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Background/Aims Long Rheumatology waiting lists in the UK were further affected by the COVID-19 pandemic;resulting in negative impacts upon the timeliness and efficiency of patient care. The use of Advanced Practitioners within Rheumatology care pathways has been shown to be safe and effective;they can support the Rheumatology workforce and expedite care where patients are appropriately triaged to them. As part of a service provision change in a NHS Trust, an Advanced Practice Physiotherapist (APP) post was funded with the intent to harness these benefits. Initial utilisation of the APP appointments within the Rheumatology provision was found to be low and could be improved. A Quality Improvement (QI) Project was initiated, with the aim to increase APP appointment utilisation to at least 85% over a period of four months, and for at least 75% of these appointments to contain patients who had been appropriately triaged. Methods The 'Model for Improvement' was chosen as the QI approach. The project was led by an APP. Firstly, a stakeholder analysis was performed to identify staff with influence and interest in the project. A root cause analysis found lack of awareness of triaging clinicians and challenges with booking processes as potential reasons for lowerthan- expected appointment utilisation. Change interventions were devised and tested over three Plan, Do, Study, Act (PDSA) cycles. PDSA one developed communication with booking and triage staff to clarify these processes with them. PDSA two educated clinical staff about the APP role, triage criteria and the booking procedures confirmed in PDSA one. PDSA three focused upon sustaining change by reinforcement of the topics established in PDSA two among staff. Outcome measures used were the percentage of available APP appointments utilised per week, and the percentage of these which contained patients who were appropriately triaged. Results APP appointment utilisation increased from a mean of 22% pre-project to 61% during the change intervention period. Sixty-three patients were seen over the 17-week change intervention period;of which 86% had been appropriately triaged. Data showed that 70% of the patients directed to the APP were managed by them (24% discharged and 46% reviewed). Of the remaining patients, 13% were followed up by a Rheumatologist, 12% did not attend and 5% had an alternative outcome such as awaiting advice. Conclusion This QI project led to an improvement in Rheumatology care provision locally. Engagement with support staff, education of clinical staff and implementation of clear standard operating procedures improved the utilisation of the Rheumatology APP resource. Results suggest that the APP role was effective locally in managing appropriately triaged patients, without a negative effect on patient care or other services. Continuing to improve utilisation will support management of the Rheumatology waiting list and improve patient care.
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Passenger behaviour on public transport has become a source of great interest in the wake of the COVID-19 pandemic. Operators are interested in employing new methods to monitor vehicle utilisation and passenger behaviour. One way to do this is through the use of Machine Learning, using the CCTV footage that is already being captured from the vehicles. However, one of the limitations of Machine Learning is that it requires large amounts of annotated training data, which is not always available. In this poster, we present a technique that uses 3D models to generate synthetic training images/data and discuss the effect that training with the synthetic data had on the Machine Learning models when applied to real-world CCTV footage. © 2022 IEEE.
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Social distancing in public spaces has become an essential aspect in helping to reduce the impact of the COVID-19 pandemic. Exploiting recent advances in machine learning, there have been many studies in the literature implementing social distancing via object detection through the use of surveillance cameras in public spaces. However, there has been no study of social distance measurement on public transport to date. The public transport setting has some unique challenges, including low-resolution images and physical camera locations that can lead to the partial occlusion of passengers, making it challenging to perform accurate detection. Thus, this paper investigates the challenges of performing accurate social distance measurements on public transportation. We benchmark several state-of-the-art object detection algorithms using real-world footage taken from the London Underground and bus network. The work highlights the complexity of performing social distancing measurements on images from current public transportation onboard cameras. Further, exploiting domain knowledge of expected passenger behaviour, we attempt to improve the quality of the detections using various strategies and show improvement over using vanilla object detection alone. © 2022 IEEE.
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Background & Aim: The COVID-19 pandemic changed the approach to aerosol mitigation in dentistry, although there is limited evidence and notable inconsistency among measures implemented in different countries. The aim of this study was to investigate aerosol mitigation by different high and low volume suction devices (HVE/LVE) during two distinct aerosol generating procedures (AGPs): a full mouth ultrasonic scaling (USS) and an anterior crown preparation with a high speed handpiece. Methods: Two different sensor set ups were optimized;a single sensor in a funnel positioned above the mouth and a two-sensor set up with sensors positioned at the patient's nose and chin. The particulate sensors (Plantower PMS5003) quantified aerosol concentration, expressed as the number of >0.3 μm particles/0.1 L of air. Defined dental procedures were carried out on a dental phantom head. Aerosol generation was measured throughout the procedures. Efficacy of different suction devices was assessed. Statistical analysis was performed using the mean normalized area under the curve of five independent experiments. Results: The high speed handpiece generated 3.4 times more aerosol/ min than ultrasonics when measured with the single sensor funnel device, and comparable amount of aerosol when measured with the two-sensor set up. HVE devices, that are moved around the mouth, provided consistent reduction of aerosol - to background levels - when carrying out ultrasonic scaling or crown preparation. We evaluated both HVE and LVE 'static' devices that are placed in the patient's mouth in a predetermined position for the duration of the procedure. These 'static' devices offered reduction of aerosol but with consistent 'spikes' recorded during procedures when aerosol escaped. Conclusions: In this simulated test system, either HVE or LVE 'static' devices provide inconsistent reduction of aerosols when conducting ultrasonic instrumentation. By contrast, an appropriately used HVE could reduce detectable aerosol to background levels during ultrasonic instrumentation in this test system.
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BACKGROUND: Previous research suggests that mindfulness training (MT) appears effective at improving mental health in young people. MT is proposed to work through improving executive control in affectively laden contexts. However, it is unclear whether MT improves such control in young people. MT appears to mitigate mental health difficulties during periods of stress, but any mitigating effects against COVID-related difficulties remain unexamined. OBJECTIVE: To evaluate whether MT (intervention) versus psychoeducation (Psy-Ed; control), implemented in after-school classes: (1) Improves affective executive control; and/or (2) Mitigates negative mental health impacts from the COVID-19 pandemic. METHODS: A parallel randomised controlled trial (RCT) was conducted (Registration: https://osf.io/d6y9q/; Funding: Wellcome (WT104908/Z/14/Z, WT107496/Z/15/Z)). 460 students aged 11-16 years were recruited and randomised 1:1 to either MT (N=235) or Psy-Ed (N=225) and assessed preintervention and postintervention on experimental tasks and self-report inventories of affective executive control. The RCT was then extended to evaluate protective functions of MT on mental health assessed after the first UK COVID-19 lockdown. FINDINGS: Results provided no evidence that the version of MT used here improved affective executive control after training or mitigated negative consequences on mental health of the COVID-19 pandemic relative to Psy-Ed. No adverse events were reported. CONCLUSIONS: There is no evidence that MT improves affective control or downstream mental health of young people during stressful periods. CLINICAL IMPLICATIONS: We need to identify interventions that can enhance affective control and thereby young people's mental health.
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Background/Aims Since the last UK wide survey of undergraduate (UG) education in rheumatology in 2000 (1), the landscape of both university teaching and clinical services has altered significantly. There has been an increase in the number of medical schools (26 to 37), rise in student numbers, curricula expansions, plus the impact of Covid-19. This survey evaluates the current status of rheumatology teaching in the UK and highlights areas for the Rheumatology community to consider when planning future training. Methods In early 2021, a 'Survey Monkey' was emailed to named MSK leads representing all 37 UK schools. This included open and closed questions and explored themes from previous published surveys. Reminders were sent after 2 and 4 weeks. Results Responses were received from 34/37 (92%) schools. There is wide variation in what, when and how teaching is delivered, but the vast majority deliver rheumatology specific teaching spread across years 1- 5. Overall length of clinical rheumatology exposure varied from 3 days to 7 weeks, delivered either as separate days (e.g. in integrated placements or PBL), as formal blocks (often with orthopaedics) or within a student selected component. Approximately 25% of teaching is delivered in primary care. Most is delivered in Year 4. Most schools have a designated rheumatology lead: a clinical academic or clinician. Teaching is acknowledged in most job plans with educational roles discussed at appraisals. Small group teaching remains the most common method of delivering formal teaching, followed by on-line learning and lectures. The majority of teaching is delivered by consultants, trainees and research fellows. A wide range of barriers were noted including competing pressures from clinical work, lack of physical space for teaching and the volume of medical students. Due to COVID-19, 50% of medical schools suspended placements at some point during the pandemic. 70% of schools reported a 50-75% reduction in patient contact time for students reflecting the national data re: 20% of rheumatology departments functioning at less than 50% during the pandemic (2). Many schools reported designing new innovative (often online) resources to support learning during the pandemic. Available resources such as the Versus Arthritis patient examination videos (available on YouTube) and flipbook were noted to be particularly useful learning resources. Conclusion Over the past 20 years, rheumatology UG teaching has remained strong but time for dedicated rheumatology training has reduced in some centres. Remote learning has become more common, which coupled with Covid, has raised concerns amongst teachers that students are not getting sufficient clinical exposure. There is interest for a rheumatology UG community to create and share online resources and act as a source of support.
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Background/AimsIn 2017 an audit and survey of giant-cell arteritis (GCA) services wereconducted across northwest England (reported previously). This resurvey in 2020, following publication of revised BSR guidance, soughtto identify what changes were made in the intervening period, andprovided the opportunity to assess the impact of COVID-19.MethodsRheumatologists from 16 hospitals in northwest England were invitedto complete a survey in July 2020. Questions focused on serviceprovision for GCA, including pathways, diagnostics and steroidprescription.ResultsResponses were received from 14/16 sites in 2017, and 15/16 in 2020.9/15 (60%) sites reported that the 2017 audit and survey promptedchanges to GCA services, with two (13%) stating that it clarified theneed for implementation of existing plans. Two sites had a GCApathway in 2017. Four of the seven sites who committed to introducingone have now done so, bringing the total in 2020 to six. Eight of thenine remaining sites plan to implement one, six with a specific datewithin six months. Six (40%) have completed additional local audit/QIsince 2017. Temporal artery (TA) ultrasound (US) is now available in anadditional four sites, bringing the total to 6/15 (40%) in 2020. Two sitesreported improvement in both time between first rheumatologyconsultation and TA biopsy, and time to receive results (now <7days for each task in 6/15 (40%)). Six additional sites reportedproviding leaflets on steroids routinely, bringing the total in 2020 to 12/15 (80%), versus 6/14 (43%) previously. Four sites (27%) now have adatabase of GCA patients (one in 2017). There was no major change insites having a standard protocol for steroid taper (n = 8 2017;n = 72020, 89% and 100% of whom respectively use BSR guidance), nor inthe number of patients routinely provided steroid cards (six in 2017;five in 2020). The three sites who do not report giving leaflets onsteroids routinely, all had a pathway. 8/15 (53%) reported COVID-19having an adverse effect upon services, including: reduced access todiagnostics (n = 7: TA US, biopsy, and PET-CT);delayed appointments(n = 4);delayed referrals (n = 3). The tertiary referral centre reported animprovement because access to tocilizumab was facilitated by arelaxation of rules by NHS England.ConclusionThe original audit and survey of current GCA practice in 2017highlighted areas for improvement for each site, and regionally. Sitescontributing to this re-survey report that the exercise stimulated themto improve their current care. The 2017 exercise showed a strongcorrelation between reported practice (survey) and actual practice(audit), leading us to have confidence that responses provided a truepicture of care. This work demonstrates the power of audit to driveimprovement, at a regional level.
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Pyogranulomatous inflammation has been extensively described in cats, in particular in cases of feline infectious peritonitis and also associated with Mycobacteria, Actinomyces, Nocardia, Rhodococcus and fungal infections. Idiopathic sterile pyogranulomatous dermatitis has also been described. In this case series we describe the clinical presentation, histopathology and outcome of three cases of feline idiopathic sterile steroid-responsive pyogranuloma with different presentation and different locations of the lesion, but with the common feature of having a mass with no superficial skin involvement.