Covid-19 Impact on Macular Neovascularization and Retinal Vein Occlusion Treatment: Single-Center Experience

<b><i>Purpose:</i></b> The aim of this study was to evaluate whether the coronavirus disease 19 (COVID-19) pandemic resulted in undertreatment and subsequent loss of visual acuity (VA) in patients with macular neovascularization (MNV) or retinal vein occlusion (RVO) regularly treated with intravitreal antivascular endothelial growth factor injections. <b><i>Methods:</i></b> Single-center, retrospective study of patients scheduled for treatment between March 19 and June 1, 2020, the national mandatory quarantine period. Patients’ demographics, VA, and scheduled treatment during this period were reviewed via medical records. All patients were analyzed regarding treatment attendance rates. The visual impact of COVID-19 was assessed in patients who had been treated and presented a stable VA for &#x3e;6 months before the beginning of the quarantine. <b><i>Results:</i></b> This study included 927 eyes from 769 patients. The attendance rate increased throughout the study timeframe (<i>p</i> &#x3c; 0.001) and correlated negatively with higher patient’s age (<i>r</i> = −0.142; <i>p</i> = 0.005). Patients with age-related macular degeneration (67.6%) had lower attendance rates (<i>p</i> = 0.007) and were older (<i>p</i> &#x3c; 0.001). The visual impact analysis included 400 eyes from 325 patients. The average VA variation throughout this period was −1.7 ± 8.4 ETDRS letters and was similar in different retinal pathologies (<i>p</i> = 0.334). VA variation did not correlate with the number of missed treatments per patient (<i>r</i> = 0.100; <i>p</i> = 0.150). The prevalence of subretinal fluid and intraretinal fluid, as well as central retinal thickness decreased significantly throughout the study period (<i>p</i> values of &#x3c;0.001, &#x3c;0.001, and 0.032, respectively). <b><i>Conclusion:</i></b> The COVID-19 pandemic had a significant impact on the attendance rate of patients with MNV or RVO to their scheduled treatments, which was higher in the first week of mandatory quarantine. Nevertheless, VA did not decrease significantly during this period, with a limited VA variation regardless of primary retinal disorder and morphological parameters even improved in the eyes included in the visual impact analysis.

A Culturally Adapted Timed-Activity RCT for Latinos With ADRD and Caregivers: Feasibility, Acceptability, and Effects

Latinos are twice as likely to develop Alzheimer’s disease (AD) compared to non-Latino whites, yet, account for &lt;2% of clinical trial participants in AD research. This randomized controlled trial examined the feasibility, acceptability and effects of a culturally-adapted timed-activity intervention designed to promote quality of life (QOL) and reduce behavioral symptoms in older Latinos with AD and their caregivers. Healthy Patterns [Pautas Saludables] was implemented among 40 Spanish-speaking dyads. Measures assessed at baseline and 4 weeks post-intervention, indicate improvements in sleep efficiency (p=.06) and QOL (p=.01) among intervention participants. Pautas Saludables was found to be feasible and acceptable. Intervention attendance rate was &gt;90% with low attrition (n=0); no adverse events. Most (74%) rated timed-activity sessions as helpful and appropriate; 58% recommended refreshers. Results provide evidence that Latinos with AD will participate in clinical trials and can improve on key health outcomes, when interventions are adapted to meet their cultural needs.

Virtual day center for people with dementia and their caregivers during the COVID-19 pandemic

ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic suspended face-to-face assistance offered by community spaces, such as day centers (DCs). People with dementia (PwD) and their families were faced with the risks posed by social detachment and suspension of treatments. Objective: This study aimed to present a virtual day center (VDC) program offered as a preventive strategy to reduce the damage caused by social isolation and interruption of treatment imposed by the pandemic. Methods: The experience report, describing the feasibility of a VDC program, offered to 26 PwD and their caregivers, during the first year of the pandemic. The VDC held individual and group meetings with PwD and their families and psychoeducational support groups for caregivers. Results: The attendance rate in group activities was 80%, and that in the caregiver group was 68%, showing a good virtual interaction. Throughout the year, three PwD interrupted the service due to difficulties of the caregivers to reconcile the schedules of the activities with their professional commitments and the absence of a support network, three others died, and two were institutionalized. PwD remained physically, socially, and cognitively active through daily virtual activities. Guidance and support for caregivers contributed to the organization of routines and adaptation to the isolation and maintenance of the bond. Family meetings made it possible to mediate conflicts and expand the support network. Conclusions: VDC is a promising modality to assist the needs and demands of PwD and their caregivers. VDC can contribute to the expansion of this intervention to individuals and families who do not have access to face-to-face treatment.

SISPENA 3.0 PILOTING PROGRAM TO ASSURE READINESS FOR EDUCATION QUALITY ASSURANCE IN INDONESIA CONTEXT

The objectives of this research are: 1) improving the skills of teachers and school principals in filling out accreditation instruments as part of the implementation of school/madrasah self-evaluations, 2) measuring awareness of the importance of accreditation as seen from the participation level of SISPENA 3.0 piloting activities, and 3) knowing the evaluation results of implementing the SISPENA 3.0 pilot program. The implemented research design was descriptive mixed-method involving quantitative and qualitative data. The data was gathered through documentation of piloting the SISPENA 3.0 program and interviewing program participants. The participants were 190 schools around Lampung province, Indonesia. The results showed that the program met all of the required objectives, all the schools believed in the importance of the program which resulted in a 100% attendance rate, and the program revealed accreditation problems which were then discussed by BAN, PAUD, and PNF in Lampung to brainstorm appropriate solutions. The research provides the possibility for application of this program in other similar systems. Furthermore, it recommends that both schools and the National Accreditation Board (BAN) should establish education management in accordance with the national standard of education as stated in the accreditation system.

The Influence of Earnings Management and Board Characteristics on Company Efficiency

Earnings management is a means by which managers manipulate earnings to conceal the true performance of a company. The characteristics of the board of directors can also influence firm performance. This study applies data envelopment analysis (DEA) and the Tobin regression model to investigate the influence of earnings management and board characteristics on company efficiency. The data sample includes 396 Taiwanese electronics and biotechnology companies from 2009 to 2017. The results indicate that earnings management has an insignificant influence on company efficiency with mixed results on the interactions between earnings management and board characteristics. When companies practiced earnings management, director experiences, a higher proportion of female directors, and a higher number of board meetings increased company efficiency. In contrast, a higher number of independent directors and a higher attendance rate of the directors at the board meeting decreased company efficiency. The results of this study suggest that board diversity, more female directors, and meetings could still improve firm performance despite companies’ engagement in earnings management.

EP.WE.843Acute Appendicitis Management During the COVID-19 Pandemic: A Prospective Cohort Study From A Large UK Centre

Aims The aim of this study was to determine the efficacy and outcomes of conservative versus surgical management of acute appendicitis (AA) during the pandemic. Methods We conducted an observational study in a tertiary centre. Data was collected from all patients (≥16 years) with a diagnosis of AA between 1st November 2019 to 10th March 2020 (pre-COVID period) and 10th March 2020 to 5th July 2020 (COVID period). Results A total of 116 patients in the pre-COVID period were included versus 91 in the COVID period. 72.5% (n = 66) of the patients during the COVID period scored as high risk using the Alvarado score compared to 24.1% (n = 28) in the pre-COVID period (p-value&lt;0.001). We observed a significant increase in radiological evaluation, 69.8% versus 87.5% of patients had a CT in the pre-COVID and COVID periods respectively (p-value=0.008). 94.9% of patients were managed operatively in the pre-COVID period compared to 60.4% in the COVID period (p-value&lt;0.001). We observed more open appendicectomies (37.3% versus 0.9%; p-value&lt;0.001) during the COVID period compared to pre-COVID period. More abscess formation and free fluid were found intraoperatively in the COVID period (p-value= 0.021 and 0.023 respectively). Re-attendance rate due to appendicitis-related issues was significantly higher in the COVID period (p = 0.027). Conclusions Radiological diagnosis of AA was more frequent during COVID. More conservative management for AA was employed during COVID-19 pandemic, and for those managed operatively an open approach was preferred. Intra-operative findings were suggestive of delayed presentation during COVID without affecting the length of hospital stay.

Dental Attendances to General Medical Practitioners in Wales: A 44 Year-Analysis

One-third of the UK population is composed of problem-oriented dental attenders, seeking dental care only when they have acute dental pain or problems. Patients seek urgent dental care from a range of health care professionals, including general medical practitioners. This study aimed to identify trends in dental attendance at Welsh medical practices over a 44-y period, specifically in relation to dental policy change and factors associated with repeat attendance. A retrospective observational study was completed via the nationwide Secure Anonymised Information Linkage (SAIL) Databank of visits to general medical practice in Wales. Read codes associated with dental diagnoses were extracted for patients attending their general medical practitioner between 1974 and 2017. Data were analyzed with descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 439,361 dental Read codes, accounting for 288,147 patient attendances. The overall attendance rate was 2.60 attendances per 1,000 patient-years (95% CI, 2.59 to 2.61). The attendance rate was negligible through 1987 but increased sharply to 5.0 per 1,000 patient-years in 2006 (95% CI, 4.94 to 5.09) before almost halving to 2.6 per 1,000 in 2017 (95% CI, 2.53 to 2.63) to a pattern that coincided with changes to National Health Service policies. Overall 26,312 patients were repeat attenders and were associated with living in an area classified as urban and deprived (odds ratio [OR], 1.22; 95% CI, 1.19 to 1.25; P < 0.0001) or rural (OR, 0.84; 95% CI, 0.83 to 0.85; P < 0.0001). Repeat attendance was associated with greater odds of having received an antibiotic prescription (OR, 2.53; 95% CI, 2.50 to 2.56; P < 0.0001) but lower odds of having been referred to another service (OR, 0.75; 95% CI, 0.70 to 0.81; P < 0.0001). Welsh patients’ reliance on medical care for dental problems was influenced by social deprivation and health policy. This indicates that future interventions to discourage dental attendance at medical practitioners should be targeted at those in the most deprived urban areas or rural areas. In addition, health policy may influence attendance rates positively and negatively and should be considered in the future when decisions related to policy change are made.

Implementation of a Surgery Congress for Medical Students to Learn Transversal Competences. A Case of Student-Led Teaching Activity

Background: A dynamic training approach close to clinical work and research is highly requested by health sciences students. The aim of this paper is to present the organizational model of a student-promoted and student-managed surgical congress that encourages the acquisition of transversal competencies among the students in charge of the organization of the Congress. Methods: A two-day surgical congress for medical students organized by themselves was held. Each day comprised two separate sections corresponding to different surgical specialties; sections included three types of activities: conferences, round tables with guest professors, and practical workshops. Once the Congress had finished, an online survey was carried out to evaluate 10 items scored from 1 to 4. To assess the acquisition of transversal competences among the students organizing the congress, three evaluations were carried out by the professor involved in the organization of the congress. Results: The congress had great acceptance among the students, filling 150 available places with an attendance rate of 100%. The survey showed a high assessment of the subjects (3.48/4), conferences (3.48/4) and workshops (3.27/4). Evaluation of the round tables was significantly lower (2/4). A total of 99% considered the congress to have been useful in its formation process and 100% would recommend it. The grade of transversal competences among the students organizing the congress showed a significant increase between the first and the third evaluation, being between 1.24 and 7.25 times higher. Conclusions: the student-led student surgical congress is a well-evaluated activity for medical students, and promotes, among its organizers, the acquisition of transversal competences.

Feasibility of remote Memory Clinics using the plan, do, study, act (PDSA) cycle

Introduction A timely diagnosis of dementia is crucial for initiating and maintaining support for people living with dementia. The coronavirus disease (COVID) pandemic temporarily halted Memory Clinics, where this is organised, and rate of dementia diagnosis has fallen. Despite increasing use of alternatives to face-to-face (F2F) consultations in other departments, it is unclear whether this is feasible within the traditional Memory Clinic model. Aims The main aim of this service improvement project performed during the pandemic was to explore feasibility of telephone (TC) and videoconference (VC) Memory Clinic consultations. Methods Consecutive patients on the Memory Clinic waiting list were telephoned and offered an initial appointment by VC or TC. Data extracted included: age, internet-enabled device ownership, reason for and choice of Memory Clinic assessment. We noted Montreal Cognitive Assessment-Blind (TC) and Addenbrooke’s Cognitive Examination-III (VC via Attend Anywhere) scores, and feasibility of consultation. Results Out of 100 patients, 12 had a home assessment, moved away, been hospitalised, or died. 45, 21 and 6 preferred F2F, VC and TC assessments respectively. 16 were not contactable and offered a F2F appointment. The main reason for preferring F2F was non-ownership, or inability to use an internet-enabled device (80%). VC and TC preference reasons were unwillingness to come to hospital (59%), and convenience (41%). Attendance rate was 100% for VC and TC, but 77% for F2F. Feasibility (successful consultations) was seen in 90% (VC) and 67% (TC) patients. Conclusion For able and willing patients, remote Memory Consultations can be both feasible and beneficial. This has implications for future planning in dementia services.

842 Teleurology; A Prospective Study of Patient’s Perception and Real Time Experience in A Tertiary UK Centre

Aim To evaluate the clinical outcome and patient’s satisfaction of our real-time teleurology experience. Materials A prospective study, the whole cohort of face-to-face [FTF] clinics was shifted for telephone clinics. The data were collected prospectively for all appointments from 30th March to 3rd April. The primary objectives were clinic outcome and patient’s satisfaction evaluated using a validated questionnaire. The secondary objectives were number of non-attendance, percentage of face-to-face clinics and clinic demographics. Results Overall, 95 scheduled appointments for 7 consultants and 2 trainees. Telephone consultations performed for 75 patients, while 6 patients reviewed in FTF Clinics, and 14 patients classified as non-attendant. The non-attendance rate was 14.7%, with estimated 50% reduction in comparison to FTF rate prior to pandemic. The majority of patients (58%) treated conservatively while 14 (17.2%) patients commenced on medications, and 20 patients (24.6%) were listed for surgery. All patients but one (98.1%) agreed that cancelling FTF clinics was reasonable. The majority of the patients 94.2%, 96.2%, 84.6% found the telephone clinic was effective, long enough, and was easy to express their concerns over the phone, respectively. Approximately 90.4% and 100% satisfied with teleurology service and that clinicians were careful, respectively. Conclusions Our study elucidated the feasibility of teleurology in a real time setting and showed that it meets the tetrafecta of clinical outcomes, continuity of care, patient’s safety, and patient’s satisfaction. To our knowledge, this is the first study to assess patient’s perception of teleurology using a validated questionnaire.