Objective: Given growing interest in alternatives to hospital birth, particularly given the COVID-19 pandemic, we developed a peripartum intervention risk calculator (PIRC) to estimate maternal and neonatal risk of requiring hospital-based peripartum intervention. Design: National cohort study. Setting: United States. Sample: Hospital births captured by the Pregnancy Risk Assessment Monitoring System from 2009-2018. Methods: The cohort was stratified by receipt of hospital-based interventions, defined as: 1) operative vaginal delivery (forceps or vacuum), 2) cesarean delivery, or 3) requiring neonatal intensive care unit admission. Gravidas with prior cesarean delivery or fetal malformation were excluded. Main Outcome Measures: Risk of requiring hospital-based intervention. Results: A total of 63,234 births were evaluated (72.6% full-term, 48.5% nulliparous) including 37.9% who received one or more hospital–based interventions. Gestational age was the most predictive factor of requiring hospital-based intervention, with lowest odds at 400/7-406/7 weeks. Previous live births (Ref: none; 1, OR 0.41; 2, OR 0.35; ≥3, OR 0.29; p<0.05 for all) were protective. Other predictors included advanced maternal age, high pre-pregnancy body mass index, maternal diabetes, maternal hypertension, and not exercising during pregnancy. The resulting seven-factor model demonstrated strong discrimination (optimism corrected C-statistic=0.776) and calibration (mean absolute error=0.009). Conclusions: We developed and validated the PIRC for predicting individualized risk for hospital-based intervention among gravidas based on seven readily accessible prenatal factors. This calculator can support personalized counseling regarding planned birth setting, helping to close a critical gap in current clinical guidance and providing an evidence-based risk assessment for those contemplating alternatives to hospital birth.

Rationale, aims and objectives: Consistent data demonstrates negative psychological effects of caregiving on front-line health professionals. Evidence that psychological resilience factors can help minimise distress and the potential for low-cost interventions have created interest in resilience-based development programmes; yet evidence of perceived value amongst health professionals is lacking. This study explored health professionals’ experiences and perceptions of a novel, resilience-based intervention designed to pro-actively prepare staff for coping with error; to investigate their perceptions of what resilience meant to them, the relevance of the intervention, and impact of participation on ability to cope with error. Method: Semi-structured interviews 4-6 weeks post intervention with 23 randomly selected participants from seven cohorts (midwives, paediatricians, obstetrians/gynaecologists, paramedics) and trainees (physician associates, mammographers, sonographers). Thematic analysis of interview data. Findings: Participants reported various interpretations of, and a shift in perception regarding what the concept of psychological resilience meant to them and their practice. These included for example, resilience as a positive or negative concept and their awareness and response to a range of personal, organisational and system factors influencing personal resilience. They valued the prophylactic, clinically relevant, interactive and applied nature of the intervention; having developed and applied valuable skills beyond the context of involvement in error, noting that individuals needed to be willing to explore their own coping mechanisms and human fallibility to gain maximum benefit. There was also consensus that whilst proactively developing individual level psychological resilience is important, so too is addressing the organisational and system factors that affect staff resilience which are outside individual staff control. Conclusion: Enhancing resilience appears to be considered useful in supporting staff to prepare for coping with error and the wider emotional burden of clinical work, but such interventions require integration into wider system approaches to reduce the burden of clinical work for health professionals.

Title: Intratympanic gentamicin injection in Ménière’s disease: our twelve years’ experience and outcomes. Objective: The aim of our study is to evaluate the effectiveness of intratympanic gentamicin injection(ITG) on vertigo control with reduced doses and its hearing effects. Study design: Retrospective study Materials and Method: The study was conducted at our Otolaryngology Department of AORN “S.G. Moscati” between January 2005 and January 2015 on 72 patients with disabling unilateral Meniere’s disease treated with ITG. We use 0.2-0.3 mL of gentamicin sulfate at a concentration of 40mg/ml, injected into the affected ear through the posterior-inferior quadrant of the tympanic membrane. The procedure was carried out for three following days. Main outcome measures: vertigo control and hearing threshold changes after ITG treatment. Results: In the 98.6% of the patients (n=71) the ITG produced the full remission of the vertiginous symptoms. In the 91.6% of cases(n=66) a single treatment (three consequent injections) was sufficient to control vertigo, in the 5.5% of cases (n=4) two treatments were necessary to control vertigo and in the 1.3% of patients(n=1) three treatments were necessary to control vertigo. In no case we have had hearing loss after ITG procedure. The pre-treatment pure tone average was 48 db. The post-treatment pure tone average was 49.2 db. This difference was no statistical difference. Conclusion: In this study we reported high vertigo control, long follow-up and no case of significant hearing worsening. We consider the three injections in the following three days with low doses of gentamicin a safe and valid treatment for Meniere’s disease. Keyword : Meniere’s disease, intratympanic gentamicin injection, vertigo control, hearing worsening, aminoglycoside ototoxicity.

Objective Post-menopausal nocturia is poorly understood. This study aimed to identify hormonal and lifestyle factors associated with nocturia and to understand the relative contribution of altered urine production and bladder storage dysfunction in women. Design, setting, population and methods Women ≥40 years presenting to public continence services were enrolled in a cross-sectional study. 153 participants completed a hormone status questionnaire, a validated nocturia causality screening tool and a 3-day bladder diary. Descriptive statistics and logistic regression models for nocturia severity and bladder diary parameters were computed. Results Overall, 91.5 % reported nocturia, 55% ≥2 /night. There was a difference of 167.5 mL (p<0.001) in nocturnal urine volume between women with nocturia ≥2 (median 736mL) vs less often (517mL). Significant predictors of self-reported disruptive nocturia were age (OR 1.04, 95%CI 1.002-1.073) and vitamin D supplementation (OR 2.33, 95%CI 1.11-4.91). Nocturnal polyuria was significantly more common with nocturia ≥2 compared to less often (p<0.002). 150 minutes of exercise per week was protective for nocturnal polyuria (OR 0.22, p=0.001). Nocturia index >1.3 was significantly predicted by age (OR 1.07, p<0.001), regular exercise (OR 0.41, p=0.036), day flushes (OR 4.00, p=0.013) and use of Vitamin D (OR 2.34, p=0.043). Maximum voided volumes were significantly lower with nocturia≥2 vs less often (night: 268ml vs 350mL; day: 200mL vs 290mL). Conclusions Bothersome nocturia in post-menopausal women is associated with changes to both nocturnal diuresis and bladder storage. Regular physical activity, prolapse reduction and oestrogen replacement may be adjunctive in managing bothersome nocturia in women.

Introduction: Referrals for OE have increased but the reasons for this remain unclear. We characterise referrals to inform primary secondary care interface improvements. Methods: Questionnaire study from dedicated consultant-led research clinic for OE referrals. Results: 62 patients responded; 63% female, mean age 54 years. One was excluded (not OE). Most had multiple primary care visits before referral (average 4 GP; 2 practice nurse). 60% had received oral antibiotics (16% multiple classes). 18% had never had ear drops. 39% were not advised to keep ears dry. 21% had dermatitis; 13% contact allergy, 30% systemic allergy, 5% diabetes. <10% had narrow canals. 36% had active discharge but <7% needed a wick. Conclusion: OE occurs most commonly in women - often with associated risk factors. Lifestyle advice and ototopical drops are frequently overlooked; instead often inappropriately treated with oral antibiotics. Most ear were anatomically normal and community aural care clinics may have a role in reducing referrals.

Rationale, Aims and Objectives: Alignment between patients’ treatment choices and treatments received is acknowledged as an important outcome of shared decision-making (SDM), yet recent research suggests that patients’ choices do not always align with their actual treatment trajectories. This paper explores the alignment of patient-expressed treatment choices (for surgery or medical management) after exposure to decision aids and treatments received among patients with hip or knee osteoarthritis within High Value Healthcare Collaborative (HVHC) systems as the collaborative integrating decision aids intended to support SDM into routine clinical practice. Method: This retrospective cohort study examines data from adult (>18 years) patients with hip or knee osteoarthritis who received decision aids as part of orthopedic consultations within HVHC systems between 2012-2015. Multivariate logistic regression explored the association between patient-level characteristics with the odds of treatment choice-receipt alignment. Results: The majority of patients with knee osteoarthritis (68.3%) and hip osteoarthritis (71.9%) received treatments aligned with their choices following exposure to decision aids, but analyses reveal important differences in the odds of such alignment across patient characteristics. In adjusted models, African American patients with knee osteoarthritis had 50% lower odds of receiving treatment aligned with their choices compared with white patients (OR = 0.52, p<0.05). Medicare- or Medicaid-insured knee patients had 49% and 59% lower odds (respectively) of receiving choice-aligned treatments relative to privately insured patients. Patients with knee (OR = 0.40, p<0.01) or hip (OR = 0.75, p<0.05) osteoarthritis at earlier decision-making stages had lower odds of receiving treatments congruent with their choices. Conclusion: This work elucidates the odds of treatment choice-aligned care for patients within health care systems attempting to routinely integrate decision aids to support SDM into clinical practice and underscores the gaps in achieving this alignment among African American patients, those with public insurance and those at early decision-making stages.

Objective To explore and describe what women who have given birth in Norway emphasise as important aspects of care during childbirth. Design The study is based on data from the Babies Born Better survey, version 2, a mixed-method online survey. Setting The maternity care system in Norway. Study population Women who gave birth in Norway between 2013 and 2018. Method Descriptive statistics were used to describe sample characteristics and to compare data from the B3 survey with national data from the MBRN, using SPSS® software (version 20). The open-ended questions were analysed with an inductive thematic analysis, using NVIVO 12® software. Main outcome measures Themes developed from two open-ended questions. Results The final sample included 8,401 women. There were no important differences between the sample population and the national population with respect to maternal age, marital status, parity, mode of birth and place of birth, except for the proportion of planned homebirths. Four themes and one overarching theme were identified; Compassionate and Respectful Care, A Family Focus, Continuity and Consistency, and Sense of Security, and the overarching theme Coherence in Childbearing. Conclusions Socio-cultural and psychological aspects of care are significant for women in childbirth, alongside physical and clinical factors. Caring for the woman implies caring for her partner and having a baby is about ‘becoming a family or expanding the family’. Childbirth is a continuous experience in women’s lives and continuity and consistency are important for women to maintain and promote a coherent experience.

AIM To explore the admission process to our Neonatal Intensive Care Unit. METHODS A first phase quality improvement initiative was conducted. We utilised observational video recording of a convenience sample of inborn admissions. Two remote GoPro cameras were placed, one giving an overview of activity and the other focussed on the infant. Recordings captured the first hour after admission including transfer to the NICU by the birthing team. The video footage of each case study was reviewed by a multidisciplinary panel using an agreed semi quantitative analysis of events. RESULTS Ten admissions to the NICU were video recorded between June and October 2018. Gestational age 282- 401. A focus on maintaining airway support was inconsistent as was the ability to provide continuous monitoring of vital signs. Overall leadership of the process was lacking, and handover often appeared fragmented. Median temperature on admission was 362 (354-373) oC. Vascular access and fluid management occurred at a median of 36 (13 – 67) minutes. CONCLUSIONS Planning and approval for this study was protracted, particularly negotiating the use of video recording. Anecdotally, this delay is thought to have contributed to an improvement in managing admissions, particularly when maintaining airway support and monitoring. However, our baseline data has highlighted a lack of leadership, fragmented handover, low admission temperatures and broad time frames to achieve vascular access. A guideline to streamline handover and nursery transition is currently being implemented, a subsequent evaluation cycle is planned.

With the changes of the times and the growth of public demand for medical services, the service objects, service contents and service approaches of hospital pharmacists are also changing and increasing. By summarizing the changes of hospital pharmacists' practice in hospitals and their contributions to the improvement of hospital service quality in the practice of hospital pharmaceutical care, this paper hopes that more doctors, nurses and patients can have a more in-depth understanding of the specific work of pharmacists, which, at the same time, will also provide some reference for pharmacists at home and abroad to optimize the level of pharmaceutical care. Compared with doctors and nurses, hospital pharmacists have a much more systematic and professional drug knowledge system and service concept, which can guarantee that they can undertake the responsibilities of rational use of drugs, control of medical expenditure, guarantee of efficacy, reduction of medical risks, reduction of doctors' workload, improvement of national health and so on. After years of practice and research, pharmacists have gradually realized their own value and established professional needs through hospital pharmaceutical care.

Abstract Introduction: One stop neck lump clinics (OSNLC) are gaining popularity worldwide especially in the UK hospitals following NICE recommendation. The main aim of this speciality clinic is quick diagnosis and early management while simultaneously improving patient experience. Objectives: To analyse and compare the efficacy of OSNLC and general ENT/Head and neck clinic with specifics to number of appointments required for formulating management plan and number of ‘one stop’ visits. Design: Retrospective observational study Setting: Regional Head and Neck Cancer Center (Secondary care hospital) Participants: Patients referred by General practitioner with symptoms of neck lump Main outcome measures: Patients seen in general ENT/Head and neck and OSNLC in 2 phases to understand the difference in number of appointments, one stop visits, requirement of Ultrasound and efficiency of Fine needle aspiration. Results and Conclusions: Improved efficacy of OSNLC was noted as patients seen in clinic required lesser number of appointments, reached a faster diagnosis and management plan when compared to patients seen in general ENT clinic.

Key Points • Sepsis is associated with high morbidity and mortality and is a known complication of infections of the head and neck. Screening for sepsis should be conducted on admission in order to identify patients at risk and provide early intervention. • Our audit on an ENT ward in a district general hospital found that sepsis screening is poor, however this can be improved further by education and visual reminders such as poster or a clerking proforma. • The most common head and neck infections admitted to a district general hospital were tonsillitis, peritonsillar cellulitis and peritonsillar abscesses. • The incidence of sepsis as a complication of head and neck infections is very rare if diagnosed according to the updated qSOFA criteria. • Using SIRS criteria may result in falsely high rates of diagnosis of sepsis and may lead to excessive and inappropriate clinical management in patients who could otherwise be managed less aggressively.

Background: Despite advances in endoscopic transnasal transsphenoidal surgery (E-TNS) for pituitary adenomas (PAs), cerebrospinal fluid (CSF) leakage remains a life-threatening complication as it predisposes to meningitis and tension pneumocephalus. The purpose of the current study is to develop an accurate supervised ML model able to predict the risk of intraoperative CSF leakage by comparing different machine learning (ML) methods. Methods: A cohort of patients consecutively treated via E-TNS for PAs was selected. Clinical, radiological and endocrinological preoperative data were reviewed and elaborated through a features selecting algorithm. A customized pipeline of several ML models was programmed and trained in parallel; the best five models were included for further analyses. Selected risk factors were then used for training and hyperparameters optimization. Results: Intraoperative CSF leak occurred in 54 (22,6%) of 238 patients. Best risk’s predictors were: non secreting status, older age, x-, y- and z-axes diameters, ICD and R ratio. The random forest (RF) classifier outperformed other models, with an AUC of 0,84, high sensitivity (87%) and specificity (82%). Positive predictive value and negative predictive value were 69% and 93% respectively. F1 score was 0,87. Conclusion: A supervised machine learning prediction model able to identify patients at higher risk of intraoperative CSF leakage was trained and internally validated. The random forest classifier showed the best performance across all models selected by the authors. RF models might predict surgical outcomes in heterogeneous multimorbid and fragile populations outperforming classical statistical analyses and other machine learning models.

Five Key PointsTeam debrief is known to improve teamwork and safety.In our study of various staff groups, a third of did not have access to debrief.Exposure to team debrief was associated with better Culture of Care Barometer scores.Quality of debrief matters also: staff found structured, coaching and manager-led meetings to be more effective, useful and engaging than debriefs consisting of quick comments or informal discussion only.Debrief could be one of the ways to improve team culture.Keywords: debrief, surgical specialties, culture, coaching, professional burnout, staff engagement, operating rooms, WHO Surgical Safety Checklist

Objectives Tonsillectomy, grommet insertion and adenoidectomy are only permissible in the UK when specific criteria are met. , Children from deprived backgrounds are more likely to require tonsillectomy. Our aim was to assess correlation between tonsillectomy and deprivation plus tonsillectomy and related infections. Design Retrospective observational study of data provided by Information Service Division between 1996/7 and 2016/17. Socio-economic background was determined by Scottish Index of Multiple Deprivation (SIMD) score. Setting and Participants Complete national data for all patients under 16 years old admitted to Scottish NHS hospitals. Main outcome measures Admission to hospital for ENT procedures and ENT-related infections. Results 60,456 tonsillectomies were performed during the study period, significantly fewer following the introduction of SIGN guidelines. Children from the most deprived areas were 72.0% more likely to receive tonsillectomy than the least deprived. Significantly increased rates of tonsillitis were observed following the introduction of SIGN guidelines. The most deprived children were 59% more likely to be admitted with quinsy than the least deprived. Conclusion Tonsillectomy rates are highest in the most deprived. Complications of throat infection appear to be increasing following the introduction of SIGN and NICE guidelines.

Rationale, aims and objectives: People living with dementia admitted to hospitals are more likely to experience poorer outcomes than people without dementia. Caregivers play an important role in managing medications across transitions of care. This qualitative study explores the experiences and perspectives of caregivers about the medication management guidance provided at hospital discharge. Methods: A qualitative approach using semi-structured, telephone interviews was conducted with 31 caregivers of people with dementia across Australia. Purposive sampling was used to ensure maximum variation of diverse experiences and perspectives. Results: Caregivers’ experiences of medication guidance for people with dementia at discharge were described in three themes including: a) inadequate information about medication management at discharge; b) limited caregiver engagement in medication management decisions; and c) difficulties ensuring medication supply post discharge. Most participants indicated they would like to be included in discussions at discharge. However, participation was influenced by caregivers being overwhelmed by discharge processes; proactively seeking information on medication-related harm; and belief in advocacy as part of their caregiver role. Caregivers reported they would like to receive a tailored medication list for people with dementia which included information on medications that may impact on the patient’s cognition, and for hospital staff to communicate with both the community pharmacist and primary care physician, to improve co-ordination post transition. Discussion: In our study of caregivers of people with dementia, we identified key recommendations that could be tested to facilitate regular participation of people living with dementia and their caregiver around medication guidance at discharge.

Objective: This study aimed to evaluate the effectiveness of maternal and child health handbook (MCH) enhanced by mobile tools and to generate evidence informing the adoption of the program in Bangladesh Design: Cluster randomized controlled trial Setting: Two Upazilas in Bangladesh Population or Sample: Pregnant women Methods: Unions of the study settings were randomly allocated in either one of three groups: (1) Intervention 1 using both mobile platform and MCH, (2) Intervention 2 using MCH alone, or (3) the Control. A total of 3,002 participants were recruited. The interventions were designed to promote two-way communications between pregnant women/their families and community health workers by an empowering approach. Main outcome measures: continuum of care (CoC), neonatal mortality and morbidities Results: The interventions both significantly improved the utilization of CoC, although the overall proportion of CoC was relevantly low: 2.79% in the Control (95% CI: 1.37-3.54%), 6.16% in Intervention 2 (95% CI: 4.67-7.86%), and 7.89% in Intervention 1 (95% CI: 6.29-9.90%). Neonatal mortality rate with and without CoC was 5.43 per 1,000 (95% CI: 3.63 - 9.57 per 1,000) and 34.8 per 1,000 (95% CI: 24.3 - 45.4 per 1,000), respectively. Conclusion: our study indicated the effectiveness of the interventions by leveraging MCH and a mobile platform to promote uptake of CoC throughout prepartum, intrapartum and postpartum/neonatal periods, potentially bringing long-lasting benefits to mothers and their offspring. The explicit approach is expected to guide policy makers to adopt MCH interventions in primary healthcare strengthening at the community level.

Aim: To investigate the difference in both numbers and acuity of presentations to the Paediatric Emergency Department (PED) during the peak time period of the current global SARS-CoV-2 pandemic. Design: This single centre retrospective observational study used routinely collected electronic health data to compare patient presentation characteristics between 21st March and 26th April 2020 compared to the equivalent time period in 2019. Results: There was a 90% decrease in attendances to PED, with a 10.23% reduction re-attendance rate. Children presenting were younger during the pandemic, with a median age difference of 2 years. They were more likely to present in an ambulance (9.63%), be admitted to hospital (5.75%) and be assigned the highest two Manchester triage categories (6.26%). There was a non-significant trend towards longer lengths of stay. The top 10 presenting complaints remained constant (although the order changed) between time periods. There was no difference in mortality or admission to PICU. Implications: Our data demonstrates that there has been a significant decrease in numbers of children seeking emergency department care. It suggests that presenting patients were proportionally sicker during the pandemic; however, we would argue that this is more in keeping with appropriate acuity for PED presentations, as there were no differences in PICU admission rate or mortality. We explore some of the possible reasons behind the decrease in presentations and the implications for service planning ahead of the winter months.

Rationale, aims and objectives Patients with anterior crucial ligament injury are faced with a choice between surgery or non-surgical treatment with intensive rehabilitation. Evidence shows that surgical treatment is not superior to non-surgical treatment. To offer patients a treatment meeting their individual values, lifestyle and conditions, patients must be involved in the decision-making. The aim of the study was to develop and evaluate a patient decision aid to support shared decision-making. Method Development of the patient decision aid was based on international criteria, current literature, and former patients’ experiences and suggestions on how to optimize the decision-making process. The patient decision aid was evaluated by the SDM-Q9 questionnaire and semi-structured interviews with patients and doctors. Results A patient decision aid for patients with and an anterior crucial ligament injury was developed. On a scale from 0-5, patients experienced a high degree of shared decision-making in their treatment decision both before (score 4.3) and after (score 4.3) implementation of the patient decision aid. No statically significant difference was found (p=0.72). From interviews, patients expressed that they found the patient decision aid very useful. Especially, reflection time was important for some patients. Doctors reported that the patient decision aid improved shared decision-making by supporting the dialogue clarifying patients’ values concerning issues important for treatment choices. Conclusion No statically significant difference in the SDM Q9 -score was found between patients’ perceptions of shared decision-making before and after implementation of a patient decision aid. However, patients experienced the decision aid as very useful when making treatment decisions, and doctors reported that it improved the dialogue clarifying patients’ values important for the treatment options. Keywords patient-centered care, evaluation, person-centered medicine

Purpose:It is known that because of the pandemic, the psychosocial conditions of health workers have been affected and this carry the risk of increasing COVID-19-related mortality and morbidity by obstructing effective contact tracing. Purpose this study to determine anxiety disorders which may occur in primary contact tracers and family health center workers, and to determine their perceptions of institutional support and support from their coworkers. Results:It was found that 56.1% of participants had anxiety, 44.2% insomnia, 43.6% a low perception of organizational support, and 37.5% a lack of support from coworkers. Females and those with chronic illnesses had high levels of anxiety and insomnia and low perceptions of support from coworkers. Insomnia severity in contact tracers was high, and their support from coworkers was low. There was a positive correlation between anxiety and insomnia, and a negative correlation between organizational support and support from coworkers. It was shown in our study that sleep problems and a reduction in team and institution support increased anxiety, and reduced the team cohesion of field workers and trust in the institution. Because contact tracing is preformed independent of time, an increase in the frequency of contacts may cause anxiety and insomnia. High anxiety in females may be a result of a perception of low support from coworkers. Conclusion:Plans should be made to increase the effectiveness of training and support given to primary healthcare workers, and to operate speaking and reward mechanisms to increase motivation. For this the organizational strength of primary health care providers should be increased.

Rationale, aims and objectives Discharging low-risk pregnant women is not usually contemplated in any procedure and obstetricians are therefore fully responsible for making this decision. Thus, a protocol establishing the procedures, tasks, aims, and activities of each healthcare professional involved in such cases would allow to streamline the process of admission and discharge of low-risk pregnant women with a normal pregnancy. The aim of this study was to establish the effectiveness and safety of a standardised assessment programme for the decision-making process of midwives in relation to the admission of pregnant women in a hospital emergency department. Method Retrospective observational cohort study evaluating the decision-making process of midwives when assessing pregnant women in an emergency department during the study period 2016-2017. The study population consisted of low- to moderate-risk pregnant women with a normal pregnancy who presented to the obstetric emergency unit (labour and delivery room) because of vaginal spotting, uterine contractions, bleeding, absence of foetal movements and/or suspected rupture of membranes. The primary study variable was the appropriateness of the decisions made by midwives (whether discharging or admitting pregnant women) in an obstetric emergency unit. Safety was assessed by the incidence of neonatal complications based on the Apgar test for women who had previously been discharged. Results The performance of the instrument used was found to be excellent as both the negative predictive value (appropriate discharge) and the positive predictive value (appropriate admission) were greater than 95%. In the safety evaluation, only one in every 200 newborns had an Apgar score at five minutes less than seven. Conclusions The adequacy of our standardised assessment programme has been found to be excellent, with an almost perfect performance based on the negative predictive value and appropriate safety margins based on the Apgar scores at birth obtained for previously discharged cases.

Background: FESS encompasses numerous component procedures including antrostomy, ethmoidectomy, sphenoidotomy and frontal sinusotomy. The extent of FESS procedure will vary between patients depending on indications, imaging and surgical experience. Each procedure is remunerated according to procedural components with each component assigned an OPSC-4 cost code. In NHS hospitals, this relies on clinical coders’ interpretation from the operation note, and may potentially be subject to incorrect coding and remuneration. Background: We have devised a FESS documentation tool which includes a tick box system for each component and allied procedures performed, together with relevant OPSC-4 codes.The aim of this novel FESS operation note is to improve accuracy of coding for procedures, avoid misinterpretations and ensure accurate remuneration for FESS procedures. Design: Retrospective quality improvement study. Methods: The tool was implemented in our hospital in April 2019. Codes and costs applied to each patient undergoing FESS for a 6-month period between April to October 2019 were compared for all cases performed during the same 6 month period in 2018. Data review of coding information was performed between the two time periods including T-test analysis to calculate for statistical significance. Results: 66 patients underwent FESS in 2018 compared to 70 patients in 2019, during the equivalent 6 month period. The tool was not used in two cases in the 2019 cohort. In 2018, the average cost applied to each FESS case was £1,676, compared to £1,953 per patient in the 6 months after the tool was implemented. This resulted in an average uplift of £277 in revenue per patient where the tool was used (p=0.003), due to more accurate capture and coding of FESS component parts. On average ,approximately 140 patients undergo FESS per year in our department; using the newly devised FESS documentation tool, we can estimate a potential increase in revenue of £38,780 per annum for FESS procedures alone. Conclusion: Our novel documentation tool has improved the clarity of recording endoscopic sinus surgery allowing more accurate interpretation and application of OPSC-4 coding. It also aids in understanding complex composite procedures and can be extended to other surgical specialties.

Objectives The COVID-19 disease had an incredible impact on both hospital-based and private practices in the field of otorhinolaryngology and head and neck surgery. Practical issues faced by both types of practice were not well addressed in most studies. A national study was designed to address these issues. Design Prospective questionnaire-based study Setting Online google questionnaire sent to members of the Czech Society of Otorhinolaryngology and Head and Neck Surgery Participants All doctors practicing Otorhinolaryngology in Czech Republic with access to online link to questionnaire between 15th April and 26th April 2020. Main outcome measures Primary aims of the study was to evaluate any significant differences between the two types of practice in the field of Otorhinolaryngology. We formulated null hypotheses stating there were no statistical differences in the preparation and availability of personal protective equipment amongst both practices a month after the first cases of COVID-19 in Czech Republic. Statistical analyses including the Mann-Whitney U test were performed to test the hypotheses. Results Analysis and results were based on completion of the entire questionnaire by the doctors. There were no statistically significant differences between both the practices, however individual analyses of both the practices showed a different outcome. Conclusion Despite our statistical results, it was observed that private practices faced more deficits and were more financially vulnerable. They were also other issues reported by both practices that could compromise the care of patients, functioning of workplaces and support of doctors.

Rationale, aims and objectives Given the importance of screening for liver cancer and the lack of relevant research, this study aims to investigate the factors influencing physicians’ utilization behavior of contrast-enhanced ultrasound (CEUS) by verifying the proposed research hypotheses based on the integration of the Theory of Planned Behavior and Technology Acceptance Model. Methods A cross-sectional study was conducted in Fujian and Jiangxi province, where has a high and low incidence of liver cancer in China, respectively. Two medical consortiums were randomly selected from each province, and 50% of the medical institutions were randomly selected from each medical consortium. Physicians working in liver disease-related departments of the selected medical institutions were invited to participate in the questionnaire survey. Structural equation modeling was used to analyze the collected data. Results A total of 309 physicians were enrolled. The results showed that the research model fits the data well (χ2/df=2.906, CFI=0.947, TLI=0.939, and RMSEA=0.079). Physicians’ intention to use CEUS was directly associated with utilization behavior (β=0.287, P<0.001). Attitude (β=0.272, P<0.001), subjective norm (β=0.172, P<0.001), perceived behavioral control (β=0.491, P<0.001) and perceived usefulness (β=0.108, P<0.05) were significantly influence physicians’ intention. Besides, subjective norm (β=0.065, P<0.05), perceived behavioral control (β=0.141, P<0.01), and perceived ease of use (β=0.022, P<0.05) indirectly affected physicians’ utilization of CEUS. Conclusions The findings not only benefit expanding the knowledge of factors associated with physicians’ utilization behavior of CEUS, but also have implications for promoting the utilization of CEUS and other health technologies, such as building innovative and incentive environment, mobilizing the senior physicians and managers, and providing high quality and adequate training.

Rationale, aims and objectives: The participation of all health professionals is essential for ensuring a quality and successful national postmarketing surveillance program. The aim of this study was to assess the knowledge, attitudes, and practices (KAP) among Yemeni community pharmacists (CPs) regarding medication safety in a poor-resource setting. Methods: A survey was conducted among CPs in Aden governorate. The tool comprised of: demographic profile, knowledge-, attitude- and practice-aspects of medication safety. The survey also studied the opinion about future and benefits of ADR reporting in Yemen. The data collected from the questionnaires was analyzed using the Statistical Package for Social Science version 21.0. Descriptive statistics such as frequencies, percentages, and means (SD) were used in the analysis. Results: A total of 450 CPs were enrolled in the study. Most of the participants were males (75%) with a bachelor’s degree (91.9%) and between 3-6 years of experience (28%). The majority of CPs had good knowledge regarding the perception and objectives of PV as well as ADRs. Approximately 41% of participants knew the purpose of PV as an essential system for public health and safety with regard to drug use. Additionally, the Yemeni pharmacists had a positive attitude towards the reporting system. Approximately 84% of responders admitted that PV is the responsibility of the pharmacists. The majority of the participants (80%) declared that there is no reporting form available at their workplace. According to CPs, 59% said that ADR reporting in Yemen is not widely promoted by relevant authorities, and 57% replied that lack of information provided by the patient is an obstacle in the reporting system. Approximately 89% of the CPs believed that reporting ADRs would improve patient safety. Conclusions: The CPs have a positive attitude towards PV and an acceptable degree of knowledge. However, the practice level should be upraised.