A novel multidisciplinary approach to the management of end-stage macular disease

Introduction: In 2017, the Royal College of Ophthalmologists UK published 'The Way Forward' describing the effects of the ageing UK population on clinical demand for macular conditions. Although one-stop clinics have become accepted standard practice for combined assessment and injections, there is little guidance regarding eventual discharge of patients, and practice varies between clinicians. In 2018, NHS Lothian started a multidisciplinary one-stop clinic involving an Ophthalmologist, a Medical Photographer, a specialist Low Vision Optometrist, and a Low Vision Counsellor. We aimed to detail our experiences of this novel multidisciplinary discharge clinic for advanced macular disease patients. We also aimed to assess patient-reported anxiety and depression outcomes following this clinic. Retrospective data on 60 patients who attended the clinic from August 2018 to January 2019 were collected and included in analysis. Average age at presentation to the clinic was 85.76 ± 8.18 years old and patients had been followed up in the macula clinic for a mean of 4.80 ± 2.43 years prior to attending the clinic. In all, 31 patients responded to a survey on anxiety and depression using the Hospital Anxiety and Depression score (HADS). Three (10%) of the patients reported scores abnormal for anxiety, and there were no abnormal scores for depression. The clinic provides a holistic approach for end-stage macular disease patients and reduces unnecessary macular anti–vascular endothelial growth factor treatments and clinic review appointments. This is especially important now during the coronavirus SARS-CoV-2 global pandemic. This provides significant benefits to capacity for delivery of clinical services and facilitates a safe and supported discharge for patients.

Multiple BCG vaccinations for the prevention of COVID-19 and other infectious diseases in type 1 diabetes.

There is a need for safe and effective platform vaccines to protect against coronavirus disease 2019 (COVID-19) and other infectious diseases. In this randomized, double-blinded, placebo-controlled phase 2/3 trial, we evaluate the safety and efficacy of a multi-dose Bacillus Calmette-Guérin (BCG) vaccine for the prevention of COVID-19 and other infectious disease in a COVID-19-unvaccinated, at-risk-community-based cohort. The at-risk population is made of up of adults with type 1 diabetes. We enrolled 144 subjects and randomized 96 to BCG and 48 to placebo. There were no dropouts over the 15-month trial. A cumulative incidence of 12.5% of placebo-treated and 1% of BCG-treated participants meets criteria for confirmed COVID-19, yielding an efficacy of 92%. The BCG group also displayed fewer infectious disease symptoms and lesser severity and fewer infectious disease events per patient, including COVID-19. There were no BCG-related systemic adverse events. BCG's broad-based infection protection suggests that it may provide platform protection against new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and other pathogens.

A novel multidisciplinary approach to the management of end-stage macular disease

Introduction: In 2017, the Royal College of Ophthalmologists UK published ?The Way Forward? describing the effects of the ageing UK population on clinical demand for macular conditions. Although one-stop clinics have become accepted standard practice for combined assessment and injections, there is little guidance regarding eventual discharge of patients, and practice varies between clinicians. In 2018, NHS Lothian started a multidisciplinary one-stop clinic involving an Ophthalmologist, a Medical Photographer, a specialist Low Vision Optometrist, and a Low Vision Counsellor. We aimed to detail our experiences of this novel multidisciplinary discharge clinic for advanced macular disease patients. We also aimed to assess patient-reported anxiety and depression outcomes following this clinic. Retrospective data on 60 patients who attended the clinic from August 2018 to January 2019 were collected and included in analysis. Average age at presentation to the clinic was 85.76?±?8.18?years old and patients had been followed up in the macula clinic for a mean of 4.80?±?2.43?years prior to attending the clinic. In all, 31 patients responded to a survey on anxiety and depression using the Hospital Anxiety and Depression score (HADS). Three (10%) of the patients reported scores abnormal for anxiety, and there were no abnormal scores for depression. The clinic provides a holistic approach for end-stage macular disease patients and reduces unnecessary macular anti?vascular endothelial growth factor treatments and clinic review appointments. This is especially important now during the coronavirus SARS-CoV-2 global pandemic. This provides significant benefits to capacity for delivery of clinical services and facilitates a safe and supported discharge for patients.

The prevalence, mortality, and associated risk factors for developing COVID-19 in hip fracture patients: a systematic review and meta-analysis.

AIMS: The aims of this meta-analysis were to assess: 1) the prevalence of coronavirus disease 2019 (COVID-19) in hip fracture patients; 2) the associated mortality rate and risk associated with COVID-19; 3) the patient demographics associated with COVID-19; 4) time of diagnosis; and 5) length of follow-up after diagnosis of COVID-19. METHODS: Searches of PubMed, Medline, and Google Scholar were performed in October 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Search terms included "hip", "fracture", and "COVID-19". The criteria for inclusion were published clinical articles reporting the mortality rate associated with COVID-19 in hip fracture patients. In total, 53 articles were identified and following full text screening 28 articles satisfied the inclusion criteria. RESULTS: A total of 28 studies reported the mortality of COVID-19-positive patients, of which 21 studies reported the prevalence of COVID-19-positive patients and compared the mortality rate to COVID-19-negative patients. The prevalence of COVID-19 was 13% (95% confidence interval (CI) 11% to 16%) and was associated with a crude mortality rate of 35% (95% CI 32% to 39%), which was a significantly increased risk compared to those patients without COVID-19 (odds ratio (OR) 7.11, 95% CI 5.04 to 10.04; p < 0.001). COVID-19-positive patients were more likely to be male (OR 1.51, 95% CI 1.16 to 1.96; p = 0.002). The duration of follow-up was reported in 20 (71.4%) studies. A total of 17 studies reported whether a patient presented with COVID-19 (n = 108 patients, 35.1%) or developed COVID-19 following admission (n = 200, 64.9%), of which six studies reported a mean time to diagnosis of post-admission COVID-19 at 15 days (2 to 25). CONCLUSION: The prevalence of COVID-19 was 13%, of which approximately one-third of patients were diagnosed on admission, and was associated with male sex. COVID-19-positive patients had a crude mortality rate of 35%, being seven times greater than those without COVID-19. Due to the heterogenicity of the reported data minimum reporting standards of outcomes associated with COVID-19 are suggested. Cite this article: Bone Joint Res 2020;9(12):873-883.