In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within government faced considerable difficulties.

mortality. 4,5 NAFLD is the most rapidly increasing aetiology on the liver transplant waiting list; a retrospective study in the USA found that the incidence of NAFLD on the liver transplant list had increased by 170% between 2004 and 2013. 6 Over the past 5 years, NAFLD accounted for between 10-15% of patients listed annually for orthotopic liver transplants (OLTs) in the UK. 7 An index presentation with hepatocellular cancer or a decompensating event, such as ascites, hepatic encephalopathy or variceal haemorrhage, has a profound impact on morbidity and mortality and has a significant negative impact on the patient's quality of life. 8 Earlier detection of NAFLD provides opportunities to instigate interventions such as lifestyle modifications with the aim of sustained weight loss resulting in fibrosis regression, potentially averting or reducing the likelihood of the serious lifethreatening complications of portal hypertension. 9-14 Furthermore, earlier detection of hepatocellular cancers creates possibilities for interventions with curative potential such as resection and radiofrequency ablation rather than transplantation or palliation that are often the only option with late diagnosis. Despite the rising incidence and burden of NAFLD and its associated comorbidities, there remains a poor awareness regarding its recognition and management. Concerningly, the Veterans Administration primary care centre study highlighted that patients at highest risk of NAFLD were not being evaluated for this condition. 15 Only 21.5% of patients who were identified by study investigations had a confirmed diagnosis of NAFLD in primary care, 14.7% were counselled regarding diet and exercise and 10.4% were referred to a specialist. We hypothesise that many patients reaching liver transplant listing are only diagnosed with NAFLD at a point where liver disease has resulted in irreversible complications. We have conducted a retrospective analysis of patients with NAFLD cirrhosis referred for OLT assessment, aiming to determine their disease status at their first presentation to healthcare, and their subsequent clinical outcomes. Methods This was a cross-sectional analysis of all patients who underwent OLT assessment for a sole indication of NAFLD at the Royal Free London NHS Foundation Trust between January 2003 and December 2017. NAFLD was defined by the sonographic demonstration of hepatic steatosis in the presence of metabolic risk factors and the exclusion of significant alcoholic consumption

Background The COVID-19 pandemic has sparked a surge in the use of virtual communication tools for delivering clinical services for many non-urgent medical needs allowing telehealth or telemedicine, to become an almost inevitable part of the patient care. However, most of patients with vascular disease may require face-to-face interaction and are at risk of worse outcomes if not managed in timely manner. Objective We aimed to describe the utilization of telemedicine services in the outpatient vascular surgery clinics in a tertiary hospital. Methods A retrospective analysis of data on all vascular outpatient encounters during 2019 and 2020 was conducted and compared to reflect the pattern of practice prior to and during the COVID-19 pandemic. Results The study showed that 61% of the total patient encounters in 2020 were reported through teleconsultation. Females were the majority of patients who sought the virtual vascular care. Consultations for the new cases decreased from 29% to 26% whereas, the follow-up cases increased from 71% to 74% in 2020 (p = 0.001). The number of procedures performed in the vascular outpatient clinics decreased by 46% in 2020 when compared to 2019. This decrease in procedures was more evident in the duration from February 2020 to April 2020 in which the procedures decreased by 97%. The proportion of procedures represented 22.6% of the total encounters in 2019 and 10.5% of the encounters during 2020, (p = 0.001). Conclusions Teleconsultation, along with supporting practice guidelines, can be used to maximize the efficiency of care in vascular surgery patients during the pandemic and beyond. Adoption of the ‘hybrid care’ which combines both virtual and in-person services as an ongoing practice requires evidence obtained through audits and studies on patients and healthcare providers levels. It is essential to establish a clear practice that ensures patient’s needs.