Introduction: Ophthalmology services have been significantly impacted by the COVID-19 pandemic. Frequency of intravitreal anti-vascular endothelial growth factor (Anti-VEGF) injections are important in visual outcomes. Methods: We conducted an audit on intravitreal services in an NHS district general hospital in the UK including all new patients with diabetic macular oedema (CI-DMO) and wet age-related macular degeneration (AMD) who were initiated on intravitreal injection of Aflibercept (EYLEA) between 1st January to 15th July 2020, and had subsequent injections until October 2020. Data on injection dates and visual acuity was extracted, and the total number of all intravitreal injections for all indications between January to September 2020 and the same period in 2019. Delay to treatment was defined as more than 14 days, according to the fixed dosing schedule. Results: We found 31% (n=17) of patients initiated on treatment for wet AMD and 44% (N=11) for CI-DMO had delayed injections. There was no correlation between total duration of delay and change in best-corrected visual acuity (BCVA). Similarly, we found no association between duration of delay and change in BCVA. The number of intravitreal injections declined during the COVID-19 pandemic by 17.8% compared to 2019. Conclusion: Majority of patients initiated on anti-VEGF injections just before the pandemic or during the pandemic received injections on time. Where there were significant delays to treatment, there was no detected loss in vision over the short term. However, the long-term impact and impact of overall reduction in intravitreal injections are unknown.
{"title":"Effect of COVID-19 Pandemic on Anti-VEGF Treatment of Medical Retinal Conditions","authors":"M. Rahimzadeh, R. Muniraju, S. Izadi","doi":"10.38192/1.6.3.10","DOIUrl":"https://doi.org/10.38192/1.6.3.10","url":null,"abstract":"Introduction: Ophthalmology services have been significantly impacted by the COVID-19 pandemic. Frequency of intravitreal anti-vascular endothelial growth factor (Anti-VEGF) injections are important in visual outcomes.\u0000Methods: We conducted an audit on intravitreal services in an NHS district general hospital in the UK including all new patients with diabetic macular oedema (CI-DMO) and wet age-related macular degeneration (AMD) who were initiated on intravitreal injection of Aflibercept (EYLEA) between 1st January to 15th July 2020, and had subsequent injections until October 2020. Data on injection dates and visual acuity was extracted, and the total number of all intravitreal injections for all indications between January to September 2020 and the same period in 2019. Delay to treatment was defined as more than 14 days, according to the fixed dosing schedule.\u0000Results: We found 31% (n=17) of patients initiated on treatment for wet AMD and 44% (N=11) for CI-DMO had delayed injections. There was no correlation between total duration of delay and change in best-corrected visual acuity (BCVA). Similarly, we found no association between duration of delay and change in BCVA. The number of intravitreal injections declined during the COVID-19 pandemic by 17.8% compared to 2019.\u0000Conclusion: Majority of patients initiated on anti-VEGF injections just before the pandemic or during the pandemic received injections on time. Where there were significant delays to treatment, there was no detected loss in vision over the short term. However, the long-term impact and impact of overall reduction in intravitreal injections are unknown.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89338377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Rahimzadeh, G. S. Alg, Aisling Robinson, A. Moseley
Introduction: Falls are a major cause of morbidity and mortality in older people, and those with reduced visual acuity are twice as likely to fall as those with normal eyesight. Accordingly, NICE guidelines recommend assessment of vision as part of a multi-factorial risk assessment in older people, who present for medical attention, because of a fall. Methods: We included all patients admitted to a senior health ward at St George’s hospital because of a fall. A baseline audit was conducted in May 2020. Our primary intervention was a departmental teaching session with subsequent first cycle data. We trialled the ‘Lookout! Bedside vision check for falls prevention’ recommended by the Royal College of Physicians. Our secondary intervention was designing an ‘initial assessment’ proforma to include a section for sensory impairment followed by a second cycle data collection. Results: Our initial results showed that none of the 24 patients admitted with a fall had any form of documented visual assessment. Using a simple bedside vision check tool, we found 22% (n=2) of screened patients had significantly impaired vision. Following our teaching session, 50% (n=7) of patients had some form of visual assessment on admission and after introduction of the proforma, this increased to 56% (n=5). Visual risk factors were identified in multiple patients, including outdated prescriptions for corrective glasses. Discussion: Identifying reversible visual risk factors may reduce recurrent falls and subsequent complications as well as hospital admissions in older patients. A teaching session was found to be effective, however a ‘proforma’ may encourage more sustainable improvements. The reduction in ophthalmology and optometry services during the Covid-19 pandemic will inevitably increase the prevalence of visual risk factors. Effects including delayed eyesight tests and cataract operations. It is therefore more important now than ever, to ensure bedside assessment of vision in older adults presenting to hospital, with a fall and proactively in falls prevention strategies.
{"title":"Assessing Vision in Elderly Patients Admitted to Hospital Following a Fall","authors":"M. Rahimzadeh, G. S. Alg, Aisling Robinson, A. Moseley","doi":"10.38192/1.6.3.8","DOIUrl":"https://doi.org/10.38192/1.6.3.8","url":null,"abstract":"Introduction: Falls are a major cause of morbidity and mortality in older people, and those with reduced visual acuity are twice as likely to fall as those with normal eyesight. Accordingly, NICE guidelines recommend assessment of vision as part of a multi-factorial risk assessment in older people, who present for medical attention, because of a fall.\u0000Methods: We included all patients admitted to a senior health ward at St George’s hospital because of a fall. A baseline audit was conducted in May 2020. Our primary intervention was a departmental teaching session with subsequent first cycle data. We trialled the ‘Lookout! Bedside vision check for falls prevention’ recommended by the Royal College of Physicians. Our secondary intervention was designing an ‘initial assessment’ proforma to include a section for sensory impairment followed by a second cycle data collection.\u0000Results: Our initial results showed that none of the 24 patients admitted with a fall had any form of documented visual assessment. Using a simple bedside vision check tool, we found 22% (n=2) of screened patients had significantly impaired vision. Following our teaching session, 50% (n=7) of patients had some form of visual assessment on admission and after introduction of the proforma, this increased to 56% (n=5). Visual risk factors were identified in multiple patients, including outdated prescriptions for corrective glasses.\u0000Discussion: Identifying reversible visual risk factors may reduce recurrent falls and subsequent complications as well as hospital admissions in older patients. A teaching session was found to be effective, however a ‘proforma’ may encourage more sustainable improvements. The reduction in ophthalmology and optometry services during the Covid-19 pandemic will inevitably increase the prevalence of visual risk factors. Effects including delayed eyesight tests and cataract operations. It is therefore more important now than ever, to ensure bedside assessment of vision in older adults presenting to hospital, with a fall and proactively in falls prevention strategies.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76496027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"After the Pandemic","authors":"I. Chakravorty, A. Chopada, V. Zamvar","doi":"10.38192/1.6.2.25","DOIUrl":"https://doi.org/10.38192/1.6.2.25","url":null,"abstract":"Editorial explores the health and economic impact of the COVID-19 pandemic as the world reeling from the initial surge prepares for the second. ","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81211321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Calcium imbalance in Sarcoidosis and Renal Failure","authors":"A. Sathyanarayan","doi":"10.38192/1.6.2.21","DOIUrl":"https://doi.org/10.38192/1.6.2.21","url":null,"abstract":"Poster presented at BAPIO National Conference, London Nov 2019 \u0000Peer reviewed by Subarna Chakravorty & Sunil Daga","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78994601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Relevance of FGFR1-NMDAR2B heteroreceptor complexes in treating major depressive disorder","authors":"Ashwin Venkatesh","doi":"10.38192/1.6.2.13","DOIUrl":"https://doi.org/10.38192/1.6.2.13","url":null,"abstract":"Poster presented at BAPIO National Conference, London 2019 \u0000Peer reviewed by Subarna Chakravorty PhD & Sunil Daga PhD","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73383219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Poster presented at BAPIO National Conference, London 2019 Peer reviewed by Subarna Chakravorty PhD & Sunil Daga PhD The new service specification will be used by clinical staff to reflect on practice and outcomes. It enables clinicians to identify standards, rather than accessing them from various sources. It will aid the planning, commissioning, and provision of acute paediatric services and provide a framework against which to audit provision and demonstrate improvement. It would be possible to translate this for use across the UK.
{"title":"Development of an acute general paediatrics service specification at a major London teaching hospital","authors":"J. Avery","doi":"10.38192/1.6.2.8","DOIUrl":"https://doi.org/10.38192/1.6.2.8","url":null,"abstract":"Poster presented at BAPIO National Conference, London 2019 \u0000Peer reviewed by Subarna Chakravorty PhD & Sunil Daga PhD \u0000The new service specification will be used by clinical staff to reflect on practice and outcomes. It enables clinicians to identify standards, rather than accessing them from various sources. It will aid the planning, commissioning, and provision of acute paediatric services and provide a framework against which to audit provision and demonstrate improvement. It would be possible to translate this for use across the UK.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87441566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In December 2019, a cluster of cases of pneumonia of unknown cause was detected in Wuhan, Hubei Province, China. A novel coronavirus (SARS coronavirus-2 (SARS-CoV-2)) was subsequently identified. The associated disease is now referred to as COVID-19. The source of the outbreak has yet to be determined. A zoonotic source to the outbreak has not been identified yet, but investigations are ongoing.
{"title":"COVID-19 Pandemic","authors":"Ananthakrishnan Raghuraman","doi":"10.38192/1.6.1.1","DOIUrl":"https://doi.org/10.38192/1.6.1.1","url":null,"abstract":"In December 2019, a cluster of cases of pneumonia of unknown cause was detected in Wuhan, Hubei Province, China. A novel coronavirus (SARS coronavirus-2 (SARS-CoV-2)) was subsequently identified. The associated disease is now referred to as COVID-19. The source of the outbreak has yet to be determined. A zoonotic source to the outbreak has not been identified yet, but investigations are ongoing.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91384892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cough is a common manifestation of many respiratory conditions and mostly is non-specific on its own as a symptom of the underlying disease. Most transient coughing episodes tend to settle within 2-3 weeks. Yet cough can herald more sinister disease such as malignancy or progressive respiratory conditions. In epidemiological surveys, cough persisting more than 8 weeks has been shown to have a significant impact on the quality of life and is often difficult to diagnose and treat, taking weeks to months. There is consensus that a logical, evidence-based, standardised approach is most likely to lead to an efficient diagnosis and provide the highest chance of effective resolution. This paper describes the current evidence and offers a best practice approach for primary care practitioners and general internists.
{"title":"Chronic Cough","authors":"Triya Chakravorty, I. Chakravorty","doi":"10.38192/1.6.1.5","DOIUrl":"https://doi.org/10.38192/1.6.1.5","url":null,"abstract":"Cough is a common manifestation of many respiratory conditions and mostly is non-specific on its own as a symptom of the underlying disease. Most transient coughing episodes tend to settle within 2-3 weeks. Yet cough can herald more sinister disease such as malignancy or progressive respiratory conditions. In epidemiological surveys, cough persisting more than 8 weeks has been shown to have a significant impact on the quality of life and is often difficult to diagnose and treat, taking weeks to months. There is consensus that a logical, evidence-based, standardised approach is most likely to lead to an efficient diagnosis and provide the highest chance of effective resolution. This paper describes the current evidence and offers a best practice approach for primary care practitioners and general internists.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83471016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Colorectal cancer (CRC) is the third commonest cancer with nearly 1.4 million new cases identified throughout the world in 2012. There is a pressing need for a new non-invasive blood-based test to improve early detection and monitoring of CRC. MiRNAs are small non-coding RNAs involved in fundamental cell processes such as proliferation, survival and death. Studies have identified miRNAs in plasma of cancer patients in a stable form. This study aimed to evaluate whether circulating microRNAs are predictive of response to therapy.
{"title":"Are Circulating miRNAs Predictive of Response to Therapy?","authors":"L. Kannappa","doi":"10.38192/1.6.1.C11","DOIUrl":"https://doi.org/10.38192/1.6.1.C11","url":null,"abstract":"Colorectal cancer (CRC) is the third commonest cancer with nearly 1.4 million new cases identified throughout the world in 2012. There is a pressing need for a new non-invasive blood-based test to improve early detection and monitoring of CRC. MiRNAs are small non-coding RNAs involved in fundamental cell processes such as proliferation, survival and death. Studies have identified miRNAs in plasma of cancer patients in a stable form. This study aimed to evaluate whether circulating microRNAs are predictive of response to therapy. ","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75610605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preface to the First Edition","authors":"C. Hering","doi":"10.2307/j.ctvdmwxv4.6","DOIUrl":"https://doi.org/10.2307/j.ctvdmwxv4.6","url":null,"abstract":"","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"37 1","pages":"S5 - S9"},"PeriodicalIF":0.0,"publicationDate":"2018-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87690593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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