ABSTRACT
Aims: To support primary care to deliver diabetes services throughout the pandemic. Methods: The Grampian Diabetes Practice Outreach Programme has a solid foundation for a collaborative interface between specialist and primary care diabetes services in Grampian. Continuing this during the pandemic had new challenges and it evolved accordingly. Methods include: • Changing to virtual Practice Outreach meetings. • Webinars • Virtual Diabetes MCN conference • Diabetes in Grampian Website Results: Practice Outreach meetings between specialist and primary care were changed to virtual meetings via Microsoft teams. Between March 2020 and current, there have been approx. 25 -30 meetings, discussing approximately 100 -120 patients (data to be completed). • Webinars. The Diabetes Specialist team delivered 4 x 1hr webinar sessions on relevant topics with an average 20 healthcare professionals per live session with 10 views of recordings per session accessed later. • Virtual Diabetes Conference -Wide ranging programme delivered by multidisciplinary team with updates including service delivery, service improvement and pharmacotherapy. 171 delegates evaluated this favourably. • Website -Diabetes in Grampian Website had been under development prior to the pandemic but had not been 'formally launched'. During the pandemic its use increased significantly with ∼2000 page views/month. It has been key to supporting self-management for people with diabetes by allowing access to information when appointments were cancelled, facilitating structured education and continues to help remote consultations. Conclusion: Grampian diabetes team has helped support primary care in a cost effective, sustainable and well received way which supports professional development as well as develops good working relationships in the diabetes team across the primary and secondary care interface.
ABSTRACT
Background: COVID-19 has documented multisystem effects. Whether clinically significant cardiac involvement is related to severity of disease in a working age military population remains unknown, but has implications for occupational grading and ability to deploy. Aims: To determine in the military population 1) whether prior SARS-CoV-2 infection causes clinically significant cardiac disease and 2) whether changes are related to disease severity. Methods: 105 military personnel were recruited, 85 with prior SARS-CoV-2 infection (39±10 years, 87% male;50 mild (community), 35 severe (hospitalized) and 20 healthy volunteers (mean age 39 ±8.4 years, 90% male) underwent comprehensive cardiopulmonary investigations including;cardiopulmonary exercise test, exercise echocardiography, cardiac31MRI and P-MR spectroscopy (rest and dobutamine stress). Results: Prior SARS-CoV-2 infection was related to lower VO2max (110±18.2 vs 133±6.7% predicted, p<0.05), anaerobic threshold (45±10 vs 56±14% of peak VO2, p<0.05), VO2/HR (102±21 vs 128±24% predicted, p<0.05) and VE/VCO2 slope (28.3±5.0 vs 25.8±2.7, p<0.05) and an increase in average E/e' change from rest to exercise stress (+1.49±2.4 vs-0.16±3.6, p<0.05). Whilst resting myocardial energetics were similar, prior SARS-CoV-2 infection was associated with a fall in PCr/ATP during stress (by 8%, p=<0.01) which was not seen in healthy controls. When groups were ordered normal> mild> severe disease, RVEDVi, RV stroke volume, VO2peak, VO2pulse and VE/VCO slope were reduced (Jonckheere-Terpstra, all p<0.05). Conclusion: In a young military population, prior SARS-CoV-2 infection is associated with subclinical cardiovascular changes including;lower right ventricular volumes, reduced markers of exercise capacity and reduced myocardial energetics during stress.