Cataract Surgery Outcomes and Postoperative Patient Compliance in Limited English Proficiency Patients at a County Hospital

Background/Aims: Investigate the role of language barriers in cataract surgery outcomes at a county hospital. Methods: Retrospective chart review of patients who underwent cataract surgery March 2018-February 2019 at Lyndon B. Johnson Hospital. Patients who underwent cataract surgery combined with another procedure or had severe glaucoma or proliferative diabetic retinopathy were excluded. Patients were classified into limited English proficient (LEP) or English proficient (non-LEP) groups based on language preferences. Demographics, baseline ocular characteristics, intraoperative complications, postoperative BCVA (best-corrected visual acuity), complications, and compliance were recorded. The primary outcome was incidence of poor visual outcomes (BCVA<20/40) at the postoperative 1-month visit. Results: 354 patients (199 [56%] LEP and 155 [44%] non-LEP) with 125 (35%) males and a mean age 66.1 (+/- 10.9) years were included. LEP patients were about 5 years older than non-LEP patients (P<0.001) and were mostly Hispanic (172 [86%] LEP vs. 36 [26%] non-LEP, P<0.001). The baseline ocular characteristics were similar (P >0.05), except severity of cataract (125 [63%] NSC grade >2+ for LEP vs 70 [51%] for non-LEP, P =0.03). No significant differences in intraoperative complications (P =0.18), incidence of poor vision (P =0.59), postoperative cystoid macular edema (P =0.32), and compliance with the postoperative drop regimen (P =0.11) were noted. Conclusion: There were no statistically significant differences in incidence of poor vision, complications, or compliance. However, there was a trend toward significance, showing that language barriers may lead to more advanced disease and compliance issues with postoperative medications.

The CIO role: a relentless march forward

Stephen Slough CITP CHCIO FBCS, CIO of the Dorset County Hospital NHS Foundation Trust and Dorset Clinical Commissioning Group, talks to Johanna Hamilton AMBCS about the digital legacy of COVID and the relentless speed of change within the NHS.

Tuberculosis infection among youths in overcrowded university hostels in Kenya: a cross-sectional study

Background Tuberculosis (TB) remains a top global health problem and its transmission rate among contacts is higher when they are cohabiting with a person who is sputum smear-positive. Our study aimed to describe the prevalence of TB among student contacts in the university and determine factors associated with TB transmission. Methods We performed a cross-sectional study with an active contact case finding approach among students receiving treatment at Kilifi County Hospital from January 2016 to December 2017. The study was conducted in a public university in Kilifi County, a rural area within the resource-limited context of Kenya. The study population included students attending the university and identified as sharing accommodation or off-campus hostels, or a close social contact to an index case. The index case was defined as a fellow university student diagnosed with TB at the Kilifi County Hospital during the study period. Contacts were traced and tested for TB using GeneXpert. Results Among the 57 eligible index students identified, 51 (89%) agreed to participate. A total of 156 student contacts were recruited, screened and provided a sputum sample. The prevalence of TB (GeneXpert test positive/clinical diagnosis) among all contacts was 8.3% (95% CI 4.5–14%). Among the 8.3% testing positive 3.2% (95% CI 1.0–7.3%) were positive for GeneXpert only. Sharing a bed with an index case was the only factor significantly associated with TB infection. No other demographic or clinical factor was associated with TB infection. Conclusion Our study identified a high level of TB transmission among university students who had contact with the index cases. The study justifies further research to explore the genetic sequence and magnitude of TB transmission among students in overcrowded university in resource limited contexts.

Trends and Intensity of Rhinovirus Invasions in Kilifi, Coastal Kenya Over a Twelve-Year Period, 2007-2018

Background Rhinoviruses (RVs) are ubiquitous pathogens and the principal etiological agents of common cold. Despite the high frequency of RV infections, data describing their long-term epidemiological patterns in a defined population remain limited. Methods Here, we analysed 1,070 VP4/VP2 genomic region sequences sampled at Kilifi County Hospital on the Kenya Coast. The samples were collected between 2007 and 2018 from hospitalised paediatric patients (&lt; 60 months) with acute respiratory illness. Results Of 7,231 children enrolled, RV was detected in 1,497 (20.7%) and VP4/VP2 sequences were recovered from 1,070 samples (71.5%). A total of 144 different RV types were identified (67 Rhinovirus A, 18 Rhinovirus B and 59 Rhinovirus C) and at any month, several types co-circulated with alternating predominance. Within types multiple genetically divergent variants were observed. Ongoing RV infections through time appeared to be a combination of (i) persistent types (observed up to seven consecutive months), (ii) reintroduced genetically distinct variants and (iii) new invasions (average of eight new types, annually). Conclusion Sustained RV presence in the Kilifi community is mainly due to frequent invasion by new types and variants rather than continuous transmission of locally established types/variants.

237. Evaluating Epidural Abscess Outcomes in a County Hospital with Antibiotic Therapy Alone Compared to Antibiotics and Surgical Intervention

Background Spinal epidural abscess (SEA) remains a rare suppurative infection which bacteria invade the epidural space through contiguous spread or hematogenous dissemination. Diabetes mellitus (DM), IV drug abuse (IVDA), alcohol abuse, degenerative joint disease (DJD) have been shown to confer risk for SEA. Antimicrobial therapy is critical, but literature remains less clear on surgical intervention. Primary aim for study was to evaluated outcomes with SEA when treated with antibiotics alone compared to antibiotics and surgical intervention at our county hospital. Methods A retrospective case series assessed patients 18 years or older at our county hospital with SEA consulted by infectious disease from 7/2009 to 7/2018. Data collected included demographics, social history (IVDA, alcohol abuse, homelessness), and microbiology results. Physician review of records determined if outcomes of SEA demonstrated improvement of symptoms compared to no improvement of symptoms. Results Of 37 patients, 15 patients were treated with antibiotics alone, 22 with antibiotics plus surgical spinal intervention. Of patients treated with antibiotics alone, 12/15 (80%) had improvement of symptoms and 3/15 (20%) had no improvement of symptoms. Those treated with antibiotics plus surgical intervention, 17/22 (77%) had improvement or resolution of symptoms and 5/22 (23%) had no improvement of symptoms. No statistically difference in outcome was observed between the two groups (p=0.835). The majority of cases were positive for Staphylococcus aureus (21/37, 56.7%). Methicillin-sensitive S. aureus (MSSA) comprised (12/21, 57%) and Methicillin-resistant S. aureus (MRSA) comprised (9/21, 43%). Conclusion Our retrospective study demonstrated no differences in outcome observed between patients treated with antibiotics alone compared to those with antibiotics plus surgical spinal intervention. Staphylococcus aureus was the most common organism. Management of patients with SEA currently remains individualized based on clinical condition, comorbidities and clinician judgement given limited literature. Proper sample collection for cultures and immediate intervention, either antibiotics only or antibiotics plus surgical interventions are crucial for better patient outcomes in SEA. Disclosures All Authors: No reported disclosures

EP.TU.740Implementing a departmental handbook to improve induction for FY1s during COVID-19 pandemic

Aims The 2020 cohort of FY1s qualified during the COVID-19 pandemic; most prequalification placements were cancelled. Induction provides crucial information for new FY1s. We assessed the impact of redesigning the General Surgery induction handbook at Hereford County Hospital. Methods A 40-question survey, designed against standards in ’Recommendations for safe trainee changeover’ published by the Academy of Medical Royal Colleges, was sent to all FY1s commencing General Surgery in August 2020 two weeks following induction. The survey contained 5 sections: introduction; testing your knowledge parts A and B; team atmosphere; and demographics. Answer modalities included: binary answer; multiple choice; Net Promoter Scores (NPS); and free text. Submissions were made electronically via Microsoft Forms. Feedback guided redesign of the induction handbook which was sent to FY1s rotating December 2020. Information included: how to contact seniors; requesting investigations; referring to specialties and expected duties. A repeat survey was sent to FY1s 4 weeks following induction. Results 10/11 FY1s responded during the first rotation; 9/11 during the second. FY1s felt more confident requesting bloods (NPS +50 to + 90), requesting imaging (NPS –20 to + 70), completing discharge summaries (NPS +30 to + 80) and referring to specialties (NPS –40 to + 60). There was a better understanding of different shift types (NPS –40 to + 30). More FY1s correctly recalled on call bleeps for the medical registrar (from 56% to 75%) and the anaesthetic registrar (from 50% to 78%). Most (78%, NPS +78) felt they had enough support from other FY1s which remained the same (NPS +78) through the second rotation. As a result of the COVID-19 pandemic, prequalification experience varied greatly between individual FY1s. Conclusion Overall, FY1s were more confident requesting investigations, referring to other specialties and completing discharge summaries after redesign of the induction handbook. Considering disruptions in pre-qualification training as a result of the COVID-19 pandemic, a thorough departmental induction handbook can be an invaluable resource tool to aid rotation into a new specialty.