Short message service cancellation intervention to reduce integrated sexual health and HIV 'did not attend' appointment rates.

Did not attend (DNA) appointments create a significant impact upon resource and finance efficiency in the NHS. Despite introduction of short-message service (SMS) reminders to our patients, DNA rates remained persistently high. An option to send an SMS to cancel a booked appointment was piloted from 15 January to 16 April 2018 for integrated sexual health and human immunodeficiency virus (HIV) appointments. Absolute monthly mean DNA rates as a proportion of total bookable appointments fell by 2.24% (14.42% pre-intervention [95% CI: 13.15-15.79%] to 12.18% post-intervention [95% CI: 10.98-13.50%]). Cancellation rates increased proportionally by 14.28% from 24.4% to 38.68% (786/3224 pre-intervention [95% CI: 22.70%-26.15%] to 1184/3061 post-intervention [95% CI: 36.52-40.93%]). Findings suggest that SMS cancellations are a viable solution to reduce DNA rates in this setting.

Within-day variability in microbial concentrations at a UK designated bathing water: Implications for regulatory monitoring and the application of predictive modelling based on historical compliance data.

Prediction of bathing water quality is recommended by the World Health Organization (WHO), the European Union (EU) and the United States Environmental Protection Agency (USEPA) and is an established element in bathing water management designed to protect public health. Most commonly, historical regulatory compliance data are used for model calibration and provide the dependent variable for modelling. Independent (or predictor) variables (e.g. rainfall, river flow and received irradiance) measured over some antecedent period are used to deliver prediction of the faecal indicator concentration measured on the day of the regulatory sample collection. The implied linked assumptions of this approach are, therefore, that; (i) the independent variables accurately predict the bathing-day water quality; which is (ii) accurately characterized by the single regulatory sample. Assumption (ii) will not be the case where significant within-day variability in water quality is evident. This study built a detailed record of water quality change through 60 days at a UK coastal bathing water in 2011 using half-hourly samples each subjected to triplicate filtration designed to enhance enumeration precision. On average, the mean daily variation in FIO concentrations exceeded 1 log10 order, with the largest daily variations exceeding 2 log10 orders. Significant diurnality was observed at this bathing water, which would determine its EU Directive compliance category if the regulatory samples were collected at the same time each day. A sampling programme of this intensity has not been reported elsewhere to date and, if this pattern is proven to be characteristic of other bathing waters world-wide, it has significance for: (a) the design of regulatory sampling programmes; (b) the use of historical data to assess compliance, which often comprises a single sample taken at the compliance point on a regular, often weekly, basis; and (c) the use of regulatory compliance data to build predictive models of water quality.