HBPM in hypertensive pregnancies appears to be cost-saving compared with traditional monitoring, without compromising maternal, fetal or neonatal safety. Larger studies are required to confirm these findings.

, Clinical effectiveness and cost minimisation model of Alpha-Stim cranial electrotherapy stimulation in treatment seeking patients with moderate to severe generalised anxiety disorder.,

This paper argues that the cross-analysis of barriers with stakeholders provides a richer picture than analyzing the barriers on their own, as most of the literature in this area does. To test this hypothesis, we used the data from 33 interviews across 19 different types of stakeholders that were involved in a telemedicine system for the Chronically-ill Patient. Our findings show encouraging results. For instance, it was found that the group of stakeholders who are directly related to the governance and policy-making identified most of the barriers. This finding may imply that this group is more aware of the challenges when implementing HIS, or it may suggest that this group poses more resistance due to the current economic and Organizational models in health care. It was also found that some barriers are cited by all stakeholders whereas others not, suggesting that some barriers may be more relevant than others.

IntroductionAdrenal incidentalomas are lesions that are incidentally identified while scanning for other conditions. While most are benign and hormonally non-functional, around 20% are malignant and/or hormonally active, requiring prompt intervention. Malignant lesions can be aggressive and life-threatening, while hormonally active tumours cause various endocrine disorders, with significant morbidity and mortality. Despite this, management of patients with adrenal incidentalomas is variable, with no robust evidence base. This project aimed to establish more effective and timely management of these patients.MethodsWe developed a web-based, electronic Adrenal Incidentaloma Management System (eAIMS), which incorporated the evidence-based and National Health Service–aligned 2016 European guidelines. The system captures key clinical, biochemical and radiological information necessary for adrenal incidentaloma patient management and generates a pre-populated outcome letter, saving clinical and administrative time while ensuring timely management plans with enhanced safety. Furthermore, we developed a prioritisation strategy, with members of the multidisciplinary team, which prioritised high-risk individuals for detailed discussion and management. Patient focus groups informed process-mapping and multidisciplinary team process re-design and patient information leaflet development. The project was partnered by University Hospital of South Manchester to maximise generalisability.ResultsImplementation of eAIMS, along with improvements in the prioritisation strategy, resulted in a 49% reduction in staff hands-on time, as well as a 78% reduction in the time from adrenal incidentaloma identification to multidisciplinary team decision. A health economic analysis identified a 28% reduction in costs.ConclusionsThe system’s in-built data validation and the automatic generation of the multidisciplinary team outcome letter improved patient safety through a reduction in transcription errors. We are currently developing the next stage of the programme to proactively identify all new adrenal incidentaloma cases.

Background Only a relatively low proportion of university students seek help for anxiety and depression disorders, partly because they dislike current drug and psychological treatment options and would prefer home-based care. The aim of this study is to determine the feasibility, acceptability and cost utility of Alpha-Stim cranial electrostimulation (CES) delivered through a nurse led primary care clinic as a daily treatment for anxiety and depression symptoms by the student at home in contrast to usual primary care. Method Feasibility and acceptability of a nurse led clinic offering Alpha-Stim CES in terms of the take up and completion of the six-week course of Alpha-Stim CES. Change in score on the GAD-7 and PHQ-9 as measures of anxiety and depression symptoms at baseline and at 8 weeks following a course of Alpha-Stim CES. Similar evaluation in a non-randomised control group attending a family doctor over the same period. Cost-utility analysis of the nurse led Alpha-Stim CES and family doctor pathways with participants failing to improve following further NICE Guideline clinical care (facilitated self-help and cognitive behaviour therapy). Results Of 47 students (mean age 22.1, years, 79% female opting for Alpha-Stim CES at the nurse-led clinic 46 (97.9%) completed a 6-week daily course. Forty-seven (47) students comprised a comparison group receiving usual family doctor care. Both Alpha-Stim CES and usual family doctor care were associated with large effect size reductions in GAD-7 and PHQ-9 scores from baseline to 8 weeks. There were no adverse effects and only one participant showed a clinically important deterioration in the Alpha-Stim group. In the cost utility analysis, Alpha-Stim CES was a cheaper option than usual family doctor care under all deterministic or probabilistic assumptions. Conclusion Nurse delivered Alpha-Stim CES may be a feasible, acceptable and cheaper way of providing greater choice and home-based care for some university students seeking help from primary care with new presentations of anxiety and depression.

Background Atrial fibrillation (AF) is the most common sustained atrial arrhythmia. AF significantly affects patients' quality of life and increase morbidity and mortality. Patients with AF need to be appropriately anticoagulated to reduce the risk of stroke. Approximately every fifth stroke is due to AF and average costs for both health and social care is £44,000 over the first five years. Recent updated guidelines on the management of AF have recommended that all patients over the age of 65 be offered screening in the community using either short term ECG or manual pulse palpation. Purpose To determine the feasibility of an innovative community pharmacy led AF detection service incorporating referral for review and treatment to a specialist arrhythmia centre. Method Community pharmacists received intensive training on AF, how to record an ECG using a Kardia monitor and documenting the consultation on a referral form hosted on a national pharmacy database called PharmOutcomes. Targeted opportunistic detection was undertaken by the pharmacists for anyone over the age of 65 years with risk factors for AF. Patients were referred by the pharmacist to the specialist team via PharmOutcomes if they had possible new AF, previous AF and not anticoagulated, anticoagulated but experiencing side effects or adherence issues or a high AF symptom burden. Patients initated on anticoagulation by the specialist team were referred back to the community pharmacist via the New Medicines Service (NMS) for adherence monitoring. Results During a proof of concept phase (May to October 2016) and an upscale phase (May 2018-May 2019) 28 pharmacies were recruited and 1737 participants were enrolled in the study. 891 (51.3%) were male, 851 (41%) were aged over 75 years. 299 patients were referred by the pharmacists and 99 of these were seen by the specialist team in clinic. 28 patients (1.6%) were diagnosed with AF. 20 out of 28 (71.0%) were initiated on anticoagulation. 29 out of 146 patients (19.9%) had previous AF with either a high symptom burden (11) or a heart rate below 50 or above 100 beats per minutes (18). 7 patients (4.3%) with previous AF were started on anticoagulation. 48 out of 99 patients (48.4%) had their medication optimised. This included rate control titration and adjustment of anticoagulation doses. 31 out of 99 patients (31.3%) required further interventions such as holter monitors, echocardiograms or referral to other specialists. Conclusions The results demonstrate that the this service is a robust multidisciplinary process for the detection, protection and perfection of AF. The direct referral pathway ensures that patients are reviewed by a specialist team and receive optimal treatment and management. Referral back to the community pharmacist via the NMS enhances concordance with anticoagulation. Further analysis is being undertaken to assess the cost-effectiveness and health impact of this service. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The Health Foundation; ASHN in collaboration with BMS Pfizer

We evaluated the FDA approved SARS-CoV-2 immunoassay (developed at Mount Sinai, by Krammer and colleagues) for the identification of COVID-19 seroconversion and potential cross-reactivity of the assay in a United Kingdom (UK) National Health Service (NHS) hospital setting. In our "set up" cohort we found that the SARS-CoV-2 IgG was detectable in 100% of patients tested 14 days post positive COVID-19 nucleic acid test. Serum samples taken from pregnant women in 2018 were used as a negative control group with zero false positives. We also analysed samples from patients with non-COVID-19 viral infections, paraproteinaemia or autoantibodies and found false positive results in 6/179. Modification of the sensitivity threshold to five standard deviations from the mean of the control group eliminated all false positive result in the set up cohort. We confirmed the validity of the test with a revised threshold on an independent prospective "validation cohort" of patient samples. Taking data from both cohorts we report a sensitivity of the Mount Sinai assay of 96.6% (28/29) and specificity of 100% (299/299) using a revised threshold cut-off, at a time point at least 14 days since the diagnostic antigen test. Finally, we conducted a health economic probabilistic sensitivity analysis (PSA) on the costs of producing the tests, and the mean cost we estimate to be 13.63 pounds sterling (95%CI 9.63 - 18.40), allowing its cost effectiveness to be tested against other antibody tests. In summary, we report that the Mount Sinai IgG ELISA assay is highly sensitive test for SARS-Cov-2 infection, however modification of thresholding was required to minimise false positive results.

Background: Adrenal incidentalomas (AI) are incidentally identified lesions whilst scanning for other purposes. They are mostly benign and hormonally inactive but about 20% are hormonally-active or malignant, requiring prompt intervention. The overall reported AI prevalence is 3-5% but increases with age (up to 7% of those above 70 years). The arranged investigations (hormonal work-up and further scanning) pose significant financial pressure on providers. Methods: We developed a cost-effectiveness tool “the Adrenal Incidentaloma Intervention Cost Assessment Tool (AI 2 CAT)”. We developed a novel web-based, electronic Adrenal Incidentaloma Management System (eAIMS). We conducted time & motion study utilising the estimated time managing an individual AI case. This was undertaken for different phases of our work: (i) pre-intervention, (ii) The implementation of case prioritisation strategy + utilisation of eAIMS and (iii) future proactive case identification and streamlining into low- and high-risk groups. Results: Projecting our unit’s case load to a UK-wide context, there could be 50,000 new cases PA/year. Utilising the AI2CAT tool and the time and motion analysis data, demonstrated that introducing the eAIMS system in combination with the MDT prioritisation process (Phase 2) reduced the number of tasks required in the AI management pathway. This resulted in a reduction in the hands-on total time taken (from AI identification to MDT decision) by 48.6%. Utilising standardised staff costs, hands-on time was reduced by 28.2% of total costs/patient. Conclusion: We have developed an electronic management system for AI, together with a cost-effectiveness tool to measure the potential cost implications. The combined approach of using the eAIMS system together with a prioritisation strategy resulted in reduced staff hands-on time and cost per case.