Outpatient Attendance Research Articles

Cardiovascular disease patient reported experiences with a web-based, interactive, clinically integrated cardiac rehabilitation program

Abstract Funding Acknowledgements Type of funding sources: None. Background/introduction Patient reported experience measures (PREMS) encompasses a person’s interactions within the healthcare system. Understanding the patient experience is key to quality patient-centered care, and evaluating these experiences is essential to improving clinical outcomes and health care quality. Cardiac rehabilitation (CR) programs contribute to redressing cardiovascular disease (CVD) morbidity and mortality by slowing the progression of CVD and restoring quality of life. There is consensus that CR suboptimal attendance and completion is multifactorial, and that different causes are involved. Thus, evaluating patient experience to improve CR program attendance and completion and reduce the burden of CVD is essential. Method A retrospective descriptive survey design was used for patients ≥18 years, who were enrolled and active with the interactive, and clinically integrated web-based program for their CR between July 2021 to December 2022. The primary outcome was patient experience, and the aim was to evaluate this experience. Results Of the 54 enrolled patients, 16 met the inclusion criteria and received an online survey link. Of these 9 (56.3%) responded. Most respondents were aged between 60-70 years (55.6%) and male (77.8%). Seven (77.8%) did a web-based program only, and hybrid (combined web-based and centre CR) were two, (22.2%). The main reasons for choosing this mode of delivery were restrictions relating to the COVID-19 pandemic (66.7 %), and/or geographical isolation and work commitments (33.3%). Most stated that they participated in their goal setting (89%), and 77.8% achieved these goals. Program completion was reported by 77.5% of patients, with 7.89 (SD 4.12) mean weeks completed. Information delivered in the education sessions was clear and easy to understand, contributing to positive lifestyle changes as reported by 77.7% of patients. All patients reported increased confidence across the CR health domains and being treated with respect and dignity. Regarding Phase 3 CR, extended ongoing outpatient attendance and exercise programs, 77.9% reported working with their GP and practice nurse to maintain lifestyle changes. Overall patients reported a positive experience from the web-based CR program stating, "I found this program to be very beneficial and would strongly recommend it to people having heart ops. Pity about covid stopping me attending face to face sessions. The phone and internet support was top notch". Conclusions Patients reported a high level of satisfaction with the education received and respect and dignity shown via a web-based CR program. This is fundamental to engagement with the program, behavior change and improved clinical outcomes in particular for patients with no access to center-based CR due to pandemics, work commitments and geographical isolation.

A Qualitative Assessment of a Training and Communication Intervention on Antibiotic Prescription Practices Among Health Workers and Outpatients at Public Health Facilities in Uganda.

Antibiotic prescribing practices are 1 of the contributing causes of antimicrobial resistance (AMR). The study explored the key drivers and barriers to adherence to prescribing instructions among healthcare workers and outpatient attendees with the aim of developing a training and communication intervention to improve adherence to prescription. Prior to randomized trials at 3 health centers in Uganda (Aduku, Kihihi, and Nagongera), a pre-intervention qualitative assessment was conducted to explore behavioral drivers for adherence to prescriptions and the communication of adherence messages. Based on the findings, a training and communication package was developed for healthcare workers and patients at Day 0 of the trial. During the trial's Day 7 patient follow-up, in-depth interviews were conducted to further investigate adherence behaviors. Five main themes were identified that acted as drivers or barriers to prescription adherence. Key drivers included: drug availability at health facility, health worker knowledge, and communication to patients. Barriers included: care-seeker use of treatment resorts and an inability by care-seeker to buy drugs. The T&C appeared to influence both health workers' and patients' behavior and improve adherence to prescription.The adapted T&C should be considered a toolkit to improve antibiotic use across health facilities accompanied with appropriate guidelines to mitigate AMR.

Secular trends of health care resource utilization and costs between Brugada syndrome and congenital long QT syndrome: A territory-wide study.

Health care resource utilization (HCRU) and costs are important metrics of health care burden, but they have rarely been explored in the setting of cardiac ion channelopathies. This study tested the hypothesis that attendance-related HCRUs and costs differed between patients with Brugada syndrome (BrS) and congenital long QT syndrome (LQTS). This was a retrospective cohort study of consecutive BrS and LQTS patients at public hospitals or clinics in Hong Kong, China. HCRUs and costs (in USD) for Accident and Emergency (A&E), inpatient, general outpatient and specialist outpatient attendances were analyzed between 2001 and 2019 at the cohort level. Comparisons were made using incidence rate ratios (IRRs [95% confidence intervals]). Over the 19-year period, 516 BrS (median age of initial presentation: 51 [interquartile range: 38-61] years, 92% male) and 134 LQTS (median age of initial presentation: 21 [9-44] years, 32% male) patients were included. Compared to LQTS patients, BrS patients had lower total costs (2 008 126 [2 007 622-2 008 629] vs. 2 343 864 [2 342 828-2 344 900]; IRR: 0.857 [0.855-0.858]), higher costs for A&E attendances (83 113 [83 048-83 177] vs. 70 604 [70 487-70 721]; IRR: 1.177 [1.165-1.189]) and general outpatient services (2,176 [2,166-2,187] vs. 921 [908-935]; IRR: 2.363 [2.187-2.552]), but lower costs for inpatient stay (1 391 624 [1 391 359-1 391 889] vs. 1 713 742 [1 713 166-1 714 319]; IRR: 0.812 [0.810-0.814]) and lower costs for specialist outpatient services (531 213 [531 049-531 376] vs. 558 597 [558268-558926]; IRR: 0.951 [0.947-0.9550]). Overall, BrS patients consume 14% less health care resources compared to LQTS patients in terms of attendance costs. BrS patients require more A&E and general outpatient services, but less inpatient and specialist outpatient services than LQTS patients.

Health economic impact of moderate-to-severe chronic pain associated with osteoarthritis in England: a retrospective analysis of linked primary and secondary care data

ObjectiveDespite the prevalence of osteoarthritis (OA) in England, few studies have examined the health economic impact of chronic pain associated with OA. The aim of this study was to compare...

Examination of Consultations Requested from the Child and Adolescent Psychiatry Clinic and Factors Predicting Subsequent Outpatient Clinic Attendance

Objective: The aim of this study is to evaluate consultations received by the child and adolescent psychiatry consultation-liaison unit and identify factors predicting attendance at the outpatient clinic following consultation. Methods: A retrospective review was conducted on all consultations requested from the consultation-liaison psychiatry (CLP) unit at our clinic between August 2021 and March 2022. The files of cases who subsequently attended the recommended outpatient clinic were also examined. Data including age, gender, birth and developmental history, family characteristics, school history, clinical features, and number of consultations were recorded and analyzed. Results: The median age of the sample was 15.1 years (25%: 13.3 – 75%: 16.7). Among the cases, 128 (61.5%) were female and 80 (38.5%) were male. Of the consultations requested, 149 (71.6%) were from emergency services, while 52 (25%) were from inpatient services, with pediatric hematology being the most frequent service. The primary reasons for consultation were suicide attempts (22.1%) and agitation (19.2%). Approximately 26% of cases remained undiagnosed. Major depressive disorder was the most frequently diagnosed condition, accounting for 25.5% of cases. Among the cases recommended for outpatient follow-up at the time of consultation (86% of the total), 53% attended their scheduled appointments. In the predictive model for outpatient attendance, agitation (β=2.11, p<0.05) and suicide attempts (β=0.564, p<0.001) significantly predicted attendance. Conclusion: This study contributes to the existing literature by examining factors influencing the follow-up process. Our findings support the notion that agitation and suicide attempts are associated with increased morbidity. Early detection of high-risk behaviors such as suicide attempts and agitation is believed to reduce psychiatric morbidity and mortality rates, while also improving treatment compliance.

1406-P: Trends in All-Cause and Cause-Specific Mortality in Older Adults With and Without Diabetes—A Territory-Wide Analysis in One Million Older Adults in Hong Kong

Objective: Nationwide data on trends in mortality in older adults with and without diabetes in Asia are lacking. We described the recent trends of all-cause and cause-specific (pneumonia, cardiovascular [CV], and cancer) mortality in adults aged ≥65 years in Hong Kong in 2014-2018. Methods: We performed a territory-wide analysis in 1,152,418 elderlies who had at least one in- or out-patient attendance in the Hospital Authority. We used the Joinpoint regression to assess patterns of mortality rate. Results: In 2014-2018, 354,357 (31.7%) and 763,488 (68.3%) old adults with and without diabetes were included respectively. All-cause death rate has declined in older adults with (458.7 vs. 431.2 events/10,000 person-years, average annual percent change [AAPC]: -3.1% [95% CI -4.2%, -2.1%]) and without (337.0 vs. 294.6 events/10,000 person-years, AAPC: -1.6% [-2.7, -0.4%]) diabetes. In 2018, compared with adults without diabetes, those with diabetes had higher all-cause mortality (1.4-fold), CV- (1.9-fold), and pneumonia-cause (1.3-fold) mortality. Pneumonia was the leading cause of death. CV death has declined significantly in old adults with with (AAPC: -5.5% [-6.8, -4.1%]) and without (AAPC: -5.8% [-8.6, -2.9%]) diabetes. There were no declines in cancer death in older adults with (AAPC: -1.6% [-2.7, 0.4%]) and without (AAPC: -1.6% [-2.7, 3.9%]) diabetes, while cancer death has surpassed CV death in old adults with diabetes. Cancer death has increased markedly in men with diabetes versus those without diabetes (AAPC: 2.9% [1.1, 4.6%] vs. 1.8% [-5.0, 1.4%]), particularly in the youngest-older adults (65-74 years) with diabetes. Conclusions: One in 3 elderlies had diabetes. Overall, cardiovascular-death had declined in these elderlies. Although elderly people with diabetes had a greater decline in all-cause death, they had substantially higher risk of cancer-death than those without diabetes, especially in younger men. Disclosure A.Yang: None. M.Shi: None. E.S.H.Lau: None. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd.

Treaties for "offshoring" hospital treatment of Asian patients from Christmas Island, 1963-1985: a racist chapter in the history of Australian medical care.

Treaties for "offshoring" hospital treatment of Asian patients from Christmas Island, 1963-1985: a racist chapter in the history of Australian medical care.

SAFETY, FEASIBILITY, AND ACCEPTABILITY OF TELEMEDICINE FOR HYPERTENSION IN PRIMARY CARE: A PROOF-OF-CONCEPT AND PILOT RANDOMIZED CONTROLLED TRIAL (SATE-HT)

Objective: Hypertension (HT) continues to be a leading cause of cardiovascular death and an enormous burden on the healthcare system. Although telemedicine may provide improved blood pressure (BP) monitoring and control, it remains unclear whether it could replace face-to-face consultations in patients with optimal BP control. We hypothesized that an automatic drug refill coupled with a telemedicine system tailored to patients with optimal BP would lead to non-inferior BP control Design and method: In this pilot, multicenter, randomized control trial (RCT), participants receiving anti-HT medications were randomly assigned (1:1) to either the telemedicine or usual care group. Patients in the telemedicine group measured and transmitted their home BP readings to the clinic. The medications were refilled without consultation when optimal control (BP <135/85 mmHg) was confirmed. The primary outcome of this trial was the feasibility of using the telemedicine app. Office and ambulatory BP readings were compared between the two groups at the study endpoint. Acceptability was assessed through interviews with the telemedicine study participants. Results: Overall, 49 participants were recruited in 6 months and retention rate was 98%. Participants from both groups had similar BP control (daytime systolic BP: 128.2 versus 126.9 mmHg [telemedicine vs. usual care], p = 0.41) and no adverse events. Participants in the telemedicine group had fewer general outpatient clinic attendances (0.8 vs. 2, p<0.001). Interviewees reported that the system was convenient, timesaving, cost saving, and educational. Conclusions: The system could be safely used. However, the results must be verified in an adequately powered RCT.

Association between airborne particulate matter（PM 2.5） concentration and the incidence of allergic rhinitis in Shanghai

Objective:To explore the impact of PM 2.5 concentration in Shanghai on the incidence of allergic rhinitis（AR） in the population, and provide strategies for early warning and prevention of AR. Methods:Collect daily average concentrations of atmospheric pollutants monitored in Shanghai from January 1, 2017 to December 31, 2019, and clinical data of AR patients from five hospitals in Shanghai during the same period. We used a time-series analysis additive Poisson regression model to analyze the correlation between PM 2.5 levels and outpatient attendance for AR patients. Results:During the study period, a total of 56 500 AR patients were included, and the daily average concentration of PM 2.5 was（35.28±23.07）μg/m³. There is a correlation between the concentration of PM 2.5 and the number of outpatient attendance for AR cases. There is a positive correlation between the daily average number of outpatient for AR and levels of PM 2.5 air pollution（（P<0.05）） . We found that every 10 μg/m³ increase in PM 2.5, the impact of on the number of AR visits was statistically significant on the same day, the first day behind, and the second day behind, with the strongest impact being the exposure on the same day. Every 10 μg/m³ increases in PM 2.5, the number of outpatient visits increased by 0.526% on the same day（95%CI 1.000 50-1.010 04）. Conclusion:The atmospheric PM 2.5 concentration in Shanghai is positively correlated with the number of outpatient for AR, and PM 2.5 exposure is an independent factor in the onset of AR. This provides an important theoretical basis for AR.

Real world hospital costs following stress echocardiography in the UK: a costing study from the EVAREST/BSE-NSTEP multi-centre study

BackgroundStress echocardiography is widely used to detect coronary artery disease, but little evidence on downstream hospital costs in real-world practice is available. We examined how stress echocardiography accuracy and downstream hospital costs vary across NHS hospitals and identified key factors that affect costs to help inform future clinical planning and guidelines.MethodsData on 7636 patients recruited from 31 NHS hospitals within the UK between 2014 and 2020 as part of EVAREST/BSE-NSTEP clinical study, were used. Data included all diagnostic tests, procedures, and hospital admissions for 12 months after a stress echocardiogram and were costed using the NHS national unit costs. A decision tree was built to illustrate the clinical pathway and estimate average downstream hospital costs. Multi-level regression analysis was performed to identify variation in accuracy and costs at both patient, procedural, and hospital level. Linear regression and extrapolation were used to estimate annual hospital cost-savings associated with increasing predictive accuracy at hospital and national level.ResultsStress echocardiography accuracy varied with patient, hospital and operator characteristics. Hypertension, presence of wall motion abnormalities and higher number of hospital cardiology outpatient attendances annually reduced accuracy, adjusted odds ratio of 0.78 (95% CI 0.65 to 0.93), 0.27 (95% CI 0.15 to 0.48), 0.99 (95% CI 0.98 to 0.99) respectively, whereas a prior myocardial infarction, angiotensin receptor blocker medication, and greater operator experience increased accuracy, adjusted odds ratio of 1.77 (95% CI 1.34 to 2.33), 1.64 (95% CI 1.22 to 2.22), and 1.06 (95% CI 1.02 to 1.09) respectively. Average downstream costs were £646 per patient (SD 1796) with significant variation across hospitals. The average downstream costs between the 31 hospitals varied from £384–1730 per patient. False positive and false negative tests were associated with average downstream costs of £1446 (SD £601) and £4192 (SD 3332) respectively, driven by increased non-elective hospital admissions, adjusted odds ratio 2.48 (95% CI 1.08 to 5.66), 21.06 (95% CI 10.41 to 42.59) respectively. We estimated that an increase in accuracy by 1 percentage point could save the NHS in the UK £3.2 million annually.ConclusionThis study provides real-world evidence of downstream costs associated with stress echocardiography practice in the UK and estimates how improvements in accuracy could impact healthcare expenditure in the NHS. A real-world downstream costing approach could be adopted more widely in evaluation of imaging tests and interventions to reflect actual value for money and support realistic planning.

Assessment of Hypertension Complications and Health Service Use 5 Years After Implementation of a Multicomponent Intervention

There is a lack of information regarding the impact of implementing a protocol-driven, team-based, multicomponent intervention in public primary care settings on hypertension-related complications and health care burden over the long term. To compare hypertension-related complications and health service use at 5 years among patients managed with Risk Assessment and Management Program for Hypertension (RAMP-HT) vs usual care. In this population-based prospective matched cohort study, patients were followed up until the date of all-cause mortality, an outcome event, or last follow-up appointment before October 2017, whichever occurred first. Participants included 212 707 adults with uncomplicated hypertension managed at 73 public general outpatient clinics in Hong Kong between 2011 and 2013. RAMP-HT participants were matched to patients receiving usual care using propensity score fine stratification weightings. Statistical analysis was conducted from January 2019 to March 2023. Nurse-led risk assessment linked to electronic action reminder system, nurse intervention, and specialist consultation (as necessary), in addition to usual care. Hypertension-related complications (cardiovascular diseases, end-stage kidney disease), all-cause mortality, public health service use (overnight hospitalization, attendances at accident and emergency department, specialist outpatient clinic, and general outpatient clinic). A total of 108 045 RAMP-HT participants (mean [SD] age: 66.3 [12.3] years; 62 277 [57.6%] female) and 104 662 patients receiving usual care (mean [SD] age 66.3 [13.5] years; 60 497 [57.8%] female) were included. After a median (IQR) follow-up of 5.4 (4.5-5.8) years, RAMP-HT participants had 8.0% absolute risk reduction in cardiovascular diseases, 1.6% absolute risk reduction in end-stage kidney disease, and 10.0% absolute risk reduction in all-cause mortality. After adjusting for baseline covariates, the RAMP-HT group was associated with lower risk of cardiovascular diseases (hazard ratio [HR], 0.62; 95% CI, 0.61-0.64), end-stage kidney disease (HR, 0.54; 95% CI, 0.50-0.59), and all-cause mortality (HR, 0.52; 95% CI, 0.50-0.54) compared with the usual care group. The number needed to treat to prevent 1 cardiovascular disease event, end-stage kidney disease, and all-cause mortality was 16, 106, and 17, respectively. RAMP-HT participants had lower hospital-based health service use (incidence rate ratios ranging from 0.60 to 0.87) but more general outpatient clinic attendances (IRR, 1.06; 95% CI, 1.06-1.06) compared with usual care patients. In this prospective matched cohort study involving 212 707 primary care patients with hypertension, participation in RAMP-HT was associated with statistically significant reductions in all-cause mortality, hypertension-related complications, and hospital-based health service use after 5 years.

Community-level impacts of the coronavirus pandemic on malaria prevention and health-seeking behaviours in rural Benin: A mixed methods study.

Globally, negative impacts of the COVID-19 pandemic on malaria prevention and control efforts have been caused by delayed distributions of long-lasting insecticidal nets (LLIN), decreased outpatient attendance, and disruptions to malaria testing and treatment. Using a mixed methods approach, we aimed to evaluate the impact of COVID-19 on community-level malaria prevention and health-seeking practices in Benin more than one year after the start of the COVID-19 pandemic. We collected data through community-based cross-sectional surveys with 4200 households and ten focus group discussions (FGDs). Mixed effect logistic regression models accounting for a clustered sampling design were used to identify variables associated with main outcomes (good COVID-19 knowledge, LLIN usage and access, and avoidance of health centres). Consistent with the experiences of FGD participants, receiving information from radios or televisions was significantly associated with good COVID-19 knowledge and avoiding health centres because of the pandemic (p<0.001 for both). Qualitative findings also revealed varying and polarizing changes in health-seeking behaviours with participants noting that they either did not change their health-seeking behaviours or went to health centres less or more often because of the pandemic. LLIN usage and access did not decrease in the study area because of the pandemic (LLIN usage: 88% in 2019 to 99.9% in 2021; LLIN access: 62% in 2019 to 73% in 2021). An unexpected change and unintended challenge for sustained malaria prevention included families socially distancing in their homes, resulting in a shortage of LLINs. Our findings showed that there were minimal community-level impacts of the coronavirus pandemic on malaria prevention and health seeking behaviours in rural Benin, which highlights the importance of efforts to sustain malaria prevention and control interventions in the context of the COVID-19 pandemic.

Improving follow-up rates by optimizing patient educational materials in retinopathy of prematurity

To examine the impact of newly designed retinopathy of prematurity (ROP) patient educational materials adherent to health literacy guidelines on improving parent understanding of ROP, perceived importance of follow-up care, and subsequent outpatient follow-up attendance rates. This was a repeated-measures study of parents of premature infants at risk for developing ROP. ROP educational materials were redesigned to adhere to current NIH and AMA reading level guidelines. Participants completed surveys that assessed understanding of ROP and perceived importance of clinic follow-up before and after receiving either materials currently available on the website of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), or the newly designed materials. Results were analyzed to evaluate for an improvement in parent knowledge of ROP and follow-up compliance. Parent ROP knowledge scores improved significantly after receiving educational materials for both the AAPOS materials (55.9% vs 83.7% [P < 0.001]) and the new materials (60.9% vs 91.8% [P < 0.001]). Average post-survey ROP knowledge scores were significantly higher among participants that received the new materials compared to the AAPOS materials (91.8% vs 83.7%, [P < 0.001]). Follow-up attendance rates improved in both groups, with a significantly improved rate from pre-study baseline among the new materials group (80.0% vs 68.2%, [P = 0.008). Implementation of educational materials significantly improved parent understanding of ROP; combined with knowledge assessment, it also improved follow-up compliance. Materials designed to adhere to health literacy guidelines are the most effective resources for improving knowledge of ROP and follow-up attendance.

An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis

BackgroundThe eConsultant model of care is an outpatient substitution approach which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving primary care physicians remote access to specialist support for patient care within 3 business days. Results from initial trials of the eConsultant model in Australia support international evidence of reduced wait times and improved access to specialist input, avoidance of face-to-face hospital outpatient visits, and better integrated care. This study compared the cost of delivery of an eConsultant episode of care with that of a hospital-based outpatient appointment.MethodsA cost-minimisation analysis, using a decision analytic model, was used to compare the two approaches. eConsultant costs were calculated from specialist reported data (minutes spent preparing the response; the number of patients referred subsequently for a hospital-based outpatient appointment) and administration staff data (time spent recording the occasion-of-service). Outpatient costs were calculated using finance data and information from outpatient clinic managers at the hospital-based outpatient clinic. The primary outcome was incremental cost saving per patient from a hospital system perspective. Uncertainty was explored using one-way sensitivity analyses and characterised with probabilistic sensitivity analysis using 10,000 Monte Carlo simulations.ResultsThe traditional referral pathway cost estimate was $587.20/consult compared to $226.13/consult for an eConsultant episode: an efficiency saving of $361.07 per patient. The incremental difference between eConsultant and traditional care was most sensitive to the cost estimate of an outpatient attendance, the time for a specialist to complete an eConsult, and the probability of a patient requiring a face-to-face hospital-based attendance following an eConsult. However, at the upper bounds of each of these estimates, an eConsult remained the most cost-efficient model. In 96.5% of the Monte Carlo simulations eConsult was found to be more cost efficient than the traditional approach.ConclusionsThe eConsultant model of care was associated with a 61.5% efficiency gain, allowing diversion of support to hospital-based outpatient appointments.

A Correlational Study on the Participation Level of Expecting Fathers During Pregnancy and Psychological Well Being among Antenatal Women Attending Outpatient Department in Selected Hospitals of District Mohali, Punjab

A Correlational Study on the Participation Level of Expecting Fathers During Pregnancy and Psychological Well Being among Antenatal Women Attending Outpatient Department in Selected Hospitals of District Mohali, Punjab

The Impact of Bacteriospermia on Semen Parameters Among Infertile Egyptian Men: A Case-Control Study.

This study aimed to detect the impact of bacteriospermia on semen parameters and sperm DNA fragmentation. This prospective case-control study was conducted over a period of 9 months. Samples were collected from andrology outpatient clinic attendants of Cairo University Hospitals. We enrolled 68 semen samples divided into two groups: a study group (34 semen samples with bacteriospermia) and a control group (34 semen samples without bacteriospermia). The characteristics of the semen, including morphology, motility, count, liquefaction, viscosity, pH, volume, and appearance, were evaluated according to the standard protocols. Patients with and without bacteriospermia had a comparable liquefaction time (p = .343), semen appearance and color (p = 1.00), semen pH (p = 1.00), velocity (p = .163), and total sperm count (p = .451). Patients with bacteriospermia were associated with lower progressive motility (p = .001), nonprogressive motility (p = .032), total motility (p = .001), and normal forms (p = .001). The prevalence of abnormal semen analysis was 64.71% in the study group compared with 35.29% in the control group. Staphylococcus aureus (67.6%) and Escherichia coli (14.7%) were the most commonly detected organisms. Samples from which Methicilin-resistant Staphylococcus aureus was isolated showed significant abnormalities in both progressive motility and normal morphology of sperm. Bacteriospermia has deteriorative effects on sperm quality parameters, such as semen volume, sperm motility, and sperm normal morphology.

Combined effect of early diagnosis and treatment on the case fatality risk of COVID-19 in Japan, 2020

Japanese government initially enforced restrictions on outpatient attendances among febrile individuals suspected of having COVID-19, asking everyone to remain at home for at least 4 days from the onset of fever. This restriction was cancelled on 8 May 2020, and a new antiviral, remdesivir, was approved from 7 May 2020. To investigate how this policy change influenced the prognosis of people with COVID-19, we estimated the case fatality risk as a function of the date of illness onset from April to June 2020. We used an interrupted time-series analysis model with an intervention date of 8 May 2020, and estimated time-dependent case fatality risk by age group. The case fatality risk showed a decreasing trend in all groups, and models were favored accounting for an abrupt causal effect, i.e., immediate decline in fatality risk. The trend was estimated at − 1.1% (95% CI [confidence interval]: − 3.9, 3.0) among people aged 60–69 years, − 7.2% (95% CI − 11.2, − 2.4) among those aged 70–79 years, − 7.4% (95% CI − 14.2, 0.2) among those aged 80–89 years, and − 10.3% (95% CI − 21.1, 2.7) among those aged 90 and over. Early diagnosis and treatment greatly contributed to reducing the case fatality risk.

E050 Developing multidisciplinary models of care in rheumatology at University College London Hospital: 18 months of learning from conception to delivery and beyond

Abstract Background/Aims The COVID-19 pandemic has placed unprecedented pressures on NHS departments, with demand rapidly outstripping capacity. The British Society for Rheumatology ‘Rheumatology Workforce: a crisis in numbers (2021)’ highlighted the need to provide innovative ways of delivering rheumatology specialist care. At University College London Hospitals (UCLH) we created a rheumatology multidisciplinary team (MDT) clinic to meet rising demands on our service. The aims of the Rheumatology MDT clinic were to: reduce new appointment/follow-up waiting times, increase clinic capacity, incorporate musculoskeletal (MSK) point of care ultrasound, reduce number of hospital visits and add value to each clinic encounter. Methods We ran a 6-month pilot, supported by our outpatient transformation team, incorporating a Rheumatology Advanced Practice Physiotherapist (APP), Clinical Nurse Specialist (CNS) and MSK ultrasound within a Consultant clinic. The success of the pilot helped secure funding for a further 12 months. Over 18 months we have implemented: APP/Consultant enhanced triage - up to 40% of referrals were appropriate for APP assessment, including regional MSK problems and back pain. This increased capacity for consultant-led appointments. Standardisation of time-lapse between CNS and consultant follow-up appointments to ensure appropriate spacing between patient encounters. Facilitated overbooking of urgent cases afforded by additional capacity provided by the APP. MSK ultrasound embedded in the clinic template. ‘Zoom’ patient education webinars facilitated by MDT members and wider disciplines e.g. dietetics, to empower self-management and reduce the administrative burden of patient emails/phone calls occurring outside the clinic. Patient participation sessions and feedback to help shape the service. Results During the 6-month pilot we reduced our waiting time for follow-up appointments from 9 months to 2. We now have capacity to book 1-2 urgent cases each week. Pre-MDT the average wait from consultant referral to physiotherapist appointment was 55 days. The MDT allows for same day assessment (reducing 2-3 patient journeys a clinic) and where suitable, facilitates discharge or onwards referral to the appropriate service. A dedicated MDT CNS has shortened treatment times, reduced email traffic between CNS and consultant and allows for same day, joint decision-making resulting in fewer appointments. Zoom webinar feedback has been positive. Patients value the broad expertise of allied health professionals which supports self-management. Embedding ultrasound allows for same day diagnostics, decreased referrals to radiology and reduced hospital visits. Conclusion Our MDT model has reduced waiting lists, decreased treatment delays and cut hospital attendances. Point of care ultrasound allows for same day decision making and abolishes the cost and diagnostic delay associated with referrals to radiology or outsourced providers. Shared decision-making adds value to outpatient attendances, which is reflected in patients’ positive feedback. The MDT model maximises the existing workforce skill set by enhancing the APP and CNS role, allowing patients immediate access to their expertise. Disclosure F. Higgs: None. D. Ludwig: None. N. Allotey: None. S. Begum: None. J. Burton: None.

Bidirectional screening and testing for TB and COVID-19 among outpatient department attendees: outcome of an initial intervention in Ghana

BackgroundTuberculosis (TB) remains a major public health threat in Ghana. The impact of COVID-19 resulted in a 15% decline of TB case notification in 2020 compared to 2019. To mitigate the impact on TB services, the Ghana National Tuberculosis Programme (NTP) introduced the bidirectional screening and testing for TB and COVID-19 in 2021.ObjectiveTo evaluate the yield of bidirectional screening and testing for TB and COVID-19 among facility attendees in the Greater Accra region.MethodWe used secondary data obtained from the initial implementation stage of the bidirectional testing for TB and COVID-19 among COVID-19 and/or TB presumed cases in five health facilities in the Greater Accra Region from January to March 2021. To mitigate the impact of COVID-19 on TB services and accelerate TB case detection, the NTP of Ghana introduced bidirectional screening and testing for TB and COVID-19 in Greater Accra Region before scaling up at national level.ResultsA total of 208 presumed TB or COVID-19 cases were identified: 113 were tested for COVID-19 only, and 94 were tested for both TB and COVID-19, 1 was tested for TB only. Among presumed cases tested for COVID-19, 9.7% (95% CI, 5.6-13.7%) were tested positive. Whilst among the total presumed tested for TB, 13.7% (95% CI, 6.8-20.6%) were confirmed to have TB. Among the total 94 presumed cases tested for both TB and COVID-19, 11.7% (95% CI, 5.2-18.2%) were confirmed to have TB and 13.8% (95% CI, 6.9-20.8%) participants were COVID-19 positive and one participant (1.1%) had both COVID-19 and TB.ConclusionBidirectional screening and testing for TB and COVID-19 shows significant potential for improving overall case detection for the two diseases. The bidirectional screening and testing could be applicable to address a similar respiratory epidemic in the future that might have a masking effect on the response to TB disease.

Does the Childhood Obesity Require Special Attention? A Cross-sectional Pilot Study

Background: Childhood overweight and obesity was once a disease of affluent countries but nowadays it is a burning issue in developing countries too. As it is a lifestyle disease, it increases manifold chances of the development of different non-communicable diseases in adult life. The study was conducted to assess the effects of different determinants of childhood obesity. Objectives: The study was conducted to assess the effects of different determinants of childhood obesity. Methods: A cross-sectional study was conducted for six months among seventy-five pediatric out-patient attendees aged 5-18 years of a teaching hospital in West Bengal. Socio-demographic characteristics including physical activity levels were taken with a questionnaire, anthropometric measurements, and laboratory investigations, and carotid intima-medial thickness (CIMT) was measured with B-mode USG. Data were analyzed with SPSS software, version 22, Epi Info, and WHO Anthro plus software, version 1.0.4. Results: Statistically significant association between childhood overweight and obesity was found with exclusive breastfeeding, high lipid profile and blood sugar, physical inactivity, high liver function test, and CIMT values. Conclusions: The alarming increase in childhood overweight and obesity indicates the need for more comprehensive preventive interventions to avoid the pandemic of this impending non-communicable disease.