Safety Evaluation of an Expedited Omalizumab Home Self-Administration Pathway (Preprint)

BACKGROUND The Northern Ireland Regional Immunology Service (NIRIS) has developed an expedited omalizumab home self-administration pathway to reduce face-to-face clinic attendance during the COVID19 pandemic. This audit evaluates the safety of this pathway with a particular focus on anaphylaxis. OBJECTIVE To retrospectively audit the records of 39 patient undertaking expedited home self-administration at NIRIS for complications, particularly Emergency Department attendance for anaphylaxis. The target was for 100% of patients to complete a six-month course without experiencing anaphylaxis related to omalizumab administration. METHODS 39 records of patients who underwent expedited omalizumab self-administration were audited by a single reviewer. They were prospectively collected between March 2020 and August 2021. Clinical data was collected from the Northern Ireland Electronic Care Record (NIECR). RESULTS 100% of patients were in the process of completing or had completed a six-dose course without anaphylaxis. 7.6% of patients attended the Emergency Department during their course of omalizumab. 0% experienced anaphylaxis triggered by omalizumab. The target of 100% patients completing the expedited pathway without omalizumab-related anaphylaxis was met. CONCLUSIONS The expedited omalizumab home self-administration pathway is safe and may become the standard of care post-pandemic.

Bidirectional brain–gut axis effects influence mood and prognosis in IBD: a systematic review and meta-analysis

ObjectiveThe role of the brain–gut axis is of increasing interest in IBD, as the link between common mental disorders and GI inflammation may be bidirectional. We performed a systematic review examining these issues.DesignWe searched EMBASE Classic and EMBASE, Medline, and APA PsychInfo (to 11 July 2021) for longitudinal follow-up studies examining effect of symptoms of anxiety or depression on subsequent adverse outcomes in IBD, or effect of active IBD on subsequent development of symptoms of anxiety or depression. We pooled relative risks (RRs) and HRs with 95% CIs for adverse outcomes (flare, escalation of therapy, hospitalisation, emergency department attendance, surgery or a composite of any of these) according to presence of symptoms of anxiety or depression at baseline, or RRs and HRs with 95% CIs for new onset of symptoms of anxiety or depression according to presence of active IBD at baseline.ResultsWe included 12 separate studies, recruiting 9192 patients. All 12 studies examined brain-to-gut effects. Anxiety at baseline was associated with significantly higher risks of escalation of therapy (RR=1.68; 95% CI 1.18 to 2.40), hospitalisation (RR=1.72; 95% CI 1.01 to 2.95), emergency department attendance (RR=1.30; 95% CI 1.21 to 1.39), or a composite of any adverse outcome. Depression at baseline was associated with higher risks of flare (RR=1.60; 95% CI 1.21 to 2.12), escalation of therapy (RR=1.41; 95% CI 1.08 to 1.84), hospitalisation (RR=1.35; 95% CI 1.17 to 1.57), emergency department attendance (RR=1.38; 95% CI 1.22 to 1.56), surgery (RR=1.63; 95% CI 1.19 to 2.22) or a composite of any of these. Three studies examined gut-to-brain effects. Active disease at baseline was associated with future development of anxiety or depression (RR=2.24; 95% CI 1.25 to 4.01 and RR=1.49; 95% CI 1.11 to 1.98, respectively).ConclusionBidirectional effects of the brain–gut axis are present in IBD and may influence both the natural history of the disease and psychological health.

Trends in obstetric emergency department attendance the first months of the coronavirus pandemic

Many medical disciplines reported a decline in patient attendance during the coronavirus pandemic. Our paper examines the effects that the coronavirus pandemic had on obstetric Emergency Department (ED) attendances in a tertiary maternity centre in the Republic of Ireland. A retrospective cross-sectional analysis was performed on administrative data regarding the number of obstetric patients attending the ED from January to July in 2019 and 2020. These numbers were compared to the number of reported coronavirus cases in Ireland as released in official government publications. A paired sample t-test was carried out to see if there was a significant difference in attendance in the obstetric ED in 2020 compared to in 2019. When COVID-19 cases peaked at 17,377 in April 2020, ED attendance showed their largest decline of 27%. The cumulative decline in ED attendances from January to July in 2019 to 2020 was 13%. However, this decline was not found to be statistically significant. In contrast to other disciplines, the COVID-19 pandemic did not cause a decrease in obstetric ED attendance.

Clarifying the concept of avoidable emergency department attendance

Emergency department attendances are rising in several countries. Many of the policies aimed at reducing emergency department attendances are based on the assumption that a proportion of current utilization is ‘avoidable’ and therefore could be reduced. In considering how to achieve this aim, it is important to first understand the problem. In this essay, we review the literature on the concept and identification of avoidable emergency department attendances in England. We identified three areas of inconsistency surrounding avoidable emergency department attendances: the terminology, the underlying definition, and the method used to identify avoidable attendances. We offer a more nuanced definition which may better support action to reduce emergency department activity. Recognizing that there are different types of undesirable utilization which vary by underlying causes and potential solutions will aid policy makers in identifying areas where policies targeting reductions in emergency department attendances would best be directed.