Barriers to in-Person Focus Group Participation during the Third-Year of COVID-19 Pandemic: A Case Study of Colorectal Cancer (CRC) Screening in Underrepresented Groups

Objectives: In the process of conducting research to understand barriers to colorectal cancer (CRC) screening in underrepresented groups such as Blacks and Hispanics, it became evident that there were also barriers to recruitment in this population. This study assesses the challenges faced in recruitment of focus group participants regarding CRC screening practices among underrepresented groups. Since the COVID-19 pandemic, qualitative research participants have primarily been interviewed through online video or audio interactions. However, as restrictions on in-person interactions have been lifted, in-person focus groups are being increasingly considered. Method(s): The study investigators began recruitment through community health workers in August 2022, when COVID-19 vaccines were available for all adults (age>18 years). Eligible individuals were: age 45-75, Black or Hispanic, with Medicaid or no insurance, and no family history of CRC or diagnosis of certain colon-related diseases. We combined in-person and virtual recruitment strategies, including posting flyers in communities, advertising our study at health fairs, and on social media. Participants would receive a $50 gift card. Result(s): Fifty-five met the eligibility criteria among 144 respondents, and 45 subjects (29 women and 16 men) agreed to be contacted. An average of 2.5 attempts were made per eligible subject. Unfortunately, we were able to recruit only four women (3 Hispanic and one non-Hispanic black). Traveling to the research site was a barrier to participation. Many subjects (49%) requested virtual participation (online video or audio interactions);some declined because the topic was too sensitive (considered taboo), and eligible men were reluctant to participate in-person. Conclusion(s): The requirement of in-person participation affected our recruitment goals, suggesting that COVID-19 has shifted the preferences of research participants to virtual interaction. In response to the eligible participant preferences, the study protocol has been revised to re-contact patients and schedule virtual FG sessions.Copyright © 2023

Congress publications in a post- COVID world

Objective: To investigate how medical congresses have evolved since the COVID-19 pandemic, and its impact on how healthcare professionals interact with and develop congress publications. Research design and methods: International and regional congresses (2019-2022) in two therapy areas (obesity and oncology) were included. Data on attendance, attendee demographics, registration fees, and virtual capabilities were obtained from publicly- available sources or contacting congresses directly. Data on accepted publications were from authors' experience. Result(s): Twenty-three congresses were included. Congresses moved from face-to-face to fully virtual in 2020 and 2021, with most becoming hybrid in 2022. Despite the option of virtual attendance, total attendee numbers did not significantly change compared with pre-pandemic levels, although slightly decreased in 2021. Registration fees decreased during 2020-2021 but returned to pre-pandemic levels (regardless of virtual/live attendance) by 2022. Virtual and hybrid congresses provided access to oral session recordings and digital posters via congress apps or websites for a limited time after the event. In general, a broader range of digital publications was supported in 2021/2022, often associated with shorter lead times. Conclusion(s): Since the COVID-19 pandemic, congresses have embraced hybrid formats, offering virtual attendance options and a range of digital possibilities. Overall attendance and demographics remain relatively unchanged. Delegate testimonials support in-person attendance, citing the value of networking opportunities. Broader digital options from virtual congresses may be confounded by general advancements in journal publication extenders. As publication professionals, it is important to consider how congress delegates interact with live and digital content, and adapt content and delivery to maximise impact and optimise dissemination to all audiences.

Diversity in medical publications: a cross-sectional evaluation of COVID- 19 vaccine research

Objective: Representing diverse perspectives in medical publications is of great importance. We assessed diversity among investigators, study participants, authors and tweeters of recent publications on COVID-19 vaccine trials, a topic likely to have significant global implications. Research design and methods: Primary publications reporting on COVID vaccine randomized controlled trials (RCTs) were identified via PubMed (n=302 hits, 23 September 2022). The 100 articles with the greatest impact (Altmetric score) were selected for evaluation. National affiliation of authors and investigators, and demographics of participants were collected. Geographic locations of Tweets mentioning the publications were collected via Altmetric. Result(s): In our preliminary analysis, as expected, selected publications most frequently appeared in top-tier journals, e.g. New England Journal of Medicine (n=24) and Lancet (n=19), and had high Altmetric scores (median 886, range 30-29,153). Articles included authors from mean 2.2 countries, most frequently the USA (n=43 articles), the UK (n=31) and China (n=23). Investigators' locations were often not reported, but most frequent were the UK (n=2711 investigators), USA (n=1029) and South Africa (n=269). There was a gender balance among participants across the studies (mean 49.4% female). The most frequent ethnic groups were white, Hispanic and Asian. Tweets mentioning the publications most commonly came from the USA (8.1%), the UK (3.1%) and Japan (2.9%). Conclusion(s): Despite COVID-19 being a global health emergency, most authors, investigators and readers of high impact COVID-19 vaccine RCT publications were from a small group of countries, with some notable exceptions. Numerous studies did not report the geographic location of investigators or participant ethnicity. Consistent and transparent reporting would support the drive towards greater diversity and representation in medical research.

Domestic Violence

Domestic violence (DV) is a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner or member of the domestic unit. DV can be physical, sexual, emotional, economic, or psychological actions, threat of actions or negligence that influence another person. This includes any behavior that intimidates, manipulates, humiliates, isolates, deprives, frightens, terrorizes, coerces, threatens, blames, hurts, injures, or wounds someone. The World Health Organization (WHO) reports that violence against woman and girls globally is dramatically under reported. Recently, incidents of DV increased during the COVID-19 pandemic potentially due to the stay-at-home/lockdown orders and increased stress. For professionals in a forensic field, it is important to have a good knowledge of the characteristics of DV to be able to understand the dynamics of the repeating violence, the risk assessment, and the importance of an optimal forensic investigation. This article includes instruments for the diagnosis of DV, such as screening methods or typical patterns of injuries, and presents recommendations for a complete and excellent forensic documentation. The effect of DV on children is discussed briefly. If you or someone you know has been the victim of Domestic Violence, contact your relevant national/state support. © 2023 Elsevier Ltd. All rights reserved.

Effect of Early Treatment with Pegylated Interferon Lambda for Covid-19

Background: We assessed the efficacy of a single dose of peginterferon lambda in preventing clinical events among acutely symptomatic COVID-19 outpatients. Method(s): We conducted a placebo-controlled, randomized, adaptive platform trial among predominantly vaccinated SARS-CoV-2-positive adults in Brazil and Canada receiving either one subcutaneous injection of peginterferon lambda or placebo. The primary composite endpoint was medical admission to hospital, defined as either observation in a COVID-19 emergency setting for > 6 hours, or transfer to a tertiary hospital due to symptomatic COVID-19 within 28 days post-randomization. Result(s): For this evaluation, 931 patients received peginterferon lambda and 1018 received placebo. 84% of the population were vaccinated and the trial occurred across multiple COVID-19 variants. In the primary analysis of patients, the primary outcome was reduced by 51% in the peginterferon lambda vs. placebo groups (relative risk 0.49 [25/916 vs 57/1003], 95% Bayesian credible interval 0.30-0.76, posterior probability >99.9%). This effect was maintained in subgroup analyses including COVID-19-related hospitalization alone (relative risk 0.57, 95% Bayesian credible intervals 0.33-0.95, ) and COVID-19-related hospitalization or death (Hazard ratio 0.59, 95% Bayesian credible interval 0.35- 0.97). The effects were consistent across dominant variants and vaccination status. Among individuals with a high viral level at baseline, peginterferon lambda resulted in lower viral loads by Day 7, compared to placebo. The incidence of adverse events was similar in the two groups. Conclusion(s): Among predominantly vaccinated outpatients with COVID-19, single-dose of peginterferon lambda resulted in significantly decreased clinical events.

Advancing detection and response capacities for emerging and re-emerging pathogens in Africa

Recurrent disease outbreaks caused by a range of emerging and resurging pathogens over the past decade reveal major gaps in public health preparedness, detection, and response systems in Africa. Underlying causes of recurrent disease outbreaks include inadequacies in the detection of new infectious disease outbreaks in the community, in rapid pathogen identification, and in proactive surveillance systems. In sub-Saharan Africa, where 70% of zoonotic outbreaks occur, there remains the perennial risk of outbreaks of new or re-emerging pathogens for which no vaccines or treatments are available. As the Ebola virus disease, COVID-19, and mpox (formerly known as monkeypox) outbreaks highlight, a major paradigm shift is required to establish an effective infrastructure and common frameworks for preparedness and to prompt national and regional public health responses to mitigate the effects of future pandemics in Africa.Copyright © 2022 Elsevier Ltd

DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women

Breast cancer is now the most common cancer. Thirty years of increased awareness, early diagnosis, and treatment access contributed to a 40% decline in breast cancer deaths. Yet, in 2021, more than 281,550 new cases of invasive and 49,290 new cases of non-invasive breast cancer will be diagnosed in U.S. women. Black women are 40% more likely to die of breast cancer - the highest breast cancer death rate across racial and ethnic groups. Today, the Black-white breast cancer mortality gap persists, and Black metastatic breast cancer (MBC) patients have a poorer prognosis. The pandemic exacerbated breast cancer disparities. In 2020, delays and avoidance contributed to an 85% breast cancer screening drop while MBC patients' risk of severe illness and death from COVID-19 elevated. Therapy interruptions and abandonment increased, and conversely, clinical trial enrollment decreased. COVID-19 has accelerated the digital platform shift to telemedicine, online psychosocial support programs, virtual patient navigation, and digital engagement across the oncology care continuum. DC Pink Divas Intervening Virtually to Advance Saving Lives (DIVAS) is an award-winning evidence-based training, outreach, and patient navigation program developed to address the educational needs of Black early-stage, MBC breast cancer patients, survivors, and caretakers and provide strategies to educate, empower and impact women by increasing breast health knowledge, decreasing gaps in screenings and access, increasing awareness of MBC to ensure that where a woman lives, will not determine if she lives through a 1-year commitment of attendance in 8 cohort-based education modules where Black breast cancer mortality is highest. The DIVAS Health Behavioral Change Model adapts the Precaution Adoption Process Model, Health Behavior Model, and Social-Ecological Model. DIVAS implements innovative virtual outreach programs, training, and intervention strategies to empower Advocates to educate peers, providers, and policymakers. 3 Cohorts of Black women impacted by breast cancer trained as Lay Breast Health Advocates from 2011, 2020, and 2021 (N = 57;77.5 % 45 years or younger;36.7% early-stage 0-II, 50% late stage III-IV, 10.3% caretakers) self-reported their lifestyle behaviors, breast cancer diagnosis, breast health education, social media use, and interest in a digital-based lifestyle intervention. Participants completed pre-and post-surveys, interviews, and journaling over 10.5+ hours of education modules to understand their breast health, provider-related challenges, and community-related resources. Findings provide evidence that cohort-tailored education is a successful method of supporting Black women in a behavioral-health intervention. The provision of printed culturally attuned information along with the digital-based instruction from a Black woman health care provider or public health expert is effective in helping Black breast cancer survivors transition into patient empowerment, improve QOL and contribute to better patient outcomes. After the intervention and completion of breast health modules, participants reported increased: self-efficacy in communicating with providers (70%) and self-efficacy in making treatment decisions (70%) self-confidence (85%), and a decrease in lifestyle risk factors (87%). Patient-centric behavioral health interventions in breast cancer education must be advanced digitally to address the pandemic's compounded crisis. DC Pink Divas provides insights to combat rising disparities by educating, empowering, and mobilizing Black lay breast health advocates to improve outcomes. Collaborative digital interventions across the care continuum to improve awareness, access, adherence, infrastructure, culturally attuned training, and support are evidencebased methods for navigating the cancer care transformation accelerated by COVID-19 to advance breast health equity. (Table Presented).

MERGING AN AGE FRIENDLY UNIVERSITY WITH AN AGE FRIENDLY HEALTH CARE SYSTEM: CASE STUDY FINDINGS

Age Friendly Health Systems (AFHSs) and Age Friendly Universities (AFUs) are distinct entities in the "Age Friendly” ecosystem. While Age Friendly entities function independently, they typically exist in close proximity (e.g., universities and community hospitals);yet they remain isolated in their Age Friendly efforts. We report on a collaboration between a mid-Atlantic Age Friendly University and a new AFHS using case study methodology. Our goal is to inform and inspire key stakeholders responsible for creating innovative healthy aging communities. The collaboration began with a shared stakeholder team who articulated focus areas and overlapping goals. A charter document was developed articulating commitments and responsibilities. Using a Quality Improvement (QI) approach, projects targeted the hospital's older patient needs that linked to the AFHS 4 M's of Matters, Medications, Mobility, and Mentation. University graduate students and faculty volunteered to teach and mentor hospital staff on the QI projects: 1) Get to Know Me Boards filled by staff caring for hospitalized older adults (Matters);2) Medical Intensive Care Unit discharge opioid medication deprescribing (Medication);3) UMove Mobility Screening addressing functional status (Mobility);4) UB-2 Delirium Screening (Mentation). Data collection across projects demonstrated proof-of-concept and identified implementation challenges around communication, screening, data entry, and data extraction from electronic medical records. During Covid-19 pandemic, the collaboration allowed QI projects to conduct multiple Plan-Do-Check-Act cycles while contributing to the Age Friendly goals of both organizations. Partnerships between academic institutions and hospitals foster development of evidence- based healthy aging communities and provide opportunities for continuing education and research.

SHOT ON THE SPOT VACCINATION COMMUNITY OUTREACH

Due to the COVID-19 pandemic disproportionately affecting Black communities, The University of Alabama (UA) partnered with the Rural Alabama Prevention Center (RAPC), a community-based healthcare organization to improve the vaccination rate from 34% vaccinated Alabama Black Belt residents to 70% over a year. Health literacy training is provided to community health workers and students who, along with the team members, volunteer at pop-up Shot on the Spot vaccination sites to administer surveys collecting demographics and vaccine hesitancy data. Team members provide health literacy information and answer questions non-vaccinated individuals have. This vaccination intervention has led to drastic rate increases, such as, Choctaw County having a 36.6% increase since the beginning of the project in August (30.7% to 67.30%). However, some counties have low vaccination rate changes, such as, Crenshaw County with a rate change of 15.4% (19.5% to 34.90%). Notably, the Alabama Black Belt currently stands at a higher vaccination rate compared to Tuscaloosa County (UA's location), only having a rate of 44.3%. Within one year, there have been a total of 44 administered first and second vaccine doses and 435 booster doses, resulting in 50.24% vaccinated Black Belt residents. As the virus evolved into different variants, team members were able to observe an increase in administered booster doses in congruence with the rise of a new coronavirus variant. The partnership formed between RAPC and UA scientists and students is an important step in improving vaccination rates and building community research on minority and diverse populations.

Infection Prevention and Control for the Emergency Medical Services and 911 Workforce

OBJECTIVES: To summarize current evidence on exposures to infectious pathogens in the emergency medical services (EMS) and 911 workforce, and on practices for preventing, recognizing, and controlling occupationally acquired infectious diseases and related exposures in that workforce.

Dancing Under the Weight of Racism

The slogan “I can’t breathe” reverberated in 2020 with the Black Lives Matter movement protests against police brutality and racial injustices in America. As much as there was an uncanny coincidence with that phrase and the root of the COVID-19 pandemic, the immediate association of those words for me, a dance educator in South Africa, was the 2015 #RhodesMustFall national student protests in South Africa. Black students at the University of Cape Town, and eventually across the nation, vehemently protested racism and the suffocating whiteness of their institutions and curricula. Their motto of “We can’t breathe” resonated in our dance studios and lecture halls. Through personal narratives the author aims to reveal multiple ways in which racism can permeate dance teaching and learning and the adverse effects of this abhorrent phenomenon on dancers and dance education. A lacuna in the dance scholarship on race and racism are first-person accounts that provide rich descriptions of individual’s lived experiences with racism in dance. As a step toward healing and transformation, such storytelling is useful for demystifying a phenomenon that is complex and prone to blind spots and denial. © 2022, Pennsylvania State University Libraries. All rights reserved.

Modeling analysis of COVID 19-related delays in colorectal cancer screening on simulated clinical outcomes

Background: Colorectal cancer (CRC) screening disruptions have been observed with the COVID-19 pandemic, putting patients at risk for more advanced-stage disease at the time of diagnosis. We estimated the impact of increased use of stool-based tests for screening during the COVID-19 pandemic on near-term clinical outcomes in a simulated United States (US) population. Methods: A previously developed budget impact model was adapted to assess the impact of increasing use of multi-target stool DNA [mt-sDNA] or fecal immunochemical [FIT] tests to offset the COVID-19 related disruption in colonoscopy screening. Adults, ages 50 - 75 years, at average risk for CRC were included over a 3-year time horizon (2020 - 2023) to explore the impact of increased screening for CRC using mt-sDNA or FIT, from the perspective of a US payer. Compared to the base case (S0;85% colonoscopy and 15% non-invasive tests), the estimated number of missed CRCs and advanced adenomas (AAs) were determined for four COVID-19-affected screening scenarios: S1, 9 months of CRC screening at 50% capacity, followed by 21 months at 75% capacity;S2, S1 followed by increasing stool-based testing by an average of 10% over 3-years;S3, 18 months of CRC screening at 50% capacity, followed by 12 months of 75% capacity;and S4, S3 followed by increasing stool-based testing by an average of 13% over 3-years. Results: Increasing the proportional use of mt-sDNA, the detection of AAs improved by 6.0% (Scenario 2 versus 1) to 8.4% (Scenario 4 versus 3) and the number of missed CRCs decreased by 15.1% to 17.3% respectively. Increasing FIT utilization improved the detection of AAs by 3.3% (Scenario 2 versus 1) to 4.6% (Scenario 4 versus 3) and the number of missed CRCs decreased by 12.9% (Scenario 2 versus 1) to 14.9% (Scenario 4 versus 3). Across all scenarios, the number of AAs detected was higher for mt-sDNA than for FIT, and the number of missed CRCs was lower for mt-sDNA than for FIT. Conclusions: Using home-based stool tests for average-risk CRC screening can mitigate the consequences of reduced colonoscopy screening resulting from the COVID-19 pandemic. Use of mt-sDNA led to fewer missed CRCs and more AAs detected, compared to FIT.

Pilot exploration of low-intensity psychoeducation workbook interventions in a prison setting, adapted for use throughout the COVID-19 pandemic

Purpose: This paper aims to explore the use of low intensity in-cell workbooks within a psychological therapies service for male prisoners, an intervention adapted for use during the COVID-19 pandemic. It seeks to explore the effectiveness of the intervention in reducing psychological distress, explore individuals’ progression through the service following engagement with the workbooks and, finally, to understand individual’s experiences of the intervention through evaluating feedback provided. Design/methodology/approach: CORE-10 scores from 66 male prisoners at a Category C prison were evaluated pre and post completion of an adapted in-cell workbook intervention, to explore the potential effectiveness of the intervention in reducing psychological distress. Qualitative feedback given by participants was also explored to understand individual’s experiences of engaging with the intervention. Findings: Evaluation of 66 male prisoners revealed significant reductions in psychological distress on the CORE-10. Findings demonstrated that over half of men included in the evaluation were “stepped-up” for further interventions as per the stepped-care treatment model. Feedback forms highlighted the value of the therapeutic relationship and a “something versus nothing” approach. Research limitations/implications: The paper considers several limitations to the research approach, of which future studies should seek to explore when carrying out similar research. Practical implications: The paper includes implications for the use of low intensity self-help interventions in prison psychological services, during a time when the provision of face-to-face interventions was limited due to the COVID-19 pandemic. Originality/value: The paper explores the use of self-help materials in psychological treatment settings, of which there is very little research on in prisons. In addition, the paper contributes to the body of research on psychological well-being during the COVID-19 pandemic. © 2022, Emerald Publishing Limited.

Rapid rollout of a pacemaker home monitoring service during the 2020 COVID-19 pandemic

Introduction: In an effort to reduce non-essential face to face contact during the COVD pandemic our pacemaker service was restructured in March 2020 to home monitoring only. Home monitors were issued at implant and wound reviews were done remotely via photo messages at one month or if prompted by the patient. Existing patients were given monitors on an ad hoc basis. A dedicated physiologist worked off site on home monitoring clinics. We assessed the impact on our service and on patient experience of these changes one year after implementation. Methods: Baseline characteristics of age at implant and distance of home address from hospital were collected from all patients undergoing pacemaker home monitoring. Patients were surveyed using an adapted version of the Generic Short Patient Experiences Questionnaire (GS-PEQ). Comparison was made with our standard face-to-face follow-up model (1, 3, and 12 months). Results: Data was collected for 326 patients. 233 received a new permanent pacemaker from March 2020 onwards and 93 existing patients were issued with a home monitor. Average age at pacemaker implant was 80.6 years (±9.9 years). The average one-way distance from home to outpatient clinic saved was 15.1 miles (±10.4 miles). 567 face-to-face appointments were saved. On an average day the off-site physiologist reviewed over 100 patient records a day, contacted 10 patients by phone and dictated reports on 20 patients (14 clinic patients and 6 alerts). Of patients surveyed 88% agreed with the statement I feel safe being cared for solely with a remote monitoring service and 84% agreed with the statement I receive the same standard of care via remote monitoring and face-to-face appointments. Time saved by avoiding a face to face appointment was more than 1 hour for 90% of respondents. Respondents requested communication of reassuring monitoring, the ability to contact the pacing team in the event of concerns and clearer instructions for the home monitoring device. Only 34% of newly implanted patients were able to send a photo message of their wound without prompting. We did not get a post procedure photo in 38% and the rest either spoke to us about the wound or had a face-to face visit. There was a significant difference in mean age between those who sent a photo (73.7 years) and those who didn't (81.4 years) (P=0.0006). Conclusion: Rapid role out of a remote monitoring service for permanent pacemakers across a large county was feasible, produced significant savings in clinic time and was well received by patients. There were significant time savings for physiologists and patients. However remote wound monitoring in elderly patients was problematic due to the difficulty of sending photo messages.

Observational evidence of NAD+ biosynthetic impairment and urinary metabolomic alterations in covid-related AKI

Background: Acute kidney injury (AKI) is a frequent extrapulmonary manifestation of COVID-19 and is associated with increased morbidity and mortality. We investigated alterations in the urine metabolome associated with AKI among patients with COVID-19, with the hypothesis that changes in nicotinamide adenine dinucleotide (NAD+) metabolism described in ischemic, toxic, and inflammatory AKI will be also associated with AKI in patients with COVID-19. Methods: This is a case-control study among two adult populations with COVID-19: critically ill patients hospitalized in Boston, Massachusetts, and a general hospitalized patient population in Birmingham, Alabama. Cases had AKI stages 2 or 3 by Kidney Disease Improving Global Outcomes (KDIGO) criteria. Controls had no AKI by KDIGO criteria. Metabolites were measured by liquid chromatography -mass spectrometry. Results: 14 cases and 14 controls were included from Boston, and 8 cases and 10 controls included from Birmingham. Urinary quinolinate to tryptophan ratio, an indicator which increases with impaired NAD+ biosynthesis, was higher among cases than controls at each location and pooled across locations (median [IQR]: 1.34 [0.59-2.96] in cases, 0.31 [0.13-1.63] in controls, unadjusted p = 0.0013;p=0.03 in analyses adjusted for age and sex). We identified alterations in tryptophan, nicotinamide, and other components of energy metabolism as well as decreases in purine metabolites which contributed to a distinct urinary metabolomic signature that could reliably differentiate patients with and without AKI (supervised random forest class error: 1/14 for AKI and 1/14 for no AKI groups in Boston, 0/8 for AKI and 0/10 for no AKI groups in Birmingham). Conclusions: Conserved urinary metabolic alterations spanning multiple biochemical pathways distinguish AKI vs. non-AKI in the context of COVID-related hospitalization at two large academic medical centers. AKI is further associated with derangements in NAD+ biosynthesis that suggest impaired energy metabolism in the kidney. Augmenting renal NAD+ by administering biosynthetic precursors may present a novel therapeutic opportunity to mitigate COVID-19 associated AKI.

Follow-up of small & diminutive colonic polyps – how to balance the risks in the COVID-19 era

Abstract The COVID-19 pandemic has led to a reduced colonoscopy capacity in the UK resulting in increased waiting times for investigation. To increase diagnostic capacity and reduce the risk of diagnostic delay, CT colonography (CTC) and colon capsule endoscopy (CCE) are increasingly being relied upon. Endoscopic assessment and treatment will be required for those patients with large colonic polyps or malignant tumours detected by CTC or CCE, provided they are fit enough to undergo further investigation. The management of patients with intermediate (6-9mm) and diminutive (<6mm) colonic polyps, reported by CTC and CCE, will increasingly be decided by clinicians. Published literature suggests the risk of progression to malignancy of intermediate or diminutive polyps over 3 years is low. Furthermore, the risk of intermediate or diminutive polyps harbouring malignancy is extremely low. The benefits, and timeline, for the removal of these polyps must be carefully considered for patients. We present a pragmatic approach to managing intermediate and diminutive polyps. We suggest delayed polypectomy (up to one year) for patients with intermediate polyps who are likely to benefit. For those patients with diminutive polyps, we advocate further surveillance only for younger patients where clinical concern exists. This meets the aspirations of Realistic Medicine, providing a risk-based approach for patients, while appropriately prioritising resources.