Providing choice in pulmonary rehabilitation

Introduction/Aim: Pulmonary rehabilitation (PR) is a vital component in the management of chronic respiratory disorders (CRDs). New models of delivering PR are emerging to increase the uptake and completion of this important intervention. The aim of this study is to evaluate participant rate of attendance to PR delivered via two different delivery modes (centre based and mobile technology (mPR)). Secondary aims are to evaluate the patient preference for mode of delivery, and if mPR is non -inferior to centre-based PR in health outcomes. Method(s): A multi-centre, two-arm parallel preference based clinical trial was conducted. Participants with a chronic respiratory disorder referred for PR were offered the choice of centre-based or web-based (mPR) PR. Both programmes were 8 weeks in duration. The primary outcome was attendance. Result(s): 105 participants were recruited to the study with 67 opting for centre-based and 38 preferring web-based PR (mPR). The attendance rate was higher in the centre-based group than mPR. Results showed mPR was not inferior in terms of changes in symptom scores (CAT) or time spent in sedentary behaviour (SBQ) but inferiority could not be confirmed for changes in dyspnoea scores (mMRC) or health related quality of life (EQ5D-3L). Changes in exercise capacity could not be determined due to COVID-19 restrictions. Conclusion(s): This pragmatic study has shown that mPR was preferred by 38% of participants and a significant percentage were younger, working, with higher education inferring the demand will likely increase over time. The attendance rate with mPR was lower than anticipated. Further research with larger sample size is required to assess efficacy of mPR.

Covid-19 pandemic, a catalyst for aggressive earnings management by banks?

This paper investigates the effects of the Covid-19 pandemic on the financial reporting quality of European banks by examining the occurrence of earnings management specifically income smoothing. Using a sample of listed European banks, we employ panel estimation to compare income smoothing in the pre-pandemic period (2019Q1-2019Q4) and the pandemic period (2020Q1-2021Q4). We find that earnings management has significantly increased during the pandemic years, evidencing how the quality of financial reporting is affected during the crisis period. Our findings further suggest that amid the crisis, governance quality limits the incidence of earnings management and emphasizes how the strength of country-level governance and institutional framework affects the quality of financial reporting. Further analysis shows that though banks are inclined to manage earnings during a crisis, nevertheless, the presence of high-quality audit is a limiting factor on the incidence of earnings management in the face of crisis. Our findings which are relevant to investors, market participants, and regulators among others make a significant contribution to the accounting literature and specifically complement the strand of literature on the discretionary use of loan loss provision for earnings management during crisis. © 2022 Elsevier Inc.

COVID-19 and Other Underlying Causes of Cancer Deaths - United States, January 2018-July 2022.

Cancer survivors (persons who have received a diagnosis of cancer, from the time of diagnosis throughout their lifespan)* have increased risk for severe COVID-19 illness and mortality (1). This report describes characteristics of deaths reported to CDC's National Vital Statistics System (NVSS), for which cancer was listed as the underlying or a contributing cause (cancer deaths) during January 1, 2018-July 2, 2022. The underlying causes of death, including cancer and COVID-19, were examined by week, age, sex, race and ethnicity, and cancer type. Among an average of approximately 13,000 weekly cancer deaths, the percentage with cancer as the underlying cause was 90% in 2018 and 2019, 88% in 2020, and 87% in 2021. The percentage of cancer deaths with COVID-19 as the underlying cause differed by time (2.0% overall in 2020 and 2.4% in 2021, ranging from 0.2% to 7.2% by week), with higher percentages during peaks in the COVID-19 pandemic. The percentage of cancer deaths with COVID-19 as the underlying cause also differed by the characteristics examined, with higher percentages observed in 2021 among persons aged ≥65 years (2.4% among persons aged 65-74 years, 2.6% among persons aged 75-84 years, and 2.4% among persons aged ≥85 years); males (2.6%); persons categorized as non-Hispanic American Indian or Alaska Native (AI/AN) (3.4%), Hispanic or Latino (Hispanic) (3.2%), or non-Hispanic Black or African American (Black) (2.5%); and persons with hematologic cancers, including leukemia (7.4%), lymphoma (7.3%), and myeloma (5.8%). This report found differences by age, sex, race and ethnicity, and cancer type in the percentage of cancer deaths with COVID-19 as the underlying cause. These results might guide multicomponent COVID-19 prevention interventions and ongoing, cross-cutting efforts to reduce health disparities and address structural and social determinants of health among cancer survivors, which might help protect those at disproportionate and increased risk for death from COVID-19.

Prostheses used in hip, knee, ankle, elbow and shoulder replacement procedures 2020

This document reports the numbers of prostheses recorded and reported to the NJR between 1 January and 31 December 2020. The tables show volumes of components as they have been entered into the registry, regardless of construct. The procedure counts in this document are presented without adjustment and may vary from counts found in the corresponding main NJR Annual Report analysis. If a procedure has been submitted with missing implant information this will also cause numbers to differ. Procedure counts below four have been suppressed. Components are listed and described according to the current classifications used in the registry. It must be noted that due to COVID-19, the ratio of revision to primary procedures increased in 2020 and this may affect the relative changes in the types and brands of implants used in comparison to previous years. As this document was not published for 2019 Annual Report data, comparison has been made with the 2018 Annual Report data.

Ensuring Equitable COVID-19 Vaccine Allocation in New Hampshire: The First Eight Months toward a New Era.

The global coronavirus disease 2019 (COVID-19) pandemic has been exacerbated by social vulnerabilities and racial disparities, resulting in disproportionate morbidity and mortality that require continued attention to strategies that ensure equitable vaccine allocation. The State of New Hampshire (NH) developed a transparent framework to guide COVID-19 vaccine allocation plans, of which one key component was the allocation of 10% of vaccine supply to disproportionately impacted and highly vulnerable populations, predominantly identified through a national vulnerability index. The process, operational approaches, ethical challenges, and unanticipated consequences resulted in many valuable lessons learned. Equitable allocation of this limited and critical pandemic countermeasure required public understanding and engagement, which was achieved through a publicly available framework that was flexible, resourced using public funds, and widely communicated. Broad partnerships were also critical to addressing disparities in the delivery of vaccine. The lessons learned and described here will facilitate more nimble and equitable jurisdictional responses in future public health emergencies.

Creating Space forNarrativeMedicine and GlobalHealth Perspective: A Curriculum for Pediatric Interns During COVID-19

Background: COVID-19 resulted in sudden interruptions to medical education, including challenges to delivering global health (GH) experiences. Narrative medicine (NM), which emphasizes literary perspective and uncertainty within healthcare, may be a tool to increase physician resilience. GH and NM perspectives both have potential to augment resident education during the unprecedented disruption of COVID-19. Our objective is to describe a new curriculum incorporating NM and topics in GH disparities for pediatric interns. Methods: For the academic year 2020-21, a curriculum focused on disparities in global maternal child health (MCH) coupled with a practicebased introduction to NM was developed and piloted for pediatric interns at a single pediatric residency program during their month-long advocacy rotation. Two weeks prior to the session, interns received 2 MCH articles and 2 narrative fictional pieces with themes relevant to MCH. During a single 90-minute session, global and local disparities in MCH were reviewed, with focus on synthesis of primary data sources. An introduction to the history of NM was provided along with guided discussion of the fictional pieces. Time was provided for independent writing, with the option for interns to share their pieces. Results: Interns were sent pre-/post-surveys focused on prior experience with NM and GH;no questions about probing resident resilience were included. All 26 interns participated in the session during the academic year, with pre-survey results from 26 and post-survey results from 17. A majority had previous didactic GH learning;while a majority knew of NM as a discipline (N = 19), fewer (N = 9) had participated in any NM experience (Figure 1). Post-session data are presented in Figure 1 and Table 1. The session was wellreceived with high interest in further GH and NM content during residency. Conclusion: The addition of a joint GH and NM session to an existing pediatric resident advocacy curriculum during COVID-19 provides both foundational knowledge in GH disparities and opportunity for self-reflection during uncertain times. To our knowledge, this is the first description of such a curriculum that incorporates these two disciplines. Preliminary evaluation indicates increased knowledge and awareness of narrative medicine after the session, with majority desire for further NM and GH education during residency training. Further evaluation will consider the role of NM in increasing pediatric resident resilience and in improving self-efficacy in advocacy.

Tocilizumab Is Effective in Reducing Inflammation in T2D–COVID-Organ-on-a-Chip Model

The COVID-pandemic has contributed to more than 5 million deaths worldwide in the last two years. Co-morbid conditions such as Type 2 Diabetes (T2D) , HTN, obesity, and CKD have been associated with increased mortality with COVID-19. In a large meta-analysis, the relative risk of mortality was 1.54 for patients with T2D and COVID-19. Thus, there is an imperative need to develop a platform for rapid and reliable drug screening/selection against COVID-related morbidity/mortality in T2D patients. With limited translatability of in vitro and small animal models to humans, human organ-on-a-chip models are an attractive platform to model in vivo disease conditions and test potential therapeutics. We seeded T2D or nondiabetes patient-derived macrophage and human liver sinusoidal endothelial cells along with normal hepatocytes and kupffer cells in the liver-on-a-chip (LAMPS - Liver Acinus MicroPhysiological System) developed by our group, perfused with media mimicking normal fasting or late metabolic syndrome (LMS - high levels of glucose, fatty acids, insulin, glucagon) states. We transduced both macrophage and endothelial cells to overexpress the SARS-CoV2-S (spike) protein and compared it with a control lentivirus transduction. We found that T2D cells overexpressing S-protein in LMS media (T2D chip) displayed an increased secretion of inflammatory cytokines compared to the nondiabetes chip over days. We then tested the effect of Tocilizumab (IL6-receptor antagonist) in T2D chips. Compared to vehicle control, Tocilizumab significantly decreased the S-protein induced inflammatory cytokine secretion in T2D chips but not in nondiabetes chips, indicating its higher efficacy in severe disease states only. This is consistent with what was observed in large clinical trials providing confirmatory evidence that the LAMPS T2D and nondiabetes chips serve as a relevant in vitro model system to replicate human in vivo pathophysiology of COVID and for screening potential therapeutics.

Rising food insecurity and the impacts of the COVID-19 pandemic on emergency food assistance in Michigan

This study of eight types of emergency food assistance organizations in Michigan, USA, is the first statewide study of the COVID-19 pandemic's impacts on the operations of these organizations. It focuses on the following question: How did the pandemic affect the operations of emergency food assistance organizations? The paper examines how the race/ethnicity of the organization's director was related to program activities, the pandemic's impacts, and responses to the pandemic. It offers new insights into emergency food assistance organizations operated by Black and multicultural directors. The article examines how the sex of the emergency food assistance directors is related to programming, the pandemic's impacts, and responses to it. Most studies of emergency food assistance focus on urban areas. In addition to studying organizations in the state's metropolitan areas, we also study organizations in small towns and rural areas. The paper also analyzes two additional questions: How did the government support the state's emergency food assistance organizations during the pandemic? And how do organization leaders perceive government responses to the pandemic? The sample consists of 181 emergency food assistance organizations. Whites directed most organizations;82.9% had a primary director who was White, 11% had Black directors, and 6.1% had directors from other racial/ethnic groups. The organizations studied are long-lived;they have been operating for a mean of 20.8 years. The organizations serve meals to an average of 79 people per day. They also provide food items to roughly 185 people daily. The pandemic had profound effects on the operations of emergency food assistance organizations. About 28% of the organizations indicated that they cut back on their programming, and just over a fifth of the organizations limited their operating hours. Moreover, 23% of the organizations reported that the number of restaurants donating food declined, while 18% percent reported a decline in supermarket food donations. However, 58.9% of the organizations increased the amount of food they distributed, and 61.3% reported an increase in the number of people seeking food from the organization. During the pandemic, White-run organizations obtained government funding from 19 sources, multicultural-led organizations got government support from 10 sources, and Black-run organizations received support from three sources. Forty percent of directors in allBlack-run organizations, 23.5% of those in multiracial-led organizations, and 22.6% of the directors in all-White-led organizations criticized government responses to the pandemic.

Food literacy as a resilience factor in response to health-related uncertainty

Purpose During the Covid-19 pandemic, people were deprived of their freedom, unable to engage in physical and social activities, and worried about their health. Uncertainty, insecurity, and confinement are all factors that may induce stress, uneasiness, fear, and depression. In this context, this study aims to identify possible relationships of emotions caused by health risks and restrictions to outdoor activities with well-informed decisions about food consumption. Design/methodology/approach The theoretical framework of this research draws on the stimulus-organism-response paradigm yielding six research hypotheses. An online survey was designated to test these hypotheses. A total of 1,298 responses were gathered from Italy, Greece, and the United Kingdom. Data analyses include demographic group comparisons, moderation, and multiple regression tests. Findings The results showed that when people miss their usual activities (including freedom of movement, social contact, travelling, personal care services, leisure activities, and eating at restaurants) and worry about their health and the health of their families, they turn to safer food choices of higher quality, dedicating more of their time and resources to cooking and eating. Research limitations/implications The findings showcase how risk-based thinking is critical for management and marketing strategies. Academics and practitioners may rely on these findings to include extreme conditions within their scope, understanding food literacy as a resilience factor to cope with health risks and stimulated emotions. Originality/value This study identified food behavioural patterns under risk-laden conditions. A health risk acted as an opportunity to look at food consumption as a means of resilience.

Disease Burden And Care-Seeking Behavior For Ibs-C Patients In The United States In The Era Of Covid-19

Background: Irritable bowel syndrome with constipation (IBS-C) is a chronic disorder of gut-brain interaction (DGBI) that has a significant negative impact on patients. The objective of this study was to examine disease burden and care-seeking behavior of IBS-C patients during the COVID-19 pandemic. Methods: A cross-sectional, on-line, general health survey collected data on US adults aged >18 from Aug – Oct 2020. IBS-C patients were defined using Rome IV criteria for IBS-C and matched 1:1 by age, sex, region, and comorbidity score to the general population. Health outcomes comparing IBS-C patients vs controls included anxiety (using Generalized Anxiety Disorder scale [GAD-7]), depression (using Patient Health Questionnaire 9 [PHQ-9]), health-related quality of life (HRQoL) (using Veterans RAND 12-item Health Survey [VR-12]), and work productivity using study-specific questions. Mean frequencies were compared with ANOVA and proportions with chi-square tests. For IBS-C patients, care-seeking behavior included healthcare visits in the past 12 months, canceled visits due to COVID-19, and medication use (prescription vs over-the-counter (OTC)). Commonly reported bothersome symptoms and the impact of COVID-19 on the worsening of IBS-C symptoms were also assessed descriptively. Results: Of 7,214 survey participants, 138 met Rome IV criteria for IBS-C. Matching resulted in a sample of 130 IBS-C patients and 130 controls. Mean age of IBS-C patients was 45.1 (SD 15.1) years, with the majority being female (79.2%) and white (82.3%). IBS-C patients had a significantly higher proportion of moderate-to-severe anxiety and depression and significantly lower HRQoL versus controls (see Table). Absenteeism and presenteeism in the past 7 days were also significantly higher among IBS-C patients vs controls. 53.4% percent of IBS-C patients sought care from a healthcare provider in the past year for their IBS symptoms and nearly a quarter of IBS-C patients reported cancelling healthcare visits due to COVID-19. 25.4% of IBS-C patients reported taking a prescription medication whereas 68.5% reported currently taking an OTC for their IBS-C symptoms. The most common bothersome symptoms in the past 7 days included abdominal discomfort, abdominal pain, straining, abdominal bloating and incomplete bowel movements. Over a third of IBS-C patients indicated their symptoms worsened during the COVID-19 pandemic. Conclusions: There remains a considerable disease burden and unmet need for IBS-C patients, with patients suffering from multiple bothersome symptoms and low rates of prescription medication use. COVID-19 seems to have worsened IBS symptoms for many patients (Table Presented) (Table Presented)

Experiencing the COVID-19 Pandemic at Age 85 and Over: An MIT AgeLab Study With the 85+ Lifestyle Leaders Panel

The oldest of older adults remain at the highest risk of developing severe illness, requiring hospitalization, or dying if infected with COVID-19. As a result, the discourse about the COVID-19 pandemic has centered on short-term sacrifices to “protect” older adults. Yet much remains to be known about the prolonged impact of the pandemic on the over-85 age demographic. This symposium shares findings from a longitudinal, mixed methods study with the MIT AgeLab’s 85+ Lifestyle Leaders panel, a panel of octogenarians and nonagenarians convened since 2015. This symposium offers an update to a 2020 GSA session shared regarding the initial, cross-sectional work conducted in March 2020 with this panel. Findings will be drawn from a series of 85 interviews with 15 participants, 14 focus groups (x̅ participants=19.3), and three surveys (March 2020, N=28;August 2020, N=18;November 2020, N=16) conducted with the panel regarding the impact of the pandemic on this group over the past year. The first presentation covers the Lifestyle Leaders’ adoption and use of technology throughout the pandemic, with a focus on telehealth. The second takes an in-depth look at the unique lived experiences of Lifestyle Leaders living in senior housing communities during the pandemic. The third explores the Lifestyle Leaders’ perspectives on cultivating resilience and caring for their mental health while in a pandemic. Finally, the fourth presentation shares the Lifestyle Leaders’ experiences with social isolation and loneliness during the pandemic, with a focus on how family relationships and engagement in intergenerational programming have changed.

Pivot! How the restaurant industry adapted during COVID-19 restrictions

PurposeThe purpose of this systematic review is to highlight some of the business model changes restaurants, bars and beverage producers undertook to modify their operations in order to not only stay in business but also to better serve their employees and communities during the COVID-19 crisis.Design/methodology/approachAn analysis was conducted on 200 industry articles and categorized into three major themes: expansion of take-out/delivery, innovative practices, and community outreach/corporate support, each are further subdivided into additional themes. The systematic review is further supported by personal interviews with industry professionals.FindingsThis research finds that there were many different approaches used in adjusting business models in response to the dining restrictions put in place due to COVID-19. From these approaches, themes were developed which resulted in uncovering some suggestions such as developing contingency plans, being flexible and creative, eliminating menu items, investing in a communication platform and getting involved with local government. In addition, some practices operators should be mindful of such as selling gift cards and starting a crowdfund.Research limitations/implicationsThis research provides a systematic analysis of business model changes that occurred due to COVID-19 dining restrictions. Researchers can use this information as a guide for further analysis on a specific theme introduced herein.Practical implicationsThis research offers several practical implications which will assist the industry should another similar event occur in the future. The systematic analysis describes and documents some suggestions as well as practices to be mindful of in preparing contingency plans for the future.Originality/valueThis research documents an unprecedented time for the hospitality industry by examining how restaurant, bar and beverage producers around the country responded to COVID-19 restrictions. Distilling the multitude of information into succinct themes that highlight the business model changes that occurred will aid future research as well as operators.

Successful implementation of universal hcv screening at a safety-net hospital's emergency department during the COVID-19 pandemic

Background: In 2020, the USPSTF revised its hepatitis C (HCV) screening recommendations to include universal screening for persons aged 18-79. Grady Health System (GHS), a safety-net health system in Atlanta, GA has had an active HCV screening program for baby boomers since 2012, with a high prevalence of HCV antibody positivity (9%) as well as chronic infection (5%). The program expanded from ambulatory settings to the inpatient wards and finally to the Emergency Department (ED) in 2019. In May 2020, despite the COVID-19 pandemic, we pivoted from baby boomer (born 1945-1965) to universal HCV screening in the GHS ED. We compare HCV prevalence and linkage to care between baby boomers (BB) and non-baby boomers (non-BB) during the first year of universal ED screening. Methods: We updated the existing electronic health record algorithm, which previously flagged only baby boomers, to flag all patients aged 18-79 with no prior HCV test or diagnosis for screening. ED triage nurses offered opt-out testing to patients whose charts were flagged by the algorithm. This triggered an order for HCV antibody with reflex to HCV RNA for the medical provider to sign. We analyzed data from May 2020 to May 2021 for outcomes including HCV Ab and RNA prevalence and linkage to care, comparing BB and non-BB. Results: 2,388 HCV Ab tests were performed in the ED, 78% among non-BB. The overall HCV Ab prevalence was 6%, with a 13% prevalence in BB and only a 4% prevalence among non-BB. 77% of all positive HCV Ab tests were followed by a reflex HCV RNA test, and 41% of BB and 62% of non-BB were RNA positive. The overall prevalence of chronic infection among all tested was 2.5%. Linkage to care occurred in 25% of ED patients and was double for BB (38%) compared to non-BB (16%). Conclusion: The launch of universal HCV testing in the GHS ED showed a high prevalence of both HCV exposure and chronic infection in this safety-net health system population. Interestingly, HCV Ab prevalence was higher among BB, while HCV RNA prevalence was higher among non-BB, likely reflecting more cleared or cured infection among BB patients. Overall, linkage to care rates were suboptimal, and higher in BB. Low linkage rates were likely due to lack of inperson navigation and care access barriers associated with the COVID-19 pandemic, which affected the entire reporting period. We suspect linkage rates were higher in BB as more of this population uses GMH as their medical home than the non-BB population.

Comprehensive Immune Profiling of a Kidney Transplant Recipient With Peri-Operative SARS-CoV-2 Infection: A Case Report.

To date there is limited data on the immune profile and outcomes of solid organ transplant recipients who encounter COVID-19 infection early post-transplant. Here we present a unique case where the kidney recipient's transplant surgery coincided with a positive SARS-CoV-2 test and the patient subsequently developed symptomatic COVID-19 perioperatively. We performed comprehensive immunological monitoring of cellular, proteomic, and serological changes during the first 4 critical months post-infection. We showed that continuation of basiliximab induction and maintenance of triple immunosuppression did not significantly impair the host's ability to mount a robust immune response against symptomatic COVID-19 infection diagnosed within the first week post-transplant.

Catching COVID: Engineering Peptide-Modified Surface-Enhanced Raman Spectroscopy Sensors for SARS-CoV-2.

COVID-19 remains an ongoing issue across the globe, highlighting the need for a rapid, selective, and accurate sensor for SARS-CoV-2 and its emerging variants. The chemical specificity and signal amplification of surface-enhanced Raman spectroscopy (SERS) could be advantageous for developing a quantitative assay for SARS-CoV-2 with improved speed and accuracy over current testing methods. Here, we have tackled the challenges associated with SERS detection of viruses. As viruses are large, multicomponent species, they can yield different SERS signals, but also other abundant biomolecules present in the sample can generate undesired signals. To improve selectivity in complex biological environments, we have employed peptides as capture probes for viral proteins and developed an angiotensin-converting enzyme 2 (ACE2) mimetic peptide-based SERS sensor for SARS-CoV-2. The unique vibrational signature of the spike protein bound to the peptide-modified surface is identified and used to construct a multivariate calibration model for quantification. The sensor demonstrates a 300 nM limit of detection and high selectivity in the presence of excess bovine serum albumin. This work provides the basis for designing a SERS-based assay for the detection of SARS-CoV-2 as well as engineering SERS biosensors for other viruses in the future.

A systems-level study reveals host-targeted repurposable drugs against SARS-CoV-2 infection.

Understanding the mechanism of SARS-CoV-2 infection and identifying potential therapeutics are global imperatives. Using a quantitative systems pharmacology approach, we identified a set of repurposable and investigational drugs as potential therapeutics against COVID-19. These were deduced from the gene expression signature of SARS-CoV-2-infected A549 cells screened against Connectivity Map and prioritized by network proximity analysis with respect to disease modules in the viral-host interactome. We also identified immuno-modulating compounds aiming at suppressing hyperinflammatory responses in severe COVID-19 patients, based on the transcriptome of ACE2-overexpressing A549 cells. Experiments with Vero-E6 cells infected by SARS-CoV-2, as well as independent syncytia formation assays for probing ACE2/SARS-CoV-2 spike protein-mediated cell fusion using HEK293T and Calu-3 cells, showed that several predicted compounds had inhibitory activities. Among them, salmeterol, rottlerin, and mTOR inhibitors exhibited antiviral activities in Vero-E6 cells; imipramine, linsitinib, hexylresorcinol, ezetimibe, and brompheniramine impaired viral entry. These novel findings provide new paths for broadening the repertoire of compounds pursued as therapeutics against COVID-19.

Coping during COVID: Implementation of an online relationship education intervention for couples

Coronavirus disease (COVID-19) has increased stressors for couples related to unemployment, financial hardship, and interpersonal conflict (Luetke et al., 2020). Traditional models of care including relationship education programs need to adapt to meet the needs of couples in communication and conflict resolution during the pandemic. To this end, the aim of the current article is to highlight the transition of a face-to-face relationship education intervention to an online program, providing lessons learned focused on accessibility, modality, flexibility, engagement, and resources for maintaining cohesion and quality service delivery through the pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved) © 2021 American Psychological Association

The effect of an ambulatory care pathway on management of anaemia in a district general hospital

Content: The burden of iron deficiency anaemia (IDA) is reflected by the rising number of emergency admissions related to IDA and reports of the monumental cost of managing the condition as an inpatient. The National Health Service spends approximately 55 million per annum on IDA-related non-elective admissions, many of which could be preventable and managed in the community or ambulatory care setting. In 2018, a retrospective data collection was performed to assess the overall management of 50 newly diagnosed cases of anaemia presenting to a district general hospital between May July 2018. This data was compared to quality standards issued by the British Society of Gastroenterology and recommendations on blood transfusion as advised by the National Institute for Health and Care Excellence. An ambulatory anaemia pathway was created and implemented in 2018 with the aim of streamlining investigations for anaemia and establishing criteria for urgent referral and safe ambulation. A further 77 cases of anaemia presenting to secondary care between November and February 2019-2020 were assessed against the same quality standards used in the initial data collection and results compared. 74% cases with anaemia were appropriately investigated in 2019/2020 compared to 48% in 2018. Only 18% of the cohort with IDA had a urine dip performed and documented and 27% patients in this group did not have a coeliac screen in 2019/2020. Many patients received blood transfusions above haemoglobin thresholds recommended by NICE, however a modest increase of 17% patients in 2019/2020 had a haemoglobin review between units. Iron replacement in IDA improved from 59% to 73% in 2018 to 2019/2020, respectively. In 2019/2020 there was a 25% increase in the number of patients with a confirmed malignancy that were referred appropriately under a two-week wait compared to 2018. The proportion of patients that were clinically appropriate and subsequently ambulated was 75% and 73% in 2018 and 2019/20, respectively. Although overall management of anaemia improved after the ambulatory anaemia pathway was implemented, basic investigations such as a urine dipstick and coeliac screen were not performed in several cases. Treatment of IDA was superior in 2019/2020, as there was an improvement in iron replacement and fewer patients were transfused multiple units of blood without review between units. A greater number of patients who were subsequently diagnosed with a malignancy had appropriate urgent follow-up in 2019/2020 compared to 2018. There was a marginal decline in the number of patients who were clinically appropriate for ambulatory care and were discharged, however these decisions are often complicated by complex medical and social factors. As a result of national bed shortages following the COVID-19 pandemic, the requirement to reduce non-elective admissions and preserve blood products has never been more pressing. Therefore, it is proposed that the ambulatory anaemia pathway could help reduce non-elective admissions for anaemia by encouraging safe ambulation, avoid unnecessary blood transfusions and provide appropriate follow-up. It would be prudent to assess the impact of COVID-19 on hospital admissions with anaemia and determine whether ambulated patients demonstrate clinical improvement or require subsequent admissions for their symptoms of anaemia.