Patient Attendance Research Articles

Laboratory characterization of patients with chronic renal failure in resource-limited settings, with special reference to the post-COVID-19 milieu

Chronic kidney disease (CKD), a known global burden involving costly diagnostic and therapeutic modalities, is rampant in urban Indian localities. This study attempts to characterize a subset of proven CKD patients attending out-patient municipal clinics and dispensaries in Mumbai, with an emphasis on the post-COVID scenario. A cross-sectional and longitudinal study was executed in 60 such subjects along with an appropriate number of normal, healthy controls, who were routinely monitored i) up to March 2020, and ii) post-April 2022, the intervening period overlapping with extremely poor and even negligible patient attendance during the COVID-19 pandemic. CKD was estimated by its two most often utilized surrogate markers, serum creatinine and blood urea nitrogen. Amongst the participants, we observed slightly increased values in the aforesaid biomarkers, the underlying aetiology of which has not, to our knowledge, been studied in detail. We recommend comprehensive additional studies in order to corroborate our findings.

A cohort follow-up study for diabetic retinopathy screening incidence in the North Denmark Region

AimsTo evaluate diabetic retinopathy (DR) screening incidence in a universal healthcare system.MethodsRegistry-based cohort study based on a Danish regional population from 2009 to 2018. Individuals with diabetes were identified by medication. Screening attendance was estimated by surrogate measures using local and nationwide databases reported by cumulative incidence.Results18,832 patients were included. By the end of the first year, the cumulative incidence of screening for DR was 60.2% and by the end of the second year 74.2%. The cumulative incidence was 93.9% overall, 97.7% for patients with type 1 diabetes (T1D) and 93.4% for patients with type 2 diabetes. Screening proportions per 1, 2 and 5 years were calculated. Females, patients with T1D, and patients attending screening at hospitals had a higher Hazard Ratio of 1.084, 1.157, and 1.573, respectively. The Cochran–Armitage trend test indicated increased screening frequency from 2009 to 2018. Validation of DR screening was done at hospitals with a mean positive predictive value of 86.78%. Cumulative incidence curves showed a small right shift when censoring the first, second and third screening visits.ConclusionsNearly all patients were screened for DR over a 5-year timespan. Female patients with T1D who attended screening at hospitals were significantly more likely to be screened. Validation of screening visits at hospitals was reported with a high mean positive predictive value. Most other studies, to the best of our knowledge, only report screening attendance for patients already enrolled in a DR screening programme. This study describes the overall screening attendance for the total eligible diabetes population.

Comparison of three analgesic regimens in women undergoing cervical brachytherapy

PURPOSEEffective periprocedural analgesia is an important aspect of cervical brachytherapy delivery, with implications for patient comfort and attendance for subsequent fractions. We compared the efficacy and safety of three analgesic modalities: intravenous patient-controlled analgesia (IV-PCA), continuous epidural infusion (CEI) and programmed-intermittent epidural bolus with patient-controlled epidural analgesia (PIEB-PCEA). METHODS AND MATERIALSNinety-seven brachytherapy episodes involving 36 patients between July 2016 and June 2019 in a single tertiary center were retrospectively reviewed. Episodes were divided into two key phases: Phase 1 (while applicator remained in situ) and Phase 2 (following applicator removal until discharge or 4 h). For the primary endpoint, pain scores were retrieved and analyzed by analgesic modality with respect to median score and an internally defined “unacceptable” pain experience (>20% of scores being ≥4/10; i.e., moderate or greater). Total nonepidural oral morphine equivalent dose (OMED) and toxicity/complication events were reported as secondary endpoints. RESULTSIn Phase 1, there was a significantly higher median pain score (p < 0.001) and more episodes with unacceptable pain scores (46%) in the IV-PCA group compared with either epidural modality (6–14%; p < 0.001).In Phase 2, we observed a greater median pain score (p = 0.007) and higher proportion of patient episodes with unacceptable pain scores (38%) in the CEI group compared with both the IV-PCA (13%) and PIEB-PCEA (14%) groups (p = 0.001).There was a significant difference in median OMED used throughout all phases across the PIEB-PCEA (0 mg), IV-PCA (70 mg), and CEI (15 mg) groups (p < 0.001). CONCLUSIONSPIEB-PCEA is safe and offers superior analgesia compared to IV-PCA or CEI for pain control after applicator placement in cervical brachytherapy.

Analysis of patient demographics and attendance at a Far North Queensland public dermatology outpatient clinic.

There is limited literature focussing on the demographics of patients presenting to public dermatology outpatient clinics, with an even smaller amount focussing on clinics in regional Australia. This study presents the first patient demographic analysis for the Cairns Hospital's Dermatology Outpatient Department and analyses the cohort of patients who did not attend their appointments. In doing so, it recommends potential strategies that should be considered to address the issues of patient absenteeism and wait times in a regional setting, while also suggesting future data points that should be collected for analysis. A 4-year retrospective cohort study using demographic data from all referrals with medical officers (N = 10,333) from 1 January 2018 to 31 December 2021 at the Cairns Hospital Dermatology Outpatient Department. The hospital is the only facility with a dermatology service within the Cairns and Hinterland Hospital and Health Service. Data were extracted from the Cairns Hinterland Analytical Intelligence (CHAI) system. Data pertaining to patient demographics, attendance of appointments, triage categories and wait times were collected and reviewed for patients referred during the study period. The Dermatology Outpatient Department services an ever-growing and diverse patient cohort. Barriers to access and long wait times exist for patients referred to the Department. Strategies to combat these issues, such as an increase in funding and resourcing, should be considered to better optimise patient care and the utilisation of health resources.

Introducing a group-based psychoeducation intervention for older people in an inpatient mental healthcare setting.

This article reports on a service evaluation of a group-based psychoeducation programme for older people in an inpatient mental healthcare setting. It sought to explore how the programme was experienced by patients and staff, as well as its acceptability and the feasibility for implementation in the longer term. Via questionnaires, views were gathered from patients and staff. A focus group interview with staff facilitating the group sessions was also undertaken, and patient attendance records for sessions were collected and compared with demographic data relating to the two wards housed in the unit where the programme took place. The programme was generally viewed as a positive addition to care delivery by staff and patient respondents in offering an adjunct to pharmacological treatment, increasing familiarity with psychology staff, encouraging patients to develop a greater degree of mastery regarding their health and fostering mutual support among the patient community. The role of the ward environment in supporting access to group-based intervention is also considered.

The painful truth of waiting for hip and knee arthroplasty in Northern Ireland.

The aim of this study was to report health-related quality of life (HRQoL) and joint-specific function in patients waiting for total hip or knee arthroplasty surgery (THA or TKA) in Northern Ireland, compared to published literature and a matched normal population. Secondary aims were to report emergency department (ED) and out-of-hours general practitioner (OOH GP) visits, new prescriptions of strong opioids, and new prescriptions of antidepressants while waiting. This was a cohort study of 991 patients on the waiting list for arthroplasty in a single Northern Ireland NHS trust: 497 on the waiting list for ≤ three months; and 494 waiting ≥ three years. Postal surveys included the EuroQol five-dimension five-level questionnaire (EQ-5D-5L), visual analogue scores (EQ-VAS), and Oxford Hip and Knee scores to assess HRQoL and joint-specific function. Electronic records determined prescriptions since addition to the waiting list and patient attendances at OOH GP/EDs. Overall, 712/991 (71.8%) responded at ≤ three months for THA (n = 164) and TKA (n = 199), and ≥ three years for THA (n = 88) and TKA (n = 261). The median EQ-5D-5L score in those waiting ≤ three months was 0.155 (interquartile range (IQR) -0.118 to 0.375) and 0.189 (IQR -0.130 to 0.377) for ≥ three years. Matched controls had a median EQ-5D-5L 0.837 (IQR 0.728 to 1.000). Compared to matched controls, EQ-5D-5L scores were significantly lower in both waiting cohorts (p < 0.001) with significant differences found in every domain. Negative scores, indicating a state "worse than death", were present in 40% at ≤ three months and 38% at ≥ three years. Patients waiting ≥ three years had significantly more opioid (28.4% vs 15.2%; p < 0.001) and antidepressant prescriptions (15.2% vs 9.9%; p = 0.034) and significantly more joint-related attendances at unscheduled care (11.7% vs 0% with ≥ one ED attendance (p < 0.001) and (25.5% vs 2.5% ≥ one OOH GP attendance (p < 0.001)). Patients on waiting lists in Northern Ireland are severely disabled with the worst HRQoL and functional scores studied. The lack of deterioration in EQ-5D-5L and joint-specific scores between patients waiting ≤ three months and ≥ three years likely reflects floor effects of these scores. Prolonged waits were associated with increased dependence on strong opiates, depression, and attendances at unscheduled care.

Knowledge and Treatment Complience among Hypertensive Patient Attending in a Tertiary Level Hospital, Kathmandu

Globally, non-communicable diseases are increasing in trend in both developed and developing countries. Hypertension is considered as one of the main cardiovascular disease which is responsible for life threatening complications and premature death. Knowledge and treatment adherence on hypertension are important to control hypertension and prevent long term complications. A descriptive cross-sectional research design was used to find out the knowledge and treatment compliance among hypertensive patients in a Tertiary level hospital. on-probability sampling technique was used to collect data from 427 people with hypertension through in-person interview. Data analysis was done by using SPSS version 16. Descriptive and inferential statistics was calculated. Out of 427 study participants, half (46.1%) were belong to more than 60 years of age with mean age was 57.30, SD ±12.134, half (55.3%) of the participants were female, 30.44% have positive family history of hypertension and 62.30% had co morbidity. Regarding knowledge on hypertension, more than half (57.8%) of the participants had inadequate knowledge related to hypertension. Overall treatment compliance was poor (6.1%). There was no significant association between knowledge and treatment compliances. So, it is recommended to conduct awareness program related to risk factors and modification of life-style of the people.

Behavioral factors associated with patients’ non-attendance: A retrospective study in an outpatient specialty clinic at a women’s and children’s hospital in Singapore

ABSTRACT Background This study aimed to identify behavioral factors that affect patient attendance in outpatient clinics, especially those related to rescheduling. Methods A retrospective study was conducted on 20,386 appointment records for 6,252 patients in an outpatient specialty clinic at a women’s and children’s hospital in Singapore over 34 months (January 2012–October 2014). Multivariate logistic regression was used to analyze the influence of independent variables on appointment no-shows. Results The average no-show rate of the study population was 28.87%. Patient historical behaviors were significantly associated with appointment attendance. In particular, a larger number of previous visits, more historical no-shows, more historical rescheduling events initiated by patients, and more reschedulings initiated by the clinic for the current appointment were positively associated with no-shows. Notably, the number of previous visits was found to exhibit a significantly diminishing marginal effect on no-show rates. Further analyses suggested that for appointments rescheduled by the clinic, subsequent rescheduling by patients was associated with a reduced risk of no-shows. Conclusions No-shows were more common in patients who missed more historical appointments or had their appointments rescheduled more frequently. Encouraging patients to reschedule their own appointments could be an effective measure to reduce no-shows. However, the benefit of patient-rescheduling decreased if patients rescheduled appointments repeatedly.

#4238 UNEXPLAINED METABOLIC ACIDOSIS - A DIAGNOSTIC DILEMMA

Abstract Background and Aims Metabolic Acidosis is a common condition for which nephrology consult is sought. Most often the etiology is quite obvious like renal failure, diabetic ketoacidosis, lactic acidosis etc. We describe a case of high anion gap metabolic acidosis, unresponsive to medical management requiring hemodialysis, where finding the etiology became a diagnostic challenge because of medical and social reasons prevailing in this eastern part of India. Method A 55 year old obese gentleman came to emergency department at 3 am with complains of restlessness, pain abdomen and chest discomfort for last 4-6 hours. On clinical examination he had tachycardia with normal blood pressure and oxygen saturation. His sensorium was normal and systemic examination did not reveal any major abnormality. A possibility of acute cardiac event was considered but his ECG showed sinus tachycardia, echocardiography did not show any wall motion abnormality and Troponin I was less than 0.01 ng/mL. His blood gases showed an uncompensated metabolic acidosis with an anion gap of 21 (pH 7.19 / pCO2 44 / HCO3 15). The laboratory parameters showed a serum creatinine of 0.9 mg/dL, random blood sugar of 130 mg/dL. Any history of poisoning or drug overdose was denied by patient's attendants. Pending further workup patient was admitted in intensive care unit and correction of metabolic acidosis was started with intravenous sodium bicarbonate. Results The metabolic acidosis initially improved with medical management but within next 6 hours patient again had severe metabolic acidosis. Meanwhile patient's sensorium worsened and he had an episode of seizure. Patient was intubated and mechanical ventilation started. Within 30 minutes patient had status epilepticus which ultimately required intravenous thiopentone. Hemodialysis was started for correction of metabolic acidosis. Patient's history was re-evaluated. On persistent questioning his attendants admitted that patient had consumed alcohol 4-5 hours before the symptoms started. It is important to mention here that consumption of alcohol is a punishable offence in Bihar which a state in eastern part of India. Despite alcohol being completely banned in this part of country illicit alcohol is smuggled and consumed by some. Illicit alcohol is prone to be adulterated and sub-standard. It was because of this fact that patient's attendants suppressed the facts. Also alcohol consumption is a valid ground for rejection of medical insurance claims because of obvious reasons. After obtaining the complete history a possibility of consumption of alcohol adulterated with methyl alcohol was very likely. Serum methyl alcohol estimation was not available at our institute and patient had already received hemodialysis hence it was not done. With patient already having seizures MRI (Magnetic Resonance Imaging) of brain was done. MRI brain revealed altered hyperintense signal with cytotoxic edema in bilateral basal ganglia predominantly putamen. Subcortical white matter in bilateral cerebral hemisphere and bilateral optic nerve head showed restriction on diffusion weighted imaging. These typical features on MRI were highly suggestive of methanol toxicity. These MRI features along with the clinical scenario and history of illicit alcohol intake helped us reach the diagnosis of methanol toxicity. Patient was managed with hemodialysis sessions to remove methanol from blood until he improved clinically. Conclusion The etiology of the high anion gap metabolic acidosis turned out to be methanol toxicity. Typical MRI brain findings helped confirm the diagnosis. Our case highlights the importance of obtaining the correct medical history and how social and medicolegal issues sometimes become a hindrance to obtaining the same.

Determinants of Violence and Aggression Towards Health Care Doctors in Health Management Hub Pakistan: A Short Survey Report

The objective of this study was to investigate the frequency and potential factors associated with violence, as well as the types of perpetrators involved, physical injuries, and psychological consequences experienced by doctors in Islamabad's tertiary care hospitals. A cross-sectional survey based on research questionnaires was used. Data were collected through self-administered questionnaires from the tertiary care hospitals of Islamabad from January to August 2021. The sample consists of (n = 115) medical doctors of different specialties. A total of 53 (46.10%) participants reported a high degree of concern about violent incidents, of whom 33 (28.70%) female doctors and 20 (20.17%) male doctors showed their responses to the high degree of violent incidents. Furthermore, the results show that 58 (50.40%) participants were not properly prepared for managing the violence. Similarly, 58 (50.40%) participants have experienced violence during the past 6 months, while 95 (82.60%) doctors witnessed violent incidents toward doctors during the past 6 months. Moreover, doctors working in the emergency and accident departments were more vulnerable to be victims of violence compared with doctors working in other departments during the past 6 months. A significant perpetrator proportion (n = 43; 74.13%) were reported to be the attendants of patients. However, doctors working in the psychiatry department were more vulnerable to serious physical violence (χ2 = 10.40, p = 0.01). Approximately 90% of victims reported some kind of psychological impact where fear was found more common in females, while anger has been found more common in males (χ2 = 7.92, p = 0.01).

Models of dental care for people experiencing homelessness in the UK: a scoping review of the literature.

Background People who experience homelessness have poor oral health and face barriers to accessing care. Recommendations have been outlined for health services to address their needs, termed 'inclusion health'. The Smile4Life report recommended three 'tiers' of dental service: emergency, ad hoc and routine care. Other medical services have developed into different models of care, for example mainstream practices with enhanced services for people who experience homelessness. There is little understanding of how inclusion health recommendations have been implemented across dental settings.Aims To describe and compare dental services that exist for people who experience homelessness in the UK.Methods Two Medline searches were performed in October 2020 to assess the models of dental care for people who experience homelessness in the UK.Results Nine dental services in the UK were identified who treated people who experience homelessness. Most did not explore definitions of homelessness. There were a mixture of models, including using blended approaches, such as different sites and appointment types, to flex to the needs of their population.Conclusion Many services that are dedicated to treat this population are based in the community dental services which allows for flexible models of care due to sporadic patient attendance, high treatment requirements and complex needs. More research is required to determine how other settings can accommodate these patients, as well as understanding how more rural populations access dental care.

Impact of the COVID-19 pandemic on the hospital attendance of patients with primary cervical cancer in Heilongjiang, China.

Information regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on cervical cancer in mainland China is lacking. We explored its impact on the hospital attendance of patients with primary cervical cancer. We included 1918 patients with primary cervical cancer who initially attended Harbin Medical University Cancer Hospital between January 23, 2019, and January 23, 2021. Attendance decreased by 31%, from 1135 in 2019 to 783 in 2020, mainly from January to June (𝜒2 = 73.362, P < .001). The percentage of patients detected by screening decreased from 12.1% in January-June 2019 to 5.8% in January-June 2020 (𝜒2 = 7.187, P = .007). Patients with stage I accounted for 28.4% in 2020 significantly lower than 36.6% in 2019 (𝜒2 = 14.085, P < .001), and patients with stage III accounted for 27.1% in 2020 significantly higher than 20.5% in 2019 (𝜒2 = 11.145, P < .001). Waiting time for treatment was extended from 8 days (median) in January-June and July-December 2019 to 16 days in January-June (𝜒2 = 74.674, P < .001) and 12 days in July-December 2020 (𝜒2 = 37.916, P < .001). Of the 179 patients who delayed treatment, 164 (91.6%) were for the reasons of the healthcare providers. Compared to 2019, the number of patients in Harbin or non-Harbin in Heilongjiang Province and outside the province decreased, and cross-regional medical treatment has been hindered. The COVID-19 pandemic has negatively impacted cervical cancer patient attendance at the initial phase. These results are solid evidence that a strategy and mechanism for the effective attendance of cervical cancer patients in response to public health emergencies is urgently needed.

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.

Contingency Management in a Perinatal Substance Exposure Clinic

Project CARA, a perinatal substance exposure clinic, has implemented a contingency management program that targets appointment attendance for patients with any use disorder, regardless of substance or urine drug screen results.

Exploring factors associated with paramedic work-related psychological injury through data linkage

Introduction: In comparison to the general population and other emergency services workers, paramedics experience high rates of work-related psychological injury. However, there is limited understanding of the case and practitioner-related factors that increase the risk of psychological injury among these workers. This paper aims to identify case and practitioner-related factors associated with paramedic work-related psychological injury in Victoria, Australia, through data linkage. Methods: Data linkage of 7,223 paramedic injury reports with electronic patient care records, and paramedic demographic data from the single state-wide ambulance service in Victoria, Australia – Ambulance Victoria. Injuries reported between 1 January 2015 and 30 June 2020 were included. Factors associated with paramedic psychological injury were assessed using multivariable logistic regression analysis. Results: A total of 4,641 (64%) injury reports were successfully linked, of which, 244 (5%) were psychological injuries. Shift hours between 0401 and 0800 (AOR 1.83; 95%CI: 1.12–2.97), cardiac arrest or deceased patient attendances (AOR 2.15; 95%CI: 1.06–4.34), hospital or medical center case locations (AOR 2.44; 95%CI: 1.22–4.91), and Priority 0 (AOR 2.27; 95%CI: 1.26–4.09), Priority 2 (AOR 1.56; 95%CI: 1.04–2.33), and Priority 3 (AOR 1.95; 95%CI: 1.15–3.32) dispatch codes were associated with increased odds of psychological injury. Increasing patient age (AOR 0.98; 95%CI: 0.97–0.99), and the absence of other emergency services on scene (AOR 0.50; 95%CI: 0.34–0.72) were associated with decreased odds of paramedic psychological injury. Conclusions: This is the first study to collectively examine and identify EMS case and practitioner-related characteristics associated with paramedic psychological injury through data linkage of EMS agency-level data sources. Practical application: The findings of this study highlight the dispatch case characteristics that may increase the risk of a paramedic sustaining a work-related psychological injury, and consequently facilitate the early identification, intervention, and support of the individuals most at risk.

Attendance analysis in a phase 3 cardiovascular rehabilitation program: can behaviour regulation in exercise predict long-term attendance?

Abstract Funding Acknowledgements Type of funding sources: None. Background After a phase II cardiovascular rehabilitation (CR) program, cardiovascular disease (CVD) patients ideally continue to a phase III long-term CR program. Enrolment, attendance rates and barriers are well established for phase II or short-term CR programs (≤ 12 weeks). However, keeping CVD patients motivated and with high attendance rates (≥ 80%) in a long-term CR program (over 6 months) is more challenging. Self-Determination Theory states that more internalized types of behaviour regulation lead to feelings of self-determination and a higher behavioural adherence. Therefore, more studies analysing attendance rates and behaviour regulation of CVD patients in long-term CR programs are needed. Purpose To compare the attendance of CVD patients enrolled in a long-term CR community-based program between 3, 6 and 12 months and to assess if behavioural regulation in exercise questionnaire (BREQ-2) can predict long term attendance. Methods Patients with CVD attending for, at least, 6 months a phase III community-based CR program were selected. Enrolled patients chose to attend 60 minutes exercise CR sessions either 3 or 2 times/week. Attendance rates were calculated at 3 months, 6 months and 12 months of program completion dividing the number of sessions attended by the number of sessions planned. When admitted to the program, each patient was asked to answer BREQ-2 (19 items, 5-point lickert-type scale, 5 groups: amotivated, external, introjected, identified and intrinsic). One way ANOVA for repeated measures, paired sample t test and pearson correlations were used. Results One hundred and eighteen CVD patients (61 ± 9 years; 78.8% male; 85% with coronary artery disease) completed at least 6 months of CR exercise sessions. Attendance rates decreased significantly from 3 months to 6 months (73.38 ± 18.09% vs 68.14 ± 17.15%, p-value&amp;lt;0.001) with higher scores in intrinsic motivation being correlated with higher rates of attendance (r= 0.330; p&amp;lt;0.001) and higher scores in external motivation being correlated with lower rates of attendance (r= -0.182; p=0.048) at 6 months. Amotivated, introjected and identified motivation showed no significant correlation. A sub analysis with 92 CVD patients (62 ± 9 years, 78.3% male, 87% with coronary artery disease) that completed 12 months of CR exercise sessions was made and a significant decrease in attendance was found between 3, 6 and 12 months (75.5 ± 17.05%, 70.7 ± 15.93% and 66.8 ± 18.34%; p-value&amp;lt;0.001). Conclusion Our results show that attendance rates to exercise CR sessions tend to decrease over the first year of the CR program and that external motivation at baseline is correlated with lower rates of attendance contrary to intrinsic motivation. These findings suggest that BREQ-2 questionnaire might be a good predictor of long-term attendance and help identify CVD patients that could benefit from additional motivational strategies to keep higher attendance rates.

O020 Comparison of indices of deprivation and screening uptake within a local AAA screening programme

Abstract Introduction The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) was established nationally to reduce the number of deaths caused by ruptured AAA. NAAASP invites all men in their 65th year for a simple abdominal ultrasound scan. Across the country uptake to the programme varies greatly. The aim of this study is to determine the impact of deprivation on local screening programme attendance. Methods The attendance for patients invited to screening within the Leicester, Leicestershire and Rutland screening NAAASP programme between the years 2016 and 2021 was compared to indices of multiple deprivation (IMD) (derived from their Lower Layer Super Output Area (LSOA) for each patient). Multiple logistic regression was used to determine the most significant component contributing to the IMD score. Results 28,730 men in total were invited to attend. Mean IMD for those that attended screening was 15.6 versus 20.6 for non-attenders (P value &amp;lt;0.001). Multiple regression revealed the IMD domains most associated with non-attendance to screening to be; Health Deprivation and Disability domain (P&amp;lt;0.001), Outdoor living environment domain (P&amp;lt;0.001) and Adult skills and English language proficiency domain (P&amp;lt;0.001). Barriers to housing and service domain including ‘geographical barriers’ which relate to the physical proximity of local services and employment domains did not show any association with attendance. Conclusion In line with the contemporary medical literature, social deprivation affects the uptake of the local National Abdominal Aortic Aneurysm Screening Programme (NAAASP). Health deprivation and disability, Outdoor living environment and adult education domains are most contributory to non-attendance.

Follow-up attendance of patients with mental disorders and substance use disorders after inpatient treatment in psychiatry ward

Abstract Background: The proportion of patients attending the first follow-up appointment as an outpatient after being discharged from the inpatient setting is an outcome indicator of the quality of inpatient services provided. The objectives of this study were to determine the proportion of psychiatric inpatients with mental disorders and substance use disorders attending follow-up appointments after discharge and to determine the factors associated with attending follow-up appointments in these patients. Materials and Methods: A retrospective chart review (observational study) was conducted among the inpatients of psychiatry ward. The list of patients admitted to the psychiatry ward was obtained from the admission register. The discharge summaries and outpatient records of these patients were reviewed to obtain the following data: sociodemographic details, clinical details, and follow-up visit details. The primary outcome variable was follow-up attendance in the outpatient department within 30 days of discharge. Results: Ninety-eight patient records were included in the present study. The mean age of the participants was 37.81 (11.03) years and one-third of them were female. The mean duration of hospital stay was 11.32 (8.2) days. Sixty-six (67.35%) patients attended at least one outpatient follow-up visit within 30 days after discharge from the hospital. Patients with mood disorders had 4.25 higher odds of 30-FU when compared to patients with substance use disorders. Conclusions: Two-thirds of psychiatric inpatients with mental disorders and substance use disorders attended follow-up appointments within 30 days after discharge. Diagnostic category was associated with attending the follow-up appointments in these patients.

Successful transition for adolescent survivors of CHD: the Cambridge cardiac transition pathway.

National standards to ensure effective transition and smooth transfer of adolescents from paediatric to adult services are available but data on successful transition in CHD are limited. The aim of this study is to assess the effectiveness of our transition pathway. Adolescents with CHD, aged 15-19 years, who attended the joint cardiac transition clinic between 2009 and 2018 were identified from the Patient Administration Systems. Patient attendance at their first adult CHD service appointment at Royal Papworth Hospital was recorded. 179 adolescents were seen in the joint cardiac transition clinic in the 9-year study period. The median age of the patients when seen was 16 (range 15-19) years. 145 patients were initially planned for transfer to the Royal Papworth Hospital adult CHD service. Three patients were subsequently excluded and the success of the transfer of care in 142 patients were analysed. 112 (78%) attended their first follow-up in the adult CHD clinic as planned, 28 (20%) attended after reminders were sent out with 5/28 requiring multiple reminders, and only 2 (1.4%) failed to attend. Overall, transfer of care was achieved in 140 (98.6%) patients. A dedicated joint cardiac transition clinic involving multi-professional medical and nursing teams from paediatric and adult cardiology services appears to achieve high engagement rates with the adult services. This approach allows a 'face' to be put on a named clinician delivering the adult service and should be encouraged.

“Goals in Focus”—a targeted CBT approach for motivational negative symptoms of psychosis: study protocol for a randomized-controlled feasibility trial

BackgroundThe reduction of goal-directed behavior is the main characteristic in motivational negative symptoms of psychosis as it accounts for the long-term decline in psychological well-being and psychosocial functioning. However, the available treatment options are largely unspecific and show only small effects on motivational negative symptoms. Interventions that directly target the relevant psychological mechanisms are likely to be more effective. For “Goals in Focus”, we translated findings from basic clinical research on mechanisms underlying motivational negative symptoms into a tailored and comprehensive novel psychological outpatient treatment program. With this study, we will test the feasibility of the therapy manual and the trial procedures. We also aim to examine first estimates of the effect size that can be expected from “Goals in Focus” to inform the sample size calculation of a subsequent fully powered trial.MethodsThirty participants diagnosed with a schizophrenia spectrum disorder and at least moderate motivational negative symptoms will be randomly assigned to either 24 sessions of “Goals in Focus” over the course of 6 months (n = 15) or to a 6-month wait-list control group (n = 15). Single-blind assessments will be conducted at baseline (t0) and 6 months after baseline completion (t1). Feasibility outcomes include patient recruitment, retention, and attendance rates. Acceptability will be rated by trial therapists and by participants at end of treatment. Primary outcome for effect size estimation is the motivational negative symptom subscale sum score of the Brief Negative Symptom Scale at t1 corrected for baseline values. Secondary outcomes include psychosocial functioning, psychological well-being, depressive symptoms, expressive negative symptoms, negative symptom factor scores, and goal pursuit in everyday life.DiscussionThe feasibility and acceptability data will be used to improve trial procedures and the “Goals in Focus” intervention where necessary. The treatment effect on the primary outcome will provide the basis for the sample size calculation for a fully powered RCT.Trial registration1) ClinicalTrials.gov, NCT05252039. Registered on 23 February 2022.2) Deutsches Register Klinischer Studien, DRKS00018083. Registered on 28 August 2019.