Nurse Led Screening Clinic for New Referrals

Introduction: The COVID-19 pandemic forced many established processes to be assessed and changed, prompting new ways of working to overcome obstacles. This opened the door to a new patient referral pathway, with a nurse led screening clinic a viable option for patients as well as a development opportunity for nursing staff. Method(s): All outpatient clinics were cancelled in March 2020, with consultant slots reinstated as telephone only from April. Referrals were previously booked into a new patient consultant clinic followed by investigative blood work, before a second appointment for results. It became impractical for new referrals to be processed due to the impossibility of remote investigative blood tests, and the lack of an initial face to face review. Referrals are now screened by the attending consultant who ascertains urgency and which blood tests are required, before the patient is booked into a nurse appointment within the following month. This is a first face to face consultation where a full history is taken including medical diagnoses, family and bleed history, medications, allergies, social factors and surgical challenges. The consultation is documented electronically and blood samples are taken. The results are monitored by the nurses and repeat samples +/- further investigations are obtained, to ensure all results are available for the 1st consultant clinic appointment. Result(s): This new process enables us to safely manage urgency of appointments with clear, relevant history taking and extensive and accurate blood work being completed. This ensures all referrals into the consultant clinic are relevant and appropriate with the focus on diagnosis and discharge, as the doctor will be equipped with a full set of blood work and appropriate results. The number of patients reviewed has been steadily increasing, with 30 adults and 13 children in the past 12 months. Discussion/Conclusion: This approach enables safe screening for new patients whilst actively managing valuable consultant clinic appointment slots. It is important to be aware of the time requirement for the reviewing nurse to complete this appointment, and ensure staffing is sufficient to enable a thorough nurse led consultation to take place. Going forward we plan to formalise appointments in an official nurse screening clinic, and will also look to audit patients already seen, to ensure this approach is received as intended and to continue to obtain best practice.

Bronchopneumonia with interstitial pneumonia in beef feedlot cattle: Characterization and laboratory investigation.

Bronchopneumonia with interstitial pneumonia (BIP) has been considered a variant of acute interstitial pneumonia (AIP) rather than a distinct disease. This study compared 18 BIP, 24 bronchopneumonia (BP), and 13 AIP cases in feedlot beef cattle. Grossly, BIP cases typically had cranioventral lung lesions of similar morphology and extent as BP cases, but the caudodorsal lung appeared overinflated, bulged on section, and had interlobular edema and emphysema. Gross diagnosis of BIP had 83% sensitivity and 73% specificity relative to histopathology. Histologic lesions of BIP in cranioventral areas were of chronic BP, while caudodorsal lesions included alveolar and bronchiolar damage and inflammation, interstitial hypercellularity, and multifocal hemorrhages. In BIP cases, cranioventral lung lesions were more chronic than caudodorsal lesions. Histologic scores and microbiology data were comparable in cranioventral lung of BIP versus BP cases and caudodorsal lung of BIP versus AIP cases, with differences reflecting a more chronic disease involving less virulent bacteria in BIP versus BP. Mycoplasma bovis infection was similarly frequent among groups, and a viral cause of BIP was not identified. Lesion morphology and similar blood cytokine concentrations among groups argued against sepsis as a cause of lung injury. Surfactant dysfunction was identified in BIP and BP, and was only partially the result of protein exudation. These and other findings establish BIP as a distinct condition in which chronic cranioventral BP precedes acute caudodorsal interstitial lung disease, supporting a role of chronic inflammation in heightened sensitivity to 3-methylindole or another lung toxicant.

Impact of the Covid pandemic on health care equity in NHS General Dental Practice.

INTRODUCTION: Oral health inequalities existed before Covid, but the pandemic presented an unprecedented challenge for health services. Our aim was to determine whether patient groups at risk of health care inequality due to the pandemic could be identified from NHS dental claims. METHODS: Secondary analysis of routinely collected NHS Business Services Authority data for patients treated by General Dental Practitioners in England and Wales between April 2019 and January 2022 to assess the effect of the Covid pandemic on claims for patients attending general dental practices. Data for treatment items claimed after the start of the first lockdown were compared to the pre-lockdown period. RESULTS: The proportion of claims for child fillings, child extractions and child fluoride varnish application after March 2020 were lower than equivalent proportions for adults, in both England and Wales. Similarly, there were consistently fewer claims for fillings and extractions for patients claiming pension credit guarantee credit than all pensioners in both England and Wales. CONCLUSION: The Covid pandemic may have caused health care inequality for children and patients claiming pension credit guarantee credit. This may compound the inequality in oral health for these patients.