Evaluation of community-based CT abdomen for acute abdominal pain during COVID-19.

AIM: The purpose of this study was to determine the utility of community-based imaging to reduce use of inpatient surgical resources and enforce social distancing at the outset of the COVID-19 pandemic. METHOD: A prospective evaluation of community-based CT for patients presenting to Christchurch general practitioners with acute abdominal pain from April to November 2020. Eligible patients were discussed with the on-call general surgical team, and then referred for CT abdomen rather than hospital assessment. The positivity rate of CT scans, the 30-day all-cause hospital admission rate, and the proportion of patients where community scanning altered management setting and the number of incidental findings, were all assessed. RESULTS: Of 131 included patients, 67 (51%) patients had a positive CT scan. Thirty-nine (30%) patients were admitted to hospital within 30 days, 34 (87%) of whom had a positive CT scan and were admitted under a surgical specialty. Ninety-two (70%) patients did not require hospital admission for their acute abdominal pain, thirty-three (35%) of whom had a positive CT scan. There were three deaths within 30 days of the community CT, and the setting of the community CT did not contribute to the death of any of the cases. Forty patients (30%) had incidental findings on CT, 10 (25%) of which were significant and were referred for further investigation. CONCLUSION: Community based abdominal CT scanning is a feasible option in the management of acute abdominal pain. While trialed in response to the initial nationwide COVID-19 lockdown in New Zealand, there may be utility for acute community-based CT scanning in regular practice.

Hospital based specialists' perspectives of teleconsultation use during the COVID-19 pandemic.

AIMS: Teleconsultation has been widely utilised during the COVID-19 pandemic. It allows clinicians to provide healthcare social distance restrictions. This study investigates its safety and limitations in different specialties and the possibility of incorporating telemedicine into future practice. METHODS: This was a qualitative study of 151 hospital-based specialists in New Zealand. An electronic questionnaire was sent via email addresses. These included participants' demography and their experience of using teleconsultation during the pandemic. The safety and suitability of teleconsultation were assessed with time efficiency, data security concerns, missed clinical information and specialist's ability to examine patients. RESULTS: This study found that 92.7% of hospital-based specialists used teleconsultation during the pandemic. More specialists reported the efficiency was similar or greater with teleconsultation and most patients could be seen via teleconsultation appointments. Limitations of these were due to poor physical examination and poor non-verbal cues sensing. There is a general preference for physical consultation. CONCLUSION: Teleconsultation is used widely across many specialties during the pandemic. Despite limitations identified with teleconsultations and preference for physical consultation, doctors are prepared to provide teleconsultations in the future beyond the pandemic. In appropriately selected patients, especially in non-procedural specialties, teleconsultation will have an increasing role in healthcare.

Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol for a feasibility trial of the ACTforIBD programme.

INTRODUCTION: Inflammatory bowel disease (IBD) involves an abnormal immune response to healthy gut bacteria. When a person develops IBD, their susceptibility to anxiety and/or depression increases. The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms. There are no ACT trials for IBD using an active control group or a telemedicine approach, which is important to improve accessibility, particularly in the context of the ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 4-hour therapist involvement per participant only; if successful it can be widely implemented to improve the well-being of many individuals with IBD. METHODS AND ANALYSIS: Our team have codesigned with consumers the ACTforIBD programme, an 8-week intervention of 1-hour sessions, with the first three sessions and the last session delivered one-to-one by a psychologist, and the other sessions self-directed online. This study aims to evaluate the feasibility and preliminary efficacy of ACTforIBD to reduce psychological distress in patients with IBD. Using a randomised controlled trial, 25 participants will be randomised to ACTforIBD, and 25 patients to an active control condition. ETHICS AND DISSEMINATION: This protocol has been approved by Deakin University Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 11384). The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policy-makers and researchers, through local and international conferences. TRIAL REGISTRATION NUMBER: ACTRN12621001316897.

Paediatric presentations to Christchurch Hospital Emergency Department during COVID-19 lockdown.

AIM: To describe the variation in volumes and types of paediatric presentations to a tertiary emergency department in New Zealand during the national level 4 lockdown for COVID-19. METHODS: A retrospective, comparative cohort study in Christchurch Hospital Emergency Department, New Zealand. RESULTS: There was a 37% reduction in all emergency presentations during the 33-day lockdown period. Paediatric presentations reduced significantly more than non-paediatric presentations (53% paediatric vs. 34% non-paediatric, P < 0.00001). The decrease in both overall and paediatric presentations was significantly different than similar periods in 2019 and 2018 (P < 0.00001). The proportion of New Zealand European paediatric presentations during lockdown increased by 6.09% (P = 0.01), while Pacific peoples decreased by 3.36% (P = 0.005). The proportion of <1-year-old presentations increased by 5.56% (P = 0.001), while 11-15 years decreased by 7.91% (P = 0.0001). Respiratory-related paediatric presentations decreased by 30% and proportional decreased by 4.92% (P = 0.001). CONCLUSION: This study has identified a significant reduction in paediatric presentations to a tertiary emergency department in New Zealand during the national Alert Level 4 Lockdown for COVID-19. The proportional increase in the <1-year-old group may suggest a greater need for community-based child health services during the COVID-19 pandemic. Mental health support services may also need to adapt and expand to provide adequate psychological support for children during this crisis. Recognising the needs of these vulnerable groups will be critical during the ongoing COVID-19 pandemic in addition to informing response plans for similar events in the future.

Mental health presentations to Christchurch Hospital Emergency Department during COVID-19 lockdown.

OBJECTIVE: To describe mental health presentations to a tertiary ED in New Zealand during a national COVID-19 lockdown. METHODS: A retrospective, comparative cohort study in Christchurch Hospital, New Zealand. RESULTS: There was a 3510 (37%)-patient decrease in all presentations to Christchurch Hospital ED during the 5-week COVID-19 lockdown period from 26 March 2020 to 28 April 2020, compared to a 111 (1.2%)-patient decrease in the same time period in the previous year (P < 0.00001). There is usually a seasonal reduction in mental health attendances at this time of year compared to the weeks before. In 2019, there was a 49 (9.8%)-patient reduction in mental health presentations, whereas in 2020 there was a 193 (34%)-patient reduction (P < 0.001). In 2020, the proportion of mental health attendances compared to all ED attendances during the 5-week lockdown period was similar to the 5-week pre-lockdown period (564/9460 vs 371/5950, P = 0.48). The proportion of mental health patients presenting due to overdose increased by 6.5% (158/564 vs 128/371, P = 0.035); those due to self-harm increased by 3.5% (35/564 vs 36/371, P = 0.049). The proportion of mental health presentations due to anxiety, depression and other non-self-harm/overdose complaints decreased by 10% (371/564 vs 207/371, P = 0.002). The proportion of overdoses of paracetamol and ibuprofen increased by 13.4% during lockdown (22/158 vs 35/128, P = 0.005). CONCLUSIONS: During the COVID-19 lockdown, both overall ED presentations as well as mental health-related presentations decreased. There was a relative increase in overdoses and self-harm, particularly involving paracetamol and ibuprofen.