A chronic disease management programme can reduce days in hospital for patients with chronic obstructive pulmonary disease

BACKGROUND

A steady increase in chronic obstructive pulmonary disease (COPD) admissions was addressed by enhancing primary care to provide intensive chronic disease management.

AIM

To compare the effect of a disease management programme, including a COPD management guideline, a patient-specific care plan and collaboration between patients, general practitioners, practice nurses, hospital physicians and nurse specialists with conventional care, on hospital admissions and quality of life.

METHODS

One hundred and thirty-five patients with a clinical diagnosis of moderate to severe COPD were identified from hospital admission data and general practice records. General practices were randomized to either conventional care (CON), or the intervention (INT). Pre- and post-study assessment included spirometry, Shuttle Walk Test, Short Form-36, and the Chronic Respiratory Questionnaire (CRQ). Admission data were compared for 12 months prior to and during the trial.

RESULTS

For respiratory conditions, mean hospital bed days per patient per year for the INT group were reduced from 2.8 to 1.1, whereas those for the CON group increased from 3.5 to 4.0 (group difference, P = 0.030) The INT group also showed an improvement for two dimensions of the CRQ, fatigue (P = 0.010) and mastery (P = 0.007).

CONCLUSIONS

A chronic disease management programme for COPD patients that incorporated a variety of interventions, including pulmonary rehabilitation and implemented by primary care, reduced admissions and hospital bed days. Key elements were patient participation and information sharing among healthcare providers.

Post-discharge surgical site infection surveillance by automated telephony

Surgical site infection (SSI) is an important outcome indicator after surgery and is part of a national programme of surveillance in Scotland. Post-discharge surveillance has important cost implications for both primary and acute areas of the NHS and it is therefore important to establish a robust method to obtain these data. This study used an automated telephony system to gain information on SSI developing post-discharge. The patients included were those who had inpatient surveillance carried out following hip and knee replacements, and cardiac surgery. A recorded message was used to ask the patient questions concerning the state of their wound. These questions were answered by pressing numbers on their phone. The study population was 104 and there were 18 patients who thought they had a wound infection but after clarification only nine patients suffered a post-discharge SSI. The number of patients who responded with at least one call to the system was 62. Although this pilot study was carried out with small numbers, it was felt that with certain refinements it should continue to be used for post-discharge surgical site surveillance of infection.

Membrane activity profiling of small molecule B. subtilis growth inhibitors utilizing novel duel-dye fluorescence assay

Small molecule disruption of the bacterial membrane is both a challenge and interest for drug development. While some avoid membrane activity due to toxicity issues, others are interested in leveraging the effects for new treatments. Existing assays are available for measuring disruption of membrane potential or membrane permeability, two key characteristics of the bacterial membrane, however they are limited in their ability to distinguish between these properties. Here, we demonstrate a high throughput assay for detection and characterization of membrane active compounds. The assay distinguishes the effect of small molecules on either the membrane potential or membrane permeability using the fluorescent dyes TO-PRO-3 iodide and DiOC2(3) without the need for secondary assays. We then applied this assay to a library of 3520 synthetic molecules previously shown to inhibit growth of B. subtilis in order to determine the frequency of membrane activity within such a biologically active library. From the library, we found 249 compounds that demonstrated significant membrane activity, suggesting that synthetic libraries of this kind do not contain a plurality of membrane active molecules.

21 Does the number of pre-operative assessments of strabismus patients influence the surgical outcome?

Surgical strabismus traditionally attended for several face-to-face (FTF) measurements before being listed for surgery. During the Covid-19 pandemic, a streamlined care-pathway was adapted to reduce FTF contact time to protect staff and manage floor-flow. Patients were listed for surgery after just one face-to-face orthoptic assessment, followed by a further measurement at pre-assessment.This is a case cohort to look at surgical outcome of all consecutive exotropia patients who underwent re-do horizontal muscle surgery over the last 14 years, from a surgeon's prospective database.65 patients had surgery before the pandemic (Group-A) and 28 since the pandemic (Group-B). The mean age was 34.9 and 39.1 years respectively. The mean pre-operative near-angle was 37.5 prism dioptres (PD) and distance-angle of 34.8PD for group-A. Group B was 39.3PD for near and 36.3PD for distance. 89.1% in group-A and 89.2% in group-B had suppression. Postoperative alignment within 15PD was achieved, after a combination of fixed and adjustable procedures, for 75.4% in group-A and 88.5% in group-B with predominant adjustable procedure. The mean 2-weeks post-operative alignment was -1PD for group-A and -1.3PD for group-B. Group-A had an average of 3.6 measurements, with 3.3 doctor consultant prior to surgery and group-B had 2 FTF orthoptics and 1 FTF doctor contact.44.4% reduction in face-to-face orthoptics contact-time and 69.7% less consultant contact-time had not negatively affected the patient surgical outcome.Strabismus surgery can be considered in selected cases with less FTF pre-operatively and improve cost-efficiency of our adult strabismus service with 'block-contract' status.