The benefits of index telephone consultations in patients referred on the two-week wait colorectal cancer pathway.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic led to hospitals in the UK substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the use of virtual two-week wait (2-ww) lower gastrointestinal (LGI) clinic appointments, conducted using telephone calls at a district general hospital in England. METHODS: Patients undergoing index outpatient 2-ww LGI clinic assessment between 1 June 2019 and 31 October 2019 (FtF group) and 1 June 2020 and 31 October 2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets was assessed. Environmental and financial impact analyses were performed. RESULTS: In total, 1,531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety-two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9,288 miles, 0.7 metric tonnes of CO2 emissions and £7,482.97. Taxpayers saved £80,242.00 from VCs. No formal complaints were received from patients or staff in the VC group. CONCLUSION: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits.

The role of trade in pacific food security and nutrition

The Pacific region is experiencing a non-communicable disease epidemic largely driven by an ongoing nutrition transition from nutrient rich whole foods to imported staples and highly processed foods. Food trade is a major driver of this transition. We characterize regional and sub-regional trade from 1995 to 2018 for 18 Pacific Island Countries and Territories using the Pacific Food Trade Database. The analysis shows the growing dependence on imports of rice from South-East Asia and wheat from Australia, and recent growth in imports of meat from Australia, New Zealand and USA, and highly processed foods from South-East Asia. Findings are discussed in terms of policy and trade agreements, and global shocks including COVID-19 and the war in Ukraine.

A Single-Centre Experience of Telephone Assessment of Patients Referred to Two Week-Wait Colorectal Surgery Clinics in England

Aim: Despite Covid-19, hospitalsin the England, United Kingdom continued to assess and manage patients referred on two week-wait (2WW) suspected cancer referral pathways. Most index clinic assessments of such patients were conducted viatelephone. We retrospectively evaluated adistrict general hospital experience of managing patients on a 2WW suspected lower gastrointestinal tract (LGIT)cancer referral pathway, initially assessed via telephone Method: Data were obtained using a prospectively maintained database and electronic patient records. LGIT 2WW referrals between 01/06/2020to 31/10/2020 were included. Data were retrospectively collated and analysed using Excel (Microsoft Corporation, USA) Results: A total 757 patients (median age = 70, interquartile range = [59-79], female = 47.2%) were identified. The majority (n = 629,83.1%) were white Caucasian. All patients were initially assessed virtually and only 3 (0.4%) were re-assessed face-to- face for their index appointment. Sixteen (2.1%) missed at least one prior appointment. The most common presenting complaints included change in bowel habit, rectal bleeding, weight loss, anaemia and abdominal pain, and 415 (54.8%), 269 (35.5%) underwent endoscopy and imaging respectively as the first investigation. Forty four (5.8%) patients had malignant pathology with the majority (n = 37,84.1%) being colorectal in origin. Of those diagnosed with a primary colorectal malignancy 25 (67.6%) underwent surgical or endoscopic treatment, 3 (8.1%) were referred to chemoradiotherapy and 8 (21.6%) were referred for palliation. Conclusion(s): Patients referred on the 2WW LGIT pathway continued to be assessed and managed despite Covid-19. Index telephone clinic assessments are perhaps as effective a tool as face-to- face assessments, for patients referred on this pathway. This warrants further investigation.

The Use of Telephone Versus Face to Face Appointments in Two Week-Wait Colorectal Surgery Clinics -a Single Centre Experience

Aim: Telephone appointments have replaced face-to- face hospital clinic appointments due to the Covid-19 pandemic. We evaluated the impact of telephone appointments on patients referred on a two week-wait (2WW) suspected lower gastrointestinal tract (LGIT) cancer pathway. Method(s): Two independent patient samples between the 01/06/2019-31/ 10/2019 (face-to- face cohort) and 01/06/2020-31/ 10/2020 (telephone cohort) were identified using a prospectively maintained local database and electronic patient records. Data were retrospectively collated using Excel (Microsoft, USA). Chi-square and Man-Whitney- U statistical tests were performed using SPSS (IBM, USA). Result(s): A total 1531 (median age = 70, interquartile range [IQR] = 60-79, female = 679, 44.4%) were analysed. Of these, 757 (49.4%) were assessed via telephone;the remainder were face-to- face (n = 774,50.6%). The age, gender and ethnicity distributions across the two groups were similar. A total of 92 (6%, telephone = 44, face-to- face = 48) patients had malignant pathology and 64 (4.2%) were colorectal cancer (CRC). Of those with a CRC diagnosis, 46 (3.0%, telephone = 26, face-to- face = 20) underwent surgical or endoscopic treatment with curative intent. There was no significant difference in diagnoses made (P = 0.749) or treatment of CRC (P = 0.785) following telephone versus face-face- appointments. The median waiting times for index appointment, investigation and diagnosis for telephone appointments were significantly lower compared to face-to- face appointments (P < 0.001). There was no significant difference in median time to index treatment for CRC between the two groups (P = 0.156). Conclusion(s): Patients referred to 2WW LGIT clinics were efficiently and safely assessed and manged using telephone clinics during the Covid-19 pandemic. The cost-effectiveness and stakeholder views on permanent use of telephone assessments in these clinics must be evaluated.

The role of trade in pacific food security and nutrition

The Pacific region is experiencing a non-communicable disease epidemic largely driven by an ongoing nutrition transition from nutrient rich whole foods to imported staples and highly processed foods. Food trade is a major driver of this transition. We characterize regional and sub-regional trade from 1995 to 2018 for 18 Pacific Island Countries and Territories using the Pacific Food Trade Database. The analysis shows the growing dependence on imports of rice from South-East Asia and wheat from Australia, and recent growth in imports of meat from Australia, New Zealand and USA, and highly processed foods from South-East Asia. Findings are discussed in terms of policy and trade agreements, and global shocks including COVID-19 and the war in Ukraine.

Mortality Risk among Pregnant Women during COVID-19 Pandemic: A Case-Control Study in Rajasthan

Objective: To analyze the risk factors associated with mortality in COVID-positive pregnant women. Material(s) and Method(s): The study was designed as a case-control study and was conducted at COVID-designated tertiary care hospital. It included 42 deceased and 96 RT-PCR-positive surviving pregnant women who developed severe forms of disease. All the affected patients were admitted and managed according to Indian national guidelines. Risk factors - age, residence, socioeconomic status, gestation age, parity, and comorbidities were evaluated for their association with mortality. Result(s): Advanced maternal age (>28 years), rural residence, diabetes, and comorbidities were found to be associated with increased risk of mortality among the COVID-affected pregnant women, the respective adjusted odds ratio was 15.45, 12.61, 2.65, and 4.77, respectively. Conclusion(s): Pregnant women are vulnerable to COVID infection. They were at higher risk of mortality with comorbidities, advanced age, and low access to healthcare in the rural areas. Copyright © The Author(s).

Health Care Worker's Perception Survey and Psychological Distress during the Covid-19 Pandemic: An Indian Context

Objective: Health professionals struggled with additional stress as compared to the rest of the population during the time of COVID19 Pandemic. Previous reports and current data suggest that tremendous burden led to many stress disorders among the health care workers and their long-term effects on their state of mind need to be studied to take necessary measures. This study has been designed to assess the level of stress and other psychiatric disorders among HCWs and the role of administration to overcome it. Method: This survey based retrospective study was conducted across multiple Centres and data from health care workers who were in direct contact with confirmed or suspected cases were collected and analyzed. Result: Data were compared on the basis of different parameters, i.e., category, gender, age, marital status, years of work experience per se with the degree of stress. Our study shows significant degree of stress among the healthcare workers during and post pandemic. Nursing staffs and doctors were affected significantly with higher degree of stress. Overall higher stress was observed among females as compared to the males;and among youngers and HCWs with lesser years of work experience. Conclusion: This study is the first of its kind assessing stress levels in the health care workers on every aspect in great details. Our study also observed that instead of using Headington scale to classify the degree of stress, if we can compare stress scores using different statistical tools, obtained results are more reliable and it can accurately assess the degree of stress.

Index telephone two-week wait lower gastrointestinal clinics as a substitute to face to face outpatient appointments during the COVID-19 pandemic

Purpose/Background: The COVID-19 pandemic led to hospitals in the United Kingdom substituting face-to- face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the impact of virtual two-week wait (2-ww) lower gastrointestinal (LGI) consultations on stakeholders at a district general hospital in England. Methods/Interventions: Patients undergoing index outpatient 2-ww LGI clinic assessment between 01/06/2019-31/ 10/2019 (FtF group) and 01/06/2020-31/ 10/2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets (WTT) was assessed. Environmental and financial impact analyses were performed. Results/Outcomes: In total, 1531 patients were analysed (median age = 70, male = 852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone;the remainder were seen FtF (n = 774, 50.6%). Ninety two (6%, VC = 44, FtF = 48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC);of these, 46 (71.9%, VC = 26, FtF = 20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p < 0.001). The cancer detection rates (p = 0.749), treatments received (p = 0.785) and median time to index treatment for CRC patients (p = 0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p < 0.001). VC appointments saved patients a total of 9288 miles, 0.7 metric tonnes of CO2 emissions and £7482.97. Taxpayers saved £80,242.00 from VCs. No adverse events or complaints were reported in the VC group. Conclusion/Discussion: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits for stakeholders. (Figure Presented).

Blood sugar prediction with an improved mechanism for diabetic using recurrent neural networks

In the Current 2020 Covid-19 Situation, less expensive sensors measuring sugar levels in continuous intervals are essential. These, combined with easily usable devices plugged with SAAS based Deep Learning Solutions, allow for customized health and disease management grades. Deep Learning Systems scalable technologies are allowed by sensors, analytical tasks, and people. This brings us to the question of volume for creating such DL Solutions, which we can present for the current situation of the COVID-19 pandemic. The technique is based on scratch-trained RNN, requiring the amount of sugar of a patient in graded detail. The model predicts and estimates sugar and possible health issues accurately. There is no need for a reduction in this pre-processing system and function, which saves the calculation. © 2021, Universitatea de Vest Vasile Goldis din Arad. All rights reserved.