Wait Lists Research Articles

Suicide in young and middle-aged individuals: lessons from a psychosocial autopsy study

Abstract Background Sociodemographic characteristics of suicides are available from Statistics Netherlands. To improve suicide prevention, it is not only necessary to know who dies but also why people die. A psychosocial autopsy was conducted in the Netherlands to investigate differences in psychosocial characteristics and precipitating factors of suicides of young (<30) and middle-aged (40-70) suicide decedents. Methods Data were collected from bereaved individuals. A questionnaire detailed sociodemographic and psychosocial characteristics of the decedents. We reconstructed the suicidal process in the months preceding the suicide in an interview. Findings from the questionnaire and interview were integrated. An independent expert committee formulated recommendations for suicide prevention. Results 162 suicides were investigated. Young decedents showed high levels of substance use and academic pressure. Young adults with developmental disorders were vulnerable in the transition to adulthood. Young males reached out less to support and care. By contrast, suicides of young females were distinguished by comorbidity of psychiatric disorders, frequent suicidal behaviours, high levels of care use, wait lists and a loss of (treatment) perspective, harmful social media use and bullying. Work and financial problems were common in middle-aged decedents. Physical disability and pain were frequently mentioned for middle-aged females. Suicide in middle-aged males was characterized by financial distress, interpersonal conflicts such as divorce, high levels of binge drinking and addiction. Conclusions Our data provide a topology of the needs of individuals at risk for suicide. Suicide prevention strategies can be improved by better transition support and explicit suicide monitoring in young adults with a developmental disorder, active waitlist policies in mental healthcare, and improved collaboration between debt counsellors and mental care professionals based on shared accountability. Key messages • Bereaved individuals elucidated a wide range of psychosocial problems in suicide decedents. • Suicide prevention should adhere to a needs-based approach.

Allocation of Treatment Slots in Elective Mental Health Care-Are Waiting Lists the Ethically Most Appropriate Option?

Waiting lists are a standard approach to managing excess demand in elective health care. While waiting times are an important policy issue, the ethical validity of the first come, first served (FCFS) principle as such is rarely questioned. Presenting a psychiatric day hospital where all eligible patients have roughly equal claims as a case study, we criticize the reflex use of FCFS for allocation of elective psychiatric care, consider conditions under which this may not be the optimal strategy, and discuss alternatives. We conclude that in our example prioritizing more recent referrals (last come, first served [LCFS]) makes more sense, clinically and ethically. Where several referrals arrive (near-)simultaneously under LCFS, we propose that a higher level of scrutiny be applied to detect possible good reasons for prioritizing one of them. We believe that our observations can be applied to other health care settings that share relevant characteristics with our case.

Adapting a Telehealth Physical Activity and Diet Intervention to a Co-Designed Website for Self-Management After Stroke: Tutorial

People who experience a stroke are at a higher risk of recurrent stroke when compared with people who have not had a stroke. Addressing modifiable risk factors like physical inactivity and poor diet has been shown to improve blood pressure, a leading contributor to stroke. However, survivors of stroke often experience challenges with accessing risk reduction services including long wait lists, difficulty with transportation, fatigue, impaired function, and diminished exercise capacity. Providing health interventions via a website can extend the reach when compared with programs that are only offered face to face or via real-time telehealth. Given global challenges of accessing secondary prevention programs, it is important to consider alternative ways that this information can be made available to survivors of stroke worldwide. Using the “design thinking” framework and drawing on principles of the integrated knowledge translation approach, we adapted 2 co-designed telehealth programs called i-REBOUND – Let’s get moving (physical activity intervention) and i-REBOUND – Eat for health (diet Intervention) to create the i-REBOUND after stroke website. The aim of this paper is to describe the systematic process undertaken to adapt resources from the telehealth delivered i-REBOUND – Let’s get moving and i-REBOUND – Eat for health programs to a website prototype with a focus on navigation requirements and accessibility for survivors of stroke. We engaged a variety of key stakeholders with diverse skills and expertise in areas of stroke recovery, research, and digital health. We established a governance structure, formed a consumer advisory group, appointed a diverse project team, and agreed on scope of the project. Our process of adaptation had the following 3 phases: (1) understand, (2) explore, (3) materialize. Our approach considered the survivor of stroke at the center of all decisions, which helped establish guiding principles related to our prototype design. Careful and iterative engagement with survivors of stroke together with the application of design thinking principles allowed us to establish the functional requirements for our website prototype. Through user testing, we were able to confirm the technical requirements needed to build an accessible and easy-to-navigate website catering to the unique needs of survivors of stroke. We describe the process of adapting existing content and co-creating new digital content in partnership with, and featuring, people who have lived experience of stroke. In this paper, we provide a road map for the steps taken to adapt resources from 2 telehealth-delivered programs to a website format that meets specific navigation and accessibility needs of survivors of stroke.

Challenges and Opportunities in Transitioning Autistic Individuals Into Adulthood.

Approximately 1.2 million autistic youth will reach the legal age of adulthood over the next decade. Given dynamic changes in the socioecological context of the transition to adulthood, we produced an updated transitions research agenda reflecting the perspectives of autistic young adults, care partners (parents), and professionals who use autism research. We conducted 9 focus groups: 4 young adult, 4 care partner, and 1 professional, with 59 total participants. Young adults were grouped by self-reported identity: (1) racial and ethnic minority, (2) lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other identities, and (3) nonspeaking, in addition to a general group. We selected care partners who supported youth with varying intensity of support needs. We used rapid qualitative inquiry methods to extract key points from answers to semistructured interview questions. Delays in diagnosis and transition processes, and placement on wait lists resulted in significant obstacles to successful transitions. Parents assumed a dominant role by coordinating services, navigating systems and identifying opportunities for community participation, and providing direct supports. There was an overarching need for inclusion of autistic people in transitions research and consideration of cultural differences in priorities and values. Participants prioritized investigation of variation in transitions among autistic youth with intersecting identities, navigation support (eg, peer mentors), efficacy of services and supports (eg, transition and employment services), differences in available services by location, and problems within specific benefits programs. Research should focus on understanding population-level factors of system performance on outcomes and support needs, service delivery among marginalized groups, and transformation of complex service ecosystems.

Digital Mental Health Interventions for Alleviating Depression and Anxiety During Psychotherapy Waiting Lists: Systematic Review.

Depression and anxiety have become increasingly prevalent across the globe. The rising need for treatment and the lack of clinicians has resulted in prolonged waiting times for patients to receive their first session. Responding to this gap, digital mental health interventions (DMHIs) have been found effective in treating depression and anxiety and are potentially promising pretreatments for patients who are awaiting face-to-face psychotherapy. Nevertheless, whether digital interventions effectively alleviate symptoms for patients on waiting lists for face-to-face psychotherapy remains unclear. This review aimed to synthesize the effectiveness of DMHIs for relieving depression and anxiety symptoms of patients on waiting lists for face-to-face therapy. This review also investigated the features, perceived credibility, and usability of DMHIs during waiting times. In this systematic review, we searched PubMed, PsycINFO, Cochrane, and Web of Science for research studies investigating the effectiveness of DMHIs in reducing either depression or anxiety symptoms among individuals waiting for face-to-face psychotherapy. The search was conducted in June 2024, and we have included the studies that met the inclusion criteria and were published before June 6, 2024. Of the 9267 unique records identified, 8 studies met the eligibility criteria and were included in the systematic review. Five studies were randomized controlled trials (RCTs), and 3 studies were not. Among the RCTs, we found that digital interventions reduced depression and anxiety symptoms, but the majority of interventions were not more effective compared to the control groups where participants simply waited or received a self-help book. For the non-RCTs, the interventions also reduced symptoms, but without control groups, the interpretation of the findings is limited. Finally, participants in the included studies perceived the digital interventions to be credible and useful, but high dropout rates raised concerns about treatment adherence. Due to the lack of effective interventions among the reviewed studies, especially among the RCTs, our results suggest that waiting list DMHIs are not more effective compared to simply waiting or using a self-help book. However, more high-quality RCTs with larger sample sizes are warranted in order to draw a more robust conclusion. Additionally, as this review revealed concerns regarding the high dropout rate in digital interventions, future studies could perhaps adopt more personalized and human-centered functions in interventions to increase user engagement, with the potential to increase treatment adherence and effectiveness.

Canadian Medical Imaging Inventory 2022–2023: Methods

The Canadian Medical Imaging Inventory (CMII) was created in 2015 to track, compare, and map trends over time related to the availability, distribution, technical specifications, and use of advanced imaging equipment in Canada. This is the fourth iteration of the CMII. The CMII collects data about availability and use of CT, MRI, PET-CT, PET-MRI, SPECT, and SPECT-CT through a survey conducted approximately once every 2 years and details the use of strategies for improving appropriate imaging, enhancing system efficiencies, reducing wait lists, and addressing other systemic challenges. Senior medical imaging decision-makers within health ministries and/or regional health authority located in each province and territory were consulted to validate unit and exam counts for consistency. Data are presented using descriptive summaries and graphs of site-level and jurisdiction-level findings. Canada’s ranking among from Organisation for Economic Co-operation and Development countries was reported. The number of units and exams in Canada was projected for the years 2025, 2030, 2035, and 2040 based on the per capita values in 2022–2023 and estimated population growth provided by Statistics Canada.

Applying Artificial Intelligence in Diagnosis and Treatment of Autism Spectrum Disorder in Children

Autism Spectrum Disorder (ASD) is a disorder of increasing prevalence that affects individuals socially, emotionally, and academically. The increased prevalence and restricted access to diagnosis and treatment suggest more efficient and widely accessible services are necessary. Many individuals with ASD do not receive proper attention due to various reasons, including costs, long wait lists, and long processes. Recent developments in artificial intelligence and machine learning are believed to be able to aid this accessibility issue. Research has shown progress in using MRI and EEG datasets to develop machine learning models in diagnosing ASD and potentially finding biomarkers using supervised and unsupervised ML techniques. AI algorithms analyzing body language and physical behaviors could potentially be used to assess ASD characteristics despite the heterogeneity of the disorder. The adaptivity of artificial intelligence is believed to have the potential to create supportive software for students with ASD to support learning, emotional regulation, and development of social communication skills and increased adaptability. More evidence is required to prove the effectiveness of these applications, but many studies show a lot of promise for children with ASD.

Pilot Study for a Model for the Collection of Waiting Lists Data.

The analysis of data on waiting lists in Italy is regulated by the PNGLA (National Plan for the Governance of Waiting Lists). However, the Plan does not specify the characteristics of the data to be returned by the Regions for the purposes of monitoring, with the result that it is frequently either in aggregate form, unreadable, or incomplete, and therefore cannot be analysed in any meaningful way. Fondazione the Bridge and AGENAS, with the University of Genoa and the University of Pavia, conducted a pilot study on a methodological model for the collection of waiting lists data. The model proved to be effective and replicable, also providing a more valuable opportunity to analyse waiting lists data.

Direct-Acting Antiviral Therapy for Patients with Chronic Hepatitis C Infection and Decompensated Cirrhosis.

Patients with chronic hepatitis C virus (HCV) infection and decompensated cirrhosis are an important population for antiviral therapy yet under-represented in clinical trials. HCV direct-acting antiviral (DAA) therapies, unlike interferon-containing regimens, can be safely utilized in decompensated patients. Per guidelines from the American Association for the Study of Liver Diseases (AASLD), therapy of choice in HCV and decompensated cirrhosis is sofosbuvir, an HCV polymerase inhibitor, combined with a replication complex inhibitor (NS5A inhibitor) with or without ribavirin. Combination therapy with a HCV protease inhibitor and an NS5A inhibitor is effective in this population but is specifically not recommended in AASLD guidelines due to safety concerns. Important risk factors for further decompensation during DAA therapy are serum albumin < 3.5g/dL, MELD (Model for End-Stage Liver Disease) score > 14, or HCV genotype 3 infection. Although sustained virologic response (SVR) is achieved less often in patients with decompensated vs compensated cirrhosis, in clinical studies response rates are > 80%. Both Child-Turcotte-Pugh Class at baseline and viral genotype can affect these response rates. Achieving SVR lowers risk of mortality, but to a lesser extent than in individuals with compensated cirrhosis. Likewise, treating patients for HCV infection along with successful treatment for hepatocellular carcinoma improves risks of both liver-related and overall mortality. In fewer than one third of cases, treating transplant-eligible, HCV-infected patients pre-transplant enables their delisting from transplant wait lists.

Addiction Transfer Post Bariatric Surgery- A Case Report

Introduction Bariatric surgery is an effective treatment for patients with obesity. Rates of obesity are increasing worldwide as are the number of bariatric procedures performed. Following bariatric surgery patients have increased contact with psychiatric services, there is an increased risk of deliberate self-harm, suicide attempts and completed suicide. Compared to the general population there is 8 fold higher than average suicide rate. In Ireland wait lists for bariatric surgery are long, resulting in many patients seeking surgery abroad. Bariatric ‘tourism’ often results in reduced psychological supports both pre and post op as well as reduced pre surgical screening for psychiatric illness. Bariatric surgery is also associated with ‘addiction transfer’. The literature suggests that patients often substitute the maladaptive coping mechanism of eating with other impulsive behaviors such as substance misuse or gambling.ObjectivesCase report highlighting the issue of addiction transfer among patients that have undergone bariatric surgery.Methods Case report: A 38 year old woman admitted to the acute psychiatric unit with self harm, suicidal ideation, low mood, and recent overdose of venlafaxine. On initial presentation, she was intoxicated with alcohol, her toxicology was positive for cocaine and benzodiazepines. She had undergone a gastric bypass 14 months previous, having travelled abroad to have the procedure. She had not attended for any bariatric follow up with her GP post operatively. She was not taking any vitamins post operatively despite advice from the clinic. The patient was admitted to the acute psychiatric unit. She admitted to drinking excessively in the last year. She denied any history of mood disturbance or substance or alcohol misuse prior to surgery. She had no previous contacts with psychiatric services. Her GP had commenced her on venlafaxine for low mood 6 months prior to psychiatric admission. She was admitted to the acute unit for 5 days after which she left against medical advice. She was followed up in the day hospital and referred to addiction services.Resultscase reportConclusionsThere is growing evidence about the psychiatric and addiction implications of bariatric surgery. Offering psychological support for patients post operatively is essential. Unfortunately, because of long wait lists in Ireland many patients chose to travel abroad and often are unable to avail of MDT support. The emerging field of bariatric psychiatry could provide a useful addition to the bariatric specialist services.Disclosure of InterestNone Declared

The impact of rising NHS waiting list times on elective surgery for Dupuytren's disease.

Waiting lists for elective surgery are increasing in the United Kingdom. We report a single-centre experience of disease progression of Dupuytren's disease while on the waiting list for surgery and its effect on the type of operative treatment required.

Access to child developmental assessment services in culturally and linguistically diverse metropolitan Sydney: a retrospective cohort analysis

BackgroundDespite the increasing prevalence of neurodevelopmental disorders (NDD), data regarding access to child development services have remained limited globally. Long wait times are a major barrier to developmental assessments, impacting on care and outcomes. The aim is to retrospectively analyse the demographic profile and prioritisation of patients seen at a child developmental assessment service (CDAS) in a vulnerable region of Sydney, and explore factors affecting wait times.MethodsData was collated and analysed for 2354 patients from 2018 to 2022. Socio-Economic Indexes for Areas (SEIFA) were collated from the Australian Bureau of Statistics. Descriptive statistics were used for demographic data and various statistical methods were used to analyse the relationships and impact of factors likely to affect wait lists.ResultsThe median age was 51 months (IQR41-61) and males comprised 73.7% of the cohort. 64% of children were from culturally and linguistically diverse backgrounds (CALD) and 47% lived in the most disadvantaged suburbs. The median wait time was 302.5 days (IQR175-379) and 70% of children were seen within 12 months. CALD patients and children over 5-years had shorter wait times. Most children with Global Developmental Delay (GDD) were from the lowest four SEIFA deciles and waited longer for an appointment. 42.6% were seen within the priority allocated time or sooner. Children with ASD and/or severe GDD were prioritised to be seen earlier. Overall, the study could not demonstrate any difference in the wait times according to the prioritisation groups.ConclusionThis study provides insights into the profile, prioritisation processes and wait lists of children seen by CDAS in South Western Sydney with high rates of social vulnerability and presents an argument to discuss benchmarking targets with service providers. It identifies the need to prioritise children living in suburbs with socioeconomic disadvantage and refine prioritisation and data collection processes to improve wait times.

IN TELEHEALTH, PHYSIOTHERAPISTS CAN TRIAGE ORTHOPEDIC WAITING LISTS: PILOT STUDY

Objectives: The purpose of this study is to understand the reasons for long waiting lists in orthopedic screening clinics in terms of duration and quantity, as well as to examine physical therapy visibility as an alternative form of management to improve the patient journey according to individual current needs through Telehealth. Background:In public hospitals, there is typically a significant waiting period for outpatient orthopedic appointments with specialists. Subsequently, patients often face another waiting period if surgery is deemed necessary. Unfortunately, individuals with greater medical urgency are seldom given priority, which can lead to heightened morbidity for those who have to wait. Furthermore, alternative care options are generally unavailable during this waiting period. Methods:The current study implemented a telephone triage method executedby two physiotherapists to evaluate new patients on the waiting list of an orthopedic screening clinic. The research took place at Qatif Central Hospital in the Eastern province of Saudi Arabia, spanning from October to December 2021. Telephone triage involves remotely assessing patients over the phone to determine the nature of their condition and determine if physical therapy could serve as a viable alternative treatment option. To ensure consistency in evaluations, the physiotherapists utilized a standardized instrument consisting of a predetermined set of questions and prompts. Results: It was found that 66% of participants experienced a three-month waiting period for their appointments. Additionally, the study revealed a significant number of referrals originating from primary health centers (81%),withknee osteoarthritis being the most commonly diagnosed condition (45%). Another notable finding is that 72% of cases were considered suitable for physical therapy as an alternative treatment option. Conclusion: Integrating physiotherapists into telephone triage for orthopedic outpatient appointments presents a valuable chance to address and prioritize lengthy waiting lists for orthopedic services. This approach offers cost-effectiveness and substantial benefits for institutions facing challenges in managing their orthopedic waiting lists.

APA poll: Demand for care, worker burnout, putting strain on psychologists

Patients presenting with worsening symptoms, increased length of treatment course and longer wait lists are some of the challenges many psychologists are facing, according to a new survey conducted by the American Psychological Association (APA). Additionally, more than one‐third of psychologists report that they are burned out, despite engaging in self‐care.

How much would England’s National Health Service have to invest to bring its capacity to deliver an Alzheimer’s treatment to G7 average capacity levels?

AbstractBackgroundThe arrival of disease‐modifying treatments for Alzheimer’s disease (AD) creates a substantial challenge for health systems because of the large patient pool and a complex diagnostic pathway, and in particular, for those countries that already have comparatively low capacity to provide timely, accurate AD diagnostic services. We estimate how much NHS England would have to invest over 10 years to bring its memory assessment services infrastructure up to the average capacity of the other G7 countries and project the resulting changes in wait times for a disease‐modifying Alzheimer’s treatment.MethodDesk research and expert interviews for capacity and cost data. Markov model to estimate the effect of investment on wait times because of limited capacity for specialist visits and confirmatory biomarker testing.ResultEngland has the lowest number of MRI and PET scanners and the second lowest number of AD specialists of the G7 countries (Table 1). Closing this gap would require an estimated investment of ∼GBP 5.5 billion over 10 years, of which 9% would go toward acquisition of 126 PET and 1,196 MRI scanners including building modification, maintenance and IT equipment cost, and 91% to support operative costs (salaries, CSF assays, tracers, and facility use). On an annual basis, this number amounts to GBP 99 per capita and 3.1% of the overall NHS budget. Wait times in the diagnostic process to determine treatment eligibility would go from an average 58 months to 10 months by year 10 of the investment (Figures 1 and 2)ConclusionAs a result of a long‐standing underinvestment in health system infrastructure, wait times to receive an AD treatment would be substantial in England. Targeted investments aimed at increasing the NHS’ capacity to the average of the remaining G7 countries would decrease those wait times significantly. While the required investment is sizeable, the cost of inaction is equally so, since the disease would progress to more severe and costly stages while patients are held up on wait lists.

HPR175 Estimating the Impact of the Elective Recovery Plan on Reducing Elective Waiting Lists in England

HPR175 Estimating the Impact of the Elective Recovery Plan on Reducing Elective Waiting Lists in England

EGS P20 Registrar-led theatre lists: A safe and effective way to provide a consistent Hot Gallbladder service

Abstract Background Dedicated Hot Gallbladder lists are proven to be cost effective and provide greater patient satisfaction. Unfortunately, the high volume of cases and the lack of available hospital resources make it very challenging to provide a consistent service. The aim of this study is to evaluate the safety and efficacy of the Registrar/SAS doctor led Hot Gallbladder service introduced in our Hospital over a year ago. Methods A system was developed with a middle grade doctor reporting to an UGI consultant surgeon and one SPOC in the waiting list office to streamline the service. A dedicated scoring system questionnaire (GalBAG form – Galbladder Booking and Grading form) was validated in retrospective and prospective series, and subsequently used to assess and grade patients into GOLD, SILVER &amp; BRONZE cases based on expected difficulty and predicted length of the operation. Cases were listed based on surgeon compatibility. Outcomes measured include complications, unplanned admissions and re-admissions, need for further procedures, efficiency of the theatre lists and compared to national averages. Results Our registrar-led lists have successfully performed over 100 hot laparoscopic cholecystectomies. Complication rates, unplanned admissions, readmissions, and need for additional procedures align with national averages. Only one biliary injury occurred but was successfully treated endoscopically. The efficiency of the lists has improved with time as well as the ability to schedule progressively more complex cases Theatre utilization increased for patients referred through the Hot Gallbladder pathway. The GalBAG form accurately predicted difficulty and aided decision-making. Our Hospital now offers a secure and reliable Hot Gallbladder service, receiving positive feedback from patients and GIRFT. Conclusions In the current climate of increased waiting lists and lack of resources to provide dedicated urgent surgical services, a Registrar-led theatre list service with adequate backup/supervision could represent a safe, efficient, consistent and cost effective model to offer a Hot Gallbladder service.

The impact of the COVID-19 pandemic on speech and language therapy services in Ireland: A mixed-methods survey at two time points during the pandemic.

During the COVID-19 pandemic, Ireland implemented a series of stringent public health measures, including lockdowns and suspension of non-urgent clinical services. To investigate the impact of the COVID-19 pandemic on the demand for and delivery of speech and language therapy (SLT) services in Ireland in 2020. Two iterations of a cross-sectional, mixed-methods online survey were distributed to speech and language therapists (SLTs) and SLT students in Ireland in the spring and autumn of 2020 using a combination of purposive and snowball sampling. The spring survey yielded 407 responses (including 14 from SLT students), while 197 respondents took part in the autumn (13 students). Survey analysis focused on questions related to the impact of the COVID-19 pandemic on delivery and demand for SLT services (student responses were excluded from analysis owing to low response rate). The largest group in respect of experience were senior SLTs (58% in both surveys). The work settings most strongly represented were HSE primary care (34.4%) and disability services (26.5%) in the spring, and HSE primary care (39.1%), acute hospitals (22.8%) and disability services (20.8%) in the autumn. We used descriptive statistics, including distribution analysis, to analyse the quantitative data. Free text data were interrogated through a variant of a conventional qualitative content analysis. In the spring, cessation of face-to-face services featured prominently (reported by 65.6% versus 14.2% in the autumn), across SLTs' work settings, except acute hospitals. Lower demand was reported by 42.5% in the spring, while in the autumn, 48.7% indicated that demand was higher. SLTs experienced large-scale redeployment (spring: 45.9%, autumn: 38.4%), with HSE primary care SLTs redeployed most (spring: 71.7%; autumn: 62.3%). The need to suddenly pivot to telehealth was a significant challenge in terms of training, technology and logistics. New ways of working emerged and gradually, telehealth became more embedded. SLTs also had to adapt to working with evolving public health measures, such as space restrictions and personal protective equipment (PPE) requirements. Across the two survey iterations, SLTs reported tensions between demands and capacity: while referrals and demand initially decreased in the spring, this led to increased backlog and longer waiting lists, ongoing and increasing pressure on clinicians and services, and negatively impacted clients and families. The COVID-19 pandemic had a significant negative impact on SLT services in Ireland. Going forward, the SLT profession and its services will require sustained support to mitigate long-term negative consequences, such as increased waiting lists. What is already known on this subject The negative impact of the COVID-19 pandemic on SLT services has been examined in several countries. Ireland imposed more stringent pandemic-management measures than many other countries, and it was therefore warranted to investigate how SLT services in the country were affected. What this study adds to the existing knowledge Face-to-face SLT services effectively ceased in most non-urgent contexts in spring 2020. This coincided with large-scale redeployment of SLTs to non-SLT contexts. By autumn 2020, demand had increased again, but not all services had recommenced, and redeployment was still a factor. Although SLTs adapted to the ongoing changes imposed by the pandemic, they voiced concern about increasing backlogs and longer waiting lists, ongoing and increasing pressure on both SLTs and services, and negative impacts on clients and families. What are the actual and clinical implications of this work? The COVID-19 pandemic had a significant negative impact on SLT services in Ireland. Going forward, the SLT profession and its services will require sustained support to mitigate long-term negative consequences, such as increased waiting lists.

Use of MRI and CT in Private Imaging Facilities in Canada (2021-2023)

&#x0D; The private, for-profit imaging landscape is expanding and is anticipated to continue expanding due to changes in some provincial government policies aimed at reducing wait lists.&#x0D; The collection of data on private imaging can help to build a complete and comprehensive picture of overall procedural capacity across the country.&#x0D; Estimates on the number of publicly funded exams conducted in private facilities can inform the extent to which wait times have been impacted by the shift in some provincial government policies.&#x0D; The number of MRI and CT exams conducted at private facilities has increased over the past 4 fiscal years, with the exception of the first year of the COVID-19 pandemic (2020 to 2021).&#x0D; Payment through private insurance and out-of-pocket payments were the main funding sources for MRI scans in 2021 to 2023 in the private setting. Provincial health care insurance was the main funding source for CT scans conducted at private facilities.&#x0D;

Leveraging machine learning and prescriptive analytics to improve operating room throughput.

Successful days are defined as days when four cases were completed before 3:45pm, and overtime hours are defined as time spent after 3:45pm. Based on these definitions and the 460 unsuccessful days isolated from the dataset, 465 hours, 22 minutes, and 30 seconds total overtime hours were calculated. To reduce the increasing wait lists for hip and knee surgeries, we aim to verify whether it is possible to add a 5th surgery, to the typical 4 arthroplasty surgery per day schedule, without adding extra overtime hours and cost at our clinical institution. To predict 5th cases, 301 successful days were isolated and used to fit linear regression models for each individual day. After using the models' predictions, it was determined that increasing performance to a 77% success rate can lead to approximately 35 extra cases per year, while performing optimally at a 100% success rate can translate to 56 extra cases per year at no extra cost. Overall, this shows the extent of resources wasted by overtime costs, and the potential for their use in reducing long wait times. Future work can explore optimal staffing procedures to account for these extra cases.