 165 HCPs, including medical officers, professional nurses, enrolled nurses and assistant-enrolled nurses working in primary healthcare clinics, were invited to participate in the study, with 156 completing the questionnaires. About 53.9% had no knowledge of South African tobacco smoking cessation guidelines, while 87.2% knew the importance of counselling patients about smoking and its impact on quitting. The majority of them did not know the medicines recommended for tobacco treatment in South Africa. About 89.7% expressed that smoking cessation counselling is an important part of their jobs. However, less than half indicated that they make follow-up arrangements for those attempting to quit. The study revealed gaps in KAP regarding smoking cessation among the respondents, necessitating the need for continuing education on the existing smoking cessation guidelines among these HCPs. The results of this study will help to improve smoking cessation intervention knowledge among health providers.

Very Early Discharge of LOw-Risk ST Elevation MI patients after successful primary percutaneous coronary intervention (VEDLOR-STEMI) study

Abstract Background Current European guidelines recommend discharging low-risk STEMI patients after successful primary PCI at 48-72 hours, based on meta-analysis and large observational studies. There is overall trend towards reducing hospital stay after the COVID-19 pandemic with the risk of cross-infection and to reduce the strain on bed capacity in hospitals. Purpose With this background, we decided to create a pathway to implement very early discharge (within 48 hours) of low-risk STEMI patients after successful primary PCI. The aim of this study is to assess the feasibility and safety of this approach in our centre. Methods This is a single arm, open label prospective observational study of patients undergoing primary PCI in a single high volume tertiary cardiac center. The inclusion criteria included patients ≤70 years with STEMI presenting within 12 hours of symptom onset, one or two vessel disease (>50% stenosis) who underwent successful primary PCI with TIMI 3 flow with LVEF of ≥45% after 24 hrs. Patients with persistent arrhythmia after PCI, recurrent ischemic symptoms, severe anaemia (Hb ≤7 g/dl), eGFR ≤ 45ml/min/1.73 m2 and cardiogenic shock were excluded. We created specific pathways to identify and implement the very early discharge protocol (within 48 hours) in these patients with regular telephone follow up (1st and 3rd post-discharge days) and direct clinic visit at 1 week and after 1 month. The primary outcome of the study was major adverse cardiovascular event at 1 week and 30 days after discharge. Secondary outcome included patient’s satisfaction on early discharge. Results From Mar 2021 to Dec 2022, 84 [mean age 55 ± 9 yrs, 16 (18.2%) females] out of 106 patients provided informed consent to be included in the study. Diabetes, Hypertension, Dyslipidemia, and smoking history were noted in 46 (52.2%), 39 (44.3%), 41 (46.5%) and 6 (6.8%) patients respectively. Mean LVEF was 50±5% after 24 hours of primary PCI. The procedural characteristics of the patients are provided in Table 1. Five patients (5.7%) had minor complictions post discharge; 2 had access site pain, one had giddiness due to hypotension, one had chest pain post discharge, and another had allergic reaction. All of them were managed without the need for re-admission. At one week follow up, except for 2 patients, all others (98%) were satisfied with this early discharge protocol. There was no major adverse cardiac event at 1 week and 30 days. Conclusion This single centre study shows that very early discharge (within 48 hrs) of low-risk STEMI patients after successful primary PCI is feasible and safe with appropriate discharge pathway and follow-up arrangements. Larger studies are needed to confirm this finding.

P07 Quality improvement project of acute referrals to the on-call dermatology service

Abstract With dermatology services now integrating neural networks and artificial intelligence into departments, the importance of technology to streamline services has been timely in light of the increased influx of referrals needing remote reviews from both community and secondary care. We performed a department quality improvement project to compare referrals made to the on-call dermatology service, Dudley Group NHS trust, during September 2019 and September 2020 against the ‘COVID-19: Clinical guidelines for the management of dermatology patients remotely’. Data were collected from telephone, paper and email referrals made in September 2019 and 2020. Referral data including patient demographics, nature and urgency of referrals, diagnosis, availability of medical photography and follow-up arrangements was collated on a Microsoft Excel Proforma. Of 74 total referrals (35 in 2019; 39 in 2020), hospital referrals in September 2020 (92%, n = 36) largely outweighed GP referrals (8%, n = 3). Urgent referrals made by hospital departments rose from 17% (n = 5 of 29) in September 2019 to 53% (n = 19 of 36) in September 2020. Medical photography, often essential for triage and diagnosis, was available only at the time of referral in 8.6% (n = 3) of cases in 2019 and 48.7% (n = 19) in 2020. The rise may be explained by an increased dependence on remote services. With current pressures placing greater demand on resources, there is a need for online referral systems. Moving away from emails, letters and phone calls ensures a less user-dependent interface. Medical photography can be implemented as an integral feature of referral. Online systems facilitate triage and remote management in keeping with dermatological guidelines.

Follow-up arrangements in head and neck cancer clinics during the COVID-19 pandemic: results from two tertiary UK head and neck cancer centres.

The aim of this paper is to report the pattern of follow-up that occurred for a cohort of head and neck cancer (HNC) patients across two large centres in the UK (Aintree and Leeds), as a consequence of the COVID-19 pandemic. Patients had been treated for HNC with curative intent between April 2017 and October 2019 by 14 oral and maxillofacial (OMFS) and ear nose and throat (ENT) oncology surgeons in the Patient Concerns Inventory intervention trial. In October 2020, hospital records were reviewed, and information collected on the timing and mode (face-to-face/telephone/video) of follow-up consultations. In addition, recurrence, second primary tumours and deaths were recorded. At the start of 'lockdown', 212 members of the cohort were known to be alive. During the post-lockdown period (follow-up appointment data comprised 5 months in Aintree and 7 months in Leeds) 7 died and 13 were identified as palliative/recurrence/new primary/metastases ('new event'). In Aintree, the first ENT/OMFS consultations after lockdown were 51 (67%) telephone and 25 (33%) face-to-face appointments. In Leeds, 46 (78%) consultations were by telephone and 13 (22%) were face-to-face. The second ENT/OMFS consultations post lockdown included 11 (44%) telephone and 14 (56%) face-to-face in Aintree, and 21 (75%) telephone and 7 (25%) face-to-face in Leeds. These data suggest that clinicians favoured remote consultations. Variations in practice were observed but reached a point of a 'hybrid follow-up approach' that included both face-to-face and remote consultations. With the emergence of telemedicine, clinicians may consider a follow-up model tailored to risk stratification. The development of the mode of such a consultation model needs further evaluation.

TYPE 2 DIABETES IN YOUNG ADULTS: PREVALENCE AND RISK FACTOR CONTROL IN A TERTIARY DIABETES CENTRE

Objective: The prevalence of type 2 diabetes (T2DM) is increasing in younger adults. Diagnosis at young age translates into increased lifetime complications risk and number of years of life lost. Despite this, clinical guidelines advocate risk-factor management based on 10-year rather than lifetime risk, and there are no specific treatment targets for young adults as this group is under-represented in outcome studies. We reviewed prescribing; risk-factor management; glycaemic control; and follow-up arrangements in people with T2DM aged 18-30 living in North-East Glasgow. Design and method: We used the Scottish Care Information – Diabetes Collaboration (Sci-Diabetes) registry to identify all individuals with T2DM aged 18-30 years and collected data from online medical records. Results: We identified a cohort of 74 (70% female) individuals. Mean age at diagnosis was 23 years. Social deprivation was high (mean SIMD 1.7). Mean HbA1c was 60.4 (range 32 – 119) mmol/mol with 35 (47%) requiring more than 1 glucose-lowering medication and 7 were (9%) insulin-treated. Mean BMI was 35kg/m2 and 55 (74%) individuals were clinically obese. Dietetic review was documented in 30 (45%), GLP-1 analogues were prescribed to 18 (24%). Blood pressure (mean 125/82; range 100-168/60-101) mmHg was above target in 16 (22%) individuals. Only 8 (10%) and 4 (5%) people were on anti-hypertensive and lipid-lowering drugs respectively. Pregnancy advice had been given in 39 (75%) of female patients. Seventeen (22%) individuals were lost to follow-up. Conclusions: Follow-up and risk-factor control are inconsistent in this high-risk group. Service innovation is urgently required to ensure young adults with T2DM are offered appropriate and accessible follow-up in order to minimise cardiovascular risk in later life.

E008 I feel a bit happier about going on it now: exploring the information needs of people starting methotrexate

Abstract Background/Aims Methotrexate (MTX) is recommended as initial disease-modifying anti-rheumatic drug (DMARD) therapy for people with rheumatoid arthritis (RA). Rheumatology nurses provide information about benefits, risks and safety monitoring requirements for methotrexate during DMARD counselling, which may be provided in different formats. This study sought to explore the information needs and experiences of people with RA commencing MTX. Methods Seventy-six adults with RA referred for MTX DMARD counselling attending two rheumatology units in the West Midlands were invited to take part in qualitative semi-structured interviews (either by phone or video) before and after receiving information about MTX. Research partners with RA helped to develop interview topic guides. Interviews were digitally recorded, transcribed and analysed using reflexive thematic analysis. Results Nineteen participants, (11 male, 8 female, White British, age 45-76 years, disease duration 6 weeks - 35 years) took part in telephone (n17) or video (n2) interviews (duration 34-82 minutes). Three main themes were identified: information delivery, necessity of MTX and concerns about MTX. Information delivery: most participants received telephone DMARD counselling which was helpful for people with mobility issues or work commitments. However, most acknowledged a preference for, and the importance of face-to-face communication. Information tended to be provided in a generic manner, using a checklist, and could feel rushed. Written MTX leaflets were received but not used by all participants. Some participants felt well informed whilst others felt overwhelmed with information. Many had difficulty recalling important safety information. Unmet information needs about monitoring, prescribing and follow-up arrangements were frequently reported. Inconsistent information about MTX from different sources could increase concerns. Rheumatology helplines were valued as a direct route to information and care. Necessity of MTX: most participants wanted more information on why they should take MTX, how and when MTX would help them and how long they would be required to take MTX for. Some wanted to know about other drug treatment options. Concerns about MTX: all participants had concerns about the likelihood and severity of side-effects including mouth ulcers, nausea and hair loss. Worries about the use of MTX as a cancer treatment were frequently reported. Whilst concerns remained about MTX most participants accepted the risk of side-effects because of the need to improve their symptoms. Conclusion DMARD counselling was valued by people with RA when starting MTX but was not always responsive to information needs. Addressing individual concerns about the necessity for MTX, concerns about side-effects and prioritising essential safety information is recommended. Practical issues around obtaining supplies of MTX, monitoring, follow-up arrangements and a follow-up telephone call may help address unmet information needs for some. Disclosure S.J. Logan: None. S. Hider: None. J. Green: None. S. Ryan: None.

Application of the R2C2 Model to In-the-Moment Feedback and Coaching.

The R2C2 (relationship, reaction, content, coaching) model is an iterative, evidence-based, theory-informed approach to feedback and coaching that enables preceptors and learners to build relationships, explore reactions and reflections, confirm content, and coach for change and cocreate an action plan. This study explored application of the R2C2 model for in-the-moment feedback conversations between preceptors and learners and the factors that influence its use. A qualitative study using framework analysis through the lens of experiential learning was undertaken with 15 trained preceptor-learner dyads. Data were collected during feedback sessions and follow-up interviews between March 2021 and July 2022. The research team familiarized themselves with the data, used a coding template to document examples of the model's application, reviewed the initial framework and revised the coding template, indexed and summarized the data, created a summary document, examined the transcripts for alignment with each model phase, and identified illustrative quotations and overarching themes. Fifteen dyads were recruited from 8 disciplines (11 preceptors were paired with a single resident [n = 9] or a single medical student [n = 2]; 2 preceptors each had 2 residents). All dyads were able to apply the R2C2 phases of building relationships, exploring reactions and reflections, and confirming content. Many struggled with the coaching components, specifically in creating an action plan and follow-up arrangements. Preceptor skill in applying the model, time available for feedback conversations, and the nature of the relationship impacted how the model was applied. The R2C2 model can be adapted to contexts where in-the-moment feedback conversations occur shortly after a clinical encounter. Experiential learning approaches applying the R2C2 model are critical. Skillful application of the model requires that learners and preceptors go beyond confirming an area of change and deliberately engage in coaching and cocreating an action plan.

Development and Deployment of a Novel Diagnostic Tool Based on Conventional Ultrasound for Fibrosis Assessment in Chronic Kidney Disease

Accurate identification of risk information about fibrosis severity is crucial for clinical decision-making and clinical management of patients with chronic kidney disease (CKD). This study aimed to develop an ultrasound (US)-derived computer-aided diagnosis tool for identifying CKD patients at high risk of developing moderate-severe renal fibrosis, in order to optimize treatment regimens and follow-up strategies. A total of 162 CKD patients undergoing renal biopsies and US examinations were prospectively enrolled and randomly divided into training (n=114) and validation (n=48) cohorts. A multivariate logistic regression approach was employed to develop the diagnostic tool named S-CKD for differentiating moderate-severe renal fibrosis from mild one in the training cohort by integrating the significant variables, which were screened out from demographic characteristics and conventional US features via the least absolute shrinkage and selection operator regression algorithm. The S-CKD was then deployed as both an online web-based and an offline document-based, easy-to-use auxiliary device. In both the training and validation cohorts, the S-CKD's diagnostic performance was evaluated through discrimination and calibration.The clinical benefit of using S-CKD was revealed by decision curve analysis (DCA) and clinical impact curves. The proposed S-CKD achieved an area under the receiver operating characteristic curve of 0.84 (95% confidence interval (CI): 0.77-0.91) and 0.81 (95% CI: 0.68-0.94) in the training and validation cohorts, respectively, indicating satisfactory diagnosis performance. Results of the calibration curves showed that S-CKD has excellent predictive accuracy (Hosmer-Lemeshow test: training cohort, p=0.497; validation cohort, p=0.205). The DCA and clinical impact curves exhibited a high clinical application value of the S-CKD at a wide range of risk probabilities. The S-CKD tool developed in this study is capable of discriminating between mild and moderate-severe renal fibrosis in patients with CKD and achieving promising clinical benefits, which may aid clinicians in personalizing medical decision-making and follow-up arrangement.

The acceptability of implementing patient-reported measures in routine maternity care: A systematic review.

Patient-reported measures (PRMs) are becoming popular as they might influence clinical decisions, help to deliver patient-centered care, and improve health care quality. However, the limited knowledge and consensus about the acceptability of implementing PRMs in maternity care hinder their widespread use in clinical practice, and evidence-based recommendations are lacking. This systematic review aims to synthesize available evidence on the acceptability of implementing PRMs in routine maternity care. Literature on the implementation of PRMs in maternity care was electronically searched in six databases (PsycARTICLES, PubMed, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and CINAHL), screened and selected for the topic of "acceptability". Theoretical Framework of Acceptability was used as the basic framework guiding data analysis and synthesis. Evidence was thematically analyzed and synthesized. Mixed Method Appraisal Tool and GRADE-CERQual approach were used to assess the quality of studies and evaluate the confidence in the review findings. Overall, 4971 articles were screened. From 24 studies, we identified five themes regarding the acceptability of implementing PRMs in routine maternity care: (1) user's action and behavior, (2) stakeholders' attitudes, (3) perceived benefits, (4) perceived challenges and risks, and (5) stakeholders' preferences and suggestions on implementation. While pregnant and postpartum women, health professionals and other stakeholders involved in maternity care were generally positive about the implementation of PRMs in routine care and recognized the potential benefits (eg health improvement, women empowerment, care and services improvement and healthcare system advancement), they pointed out possible challenges and risks in answering PRMs questions, responding to answers, and setting up integrated information systems as well as suggested solutions in the aspects of PRMs data collection, follow-up care, and system-level management. The confidence in the review findings was moderate due to methodological limitations of included studies. Available empirical evidence suggested that the use of PRMs in routine maternity care is acceptable among stakeholders involved in maternity care and the potential benefits of its integration in routine clinical practice to healthcare improvement has been recognized. However, possible challenges in data collection, follow-up care arrangement and system-level integration should be appropriately addressed.

A risk-based post-resection follow-up strategy for hepatocellular carcinoma patients.

The optimal intervals for follow-up after hepatocellular carcinoma (HCC) patients undergo curative liver resection (LR) remain unclear. This study aimed to establish a risk-based post-resection follow-up strategy. Patients that were diagnosed with HCC and received LR from three hospitals in China were included. The risk-based strategy was established based on the random survival forest model and compared with a fixed strategy both internally and externally. In total, 3447 patients from three hospitals were included. The authors' strategy showed superiority in the early detection of tumor relapse compared with fixed surveillance. Under fewer total visits, risk-based strategy achieved analogous survival time compared to the total 20 times follow-ups based on fixed strategy. Twelve total visits (five, three, one, two, and one visits in years 1-5, respectively) for American Joint Committee on Cancer/International Union Against Cancer T1a stage patients, 13 total visits (five, four, one, two, and one visits in years 1-5, respectively) for T1b stage patients, 15 total visits (eight, three, three, zero, and one visits in years 1-5, respectively) for T2 stage patients, and 15 total visits (eight, four, one, one, and one visits in years 1-5, respectively) for T3 stage patients were advocated. The detailed follow-up arrangements were available to the public through an interactive website (https://sysuccfyz.shinyapps.io/RiskBasedFollowUp/). This risk-based surveillance strategy was demonstrated to detect relapse earlier and reduce the total number of follow-ups without compromising on survival. Based on the strategy and methodology of the authors, surgeons or patients could choose more intensive or flexible schedules depending on the requirements and economic conditions. A risk-based post-resection follow-up strategy was established by random survival forest model using a larger hepatocellular carcinoma population The strategy was demonstrated to detect tumor relapse earlier and reduce the total number of follow-ups without compromising on survival Our strategy and methodology could be widely applied by other surgeons and patients.

Developing a contemporary community clinic for patients with heart failure with preserved ejection fraction within the current National Health Service model

IntroductionThe diagnostic and therapeutic arsenal for heart failure with preserved ejection (HFpEF) has expanded. With novel therapies (eg, sodium-glucose co-transporter 2 inhibitors) and firmer recommendations to optimise non-cardiac comorbidities, it...

ANALYZING THE EFFECT OF WATER SEEPAGE AND SCOUR ON SLOPE STABILITY USING FINITE ELEMENT METHOD

On every slope, there is always the possibility of landslides. One of the hypotheses tested was the effect of water flow and scour on slope stability at the investigated location. A brief inspection was carried out to determine the condition and influence of the river, in addition to soil investigations, for proper follow-up arrangement. At landslide sites, water flow has an effect in raising the groundwater level so as to reduce the soil shear strength. Its causes the slope safety factor to drop below the safe rate. The scouring disrupts the stability of the slope but does not reduce the slope safety factor significantly. The parametric studies are chosen for their strong relation between measured displacement within the slope, to verify the measurements and the numerical analysis (Finite Element Method) results. The parametric study simulation shows that time-dependent numerical model could be useful as forecasting tool, including various possible scour and non-scour condition.

Text Messaging, Telephone, or In-Person Outpatient Visit to the Surgical Clinic: A Randomized Trial

IntroductionRoutine outpatient follow-up visits for surgical patients are a source of strain on health-care resources and patients. With the COVID-19 pandemic adding a new urgency to finding the safest follow-up arrangement, text message follow-up might prove an acceptable alternative to a phone call or an in-person clinic visit. MethodsAn open-label, three-arm, parallel randomized trial was conducted. The interventions were traditional in-person appointment, a telephone call, or a text message. The primary outcome was the number of postdischarge complications identified. The secondary outcomes were patient satisfaction with follow-up, future preference, default to follow-up, and preference to receiving medical information by text message. ResultsTwo hundred eight patients underwent randomization: 50 in the in-person group, 80 in the telephone group, and 78 in the text message group. There was no difference in the number of reported complications: 5 (10%) patients in the in-person group, 7 (9%) patients in the text group, and 11 (14%) patients in the telephone group (P = 0.613). The preferred method of follow-up was by telephone (106, 61.6%). The least preferred was the in-person follow-up (15, 8.7%, P = 0.002), which also had the highest default rate (44%). ConclusionsThere was no evidence that text messages and telephone calls are unsafe and ineffective methods of follow-up. Although most patients are happy to receive results by text message, the majority of patients would prefer a telephone follow-up and are less likely to default by this method. Health-care systems should develop telehealth initiatives when planning health-care services in the wake of the COVID-19 pandemic.

7 Day Follow-Up Arrangements Following Discharge From Psychiatric Hospital; How Do We Perform?

AimsThe first 7 days following discharge from inpatient to community psychiatric services is a period that is associated with an increased risk of suicide. NICE Guideline 53 recommends that patients discharged from inpatient psychiatric services should be reviewed by relevant community services within 7 days. We aim to determine how different teams in NHS Lothian performed in meeting this recommendation, and to ascertain the outcome of a specific intervention in North-West Edinburgh (NW).MethodsWe collected data of NW, North-East (NE), South-West (SW), South-East (SE) Edinburgh, East Lothian and Midlothian patients discharged from General Adult Psychiatry wards in the Royal Edinburgh Hospital for the calendar year of 2021. East and Midlothian were used as a comparison to Edinburgh services as the former have an integrated inpatient and community team.The data focused on the percentage of patients followed-up within 7 days of discharge. We also collected data for all NW CMHT patients discharged between January 2018 and November 2021 to analyse the intervention of using ‘Estimated Discharge Dates’ in ward rounds implemented in June 2020. Data were collected from NHS Lothian Analytical Services and anonymised in line with NHS Information Governance Policy.Furthermore, qualitative data were collected anonymously from staff within NHS Lothian in the form of an online questionnaire to ascertain strengths and weaknesses of the current systems.ResultsOver the calendar year of 2021, 1,398 patients were discharged. The average age was 41 years old.Regarding percentage of patients receiving 7 day follow-up, East Lothian (n = 191/249; 76.7%) and Midlothian (n = 95/122; 77.9%) performed better than Edinburgh services; NW (n = 173/268; 64.6%), NE (n = 172/301, 57.1%), SW (n = 155/247, 62.8%), SE (n = 123/211; 58.3%).The intervention in NW in June 2020 did not have a significant impact on 7 day follow-up.The questionnaire identified difficulties in transitions from inpatient to community care, particularly communication between teams.ConclusionThe performance of East and Midlothian versus Edinburgh services is interesting given their integrated model. This appears to support the findings of the questionnaire.The lack of impact of the intervention in NW will need explored further with the team to identify difficulties.Rather than complete service remodelling, perhaps moving towards a more integrated approach such as allocated discharge-coordinating community and inpatient nurses would be worthwhile. We will involve the NHS Lothian Quality Improvement team in exploring this to improve patient outcomes.

Correlation of Doppler examination parameters and brain-derived neurotrophic factor, as a neuromarker, in diabetic patients with polyneuropathy at the stage of late complications

The work was initiated to study correlation between ultrasonic Doppler examination parameters and BDNF, a neuro-marker, in blood of patients with type 2 diabetes mellitus (type 2 DM) and diabetic polyneuropathy (DPN) at the stage of late complications. A comparative prospective study with the participation of 215 patients with type 2 DM, 160 subjects with diabetic polyneuropathy at the stage of late complications were conducted from 2018 to 2021. There is a significant correlation between blood BDNF concentrations and laboratory –instrumental parameters. The correlation between the glycated hemoglobin and Doppler examination in both groups of patients was found, while the correlation with the fasting glycaemia was found insignificant. All the findings can be regarded as the evidence for necessity of timely adequate conservative therapy of chronic wound defects in low extremities of patients with type 2 diabetes mellitus as well as for prevention of recurrences and arrangement of long-term follow-up of patients at high risk of diabetic complications.

Design of Air Passenger Travel Choice Intention Prediction System Based on Deep Learning

Under the Beijing-Tianjin regional comprehensive transportation system, the flow of air passengers between multiple airports in the region is more frequent. The fundamental reason for the flow of air passengers is that there are differences in the level of service quality provided by airports and airlines in the region. Passengers’ choice intention is the consumption and purchase decision of passengers on aviation services. By constructing a Logit model, this paper analyzes the degree of influence on the travel choice intention of air passengers in the Beijing-Tianjin region from five aspects: individual passenger demographic characteristics, travel purpose, ground transportation characteristics, airport operation capacity, and airport soft power. Passengers can effectively predict the choice of air travel mode in the Beijing-Tianjin region. The results show that Beijing Capital Airport is favored by business travelers; Beijing Daxing International Airport is favored by travelers because of its fast security check-through speed; for Tianjin Binhai International Airport, the convenience of getting in and out of the airport by car and the speed of airport security check-through are two significant factors. Indicators do not affect the selection of airports; reasonable follow-up arrangements when airport flights are delayed are the only significant but negatively correlated factor; the research design results provide new ideas for the analysis of passenger travel mode selection behavior in multiple airport areas, enriching the data-driven research on transportation choices.