1940 Eating disorder ‘pandemic’

Abstract

Objectives Children and young people (CYP) admitted with eating disorders (ED) during COVID19 increased dramatically, by 69%, from 2019-2021 according to NHS England. 1 This was reflected in Belfast on our general paediatric ward.This project aimed to improve multidisciplinary team (MDT) communication and knowledge in the management of CYP using Junior Marsipan guidelines (JMG) 2 and the subsequent Medical Emergencies in Eating Disorders guidelines (MEED). 3 Secondary aims included educating healthcare staff regarding admission criteria, improving acute medical management of ED and providing patient centred care. Methods An MDT admission care pathway and triage card were designed with contribution from paediatric medical and nursing staff, dietetics and CAMHS Eating Disorder Youth Service. The triage card and care pathway aimed to identify high risk CYP with suspected ED and guide medical staff regarding admission. The pathway directs history taking, investigations, medical management, potential complications, meal plans and CAMHS review. The eating disorder triage card was launched in May 2021 and admission care pathway in November 2021 in the Ulster Hospital.We assessed staff confidence levels managing CYP with ED prior to the intervention in November 2021, using an online anonymised questionnaire. This evaluated staff knowledge, confidence and patient care provision. Respondents included consultants, registrars, SHOs and nurses.A subsequent PDSA cycle in July 2022 involved review of the 2022 MEED Guidelines, 3 incorporating these into the admission care pathway. A key change was the updated risk assessment framework. ResultsThe initial questionnaire showed that 100% of respondents observed an increase in the number of ED patients encountered in their practice compared with pre Covid. 33% of respondents felt confident managing ED, 39% equivocal and 28% did not feel confident. Only 33% felt confident applying JMG when managing these CYP. Current MDT communication was deemed poor/very poor by 66.7% and 94% felt introduction of a care pathway would help management of children and young people with ED and MDT communication.Conclusions CYP with ED are a challenging patient group and management requires an MDT approach. This project has improved MDT management/communication of CYP with ED on general paediatric wards. We are currently undertaking a questionnaire to assess staff feedback following introduction of the triage card and admission care pathway.Our next step is to develop a regional eating disorder admission care pathway for use throughout NI. We plan to introduce an information leaflet for parents of CYP admitted for medical management of eating disorders and to collaborate further with the CAMHS ED service to streamline the referral process.

The relationship between household consumption and activities of tourism in RN Macedonia

“…The well-known equation for macroeconomic equilibrium states that total spending in the economy (C + I + G + NX) is equal to the total output in the economy (Y).Household consumption (C) is the dominant and most important component of total expenditures in macroeconomics in the structure of GDP. [1] As is known, domestic tourist consumption comprises the consumption of resident visitors at tourism activities capacity within the economic territory of the country in reference, in their non-usual environment (out of living place).It is different from inbound tourism (the consumption of non-resident visitors within the economic territory of the country of reference) and outbound tourism (the consumption of resident visitors outside the economic territory of the country of reference).…”

“…Such data are presented in table 2. 1 which seriously affected international tourist travel. [14]For Macedonian tourism, this meant the need for a tactical change in order to attract domestic tourists within the framework of the international tourism strategy(not only inbound tourism but more domestic tourism and less outbound tourism).In support of such tactics is the result of the index for international competitiveness in tourism and travel in RN Macedonia, where in 2019 it was 3.4 (maximum of 7.0) in the period from 2015 to 2019 has further fall in rank list from 82 to 101 seats.…”

“….Total disposable household income by type in RN Macedoniaannual average per household In denars Household consumption in RН Macedonia for travel Macroeconomic theory shows that consumption is a positive function of disposable income -it grows as household income increases [1]. Outbound tourism demanded by households is a function of disposable incomes.…”