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.

Sequential retinal necrosis secondary to varicella zoster in unrecognised long-standing HIV infection: patient safety report.

A retired woman with left ophthalmic shingles of over 2 years' duration attended with bilateral vision loss and systemic upset. Acute retinal necrosis with detachment was detected on right fundus examination. Cataract in left eye precluded funduscopy. Ocular ultrasonography revealed fibrotic retinal detachment in the left eye. MRI brain and orbits also showed signals of retinal detachment. No abnormal MRI signal within the optic nerve or brain was found. Varicella zoster virus was detected in ocular aqueous and blood samples. High-dose intravenous acyclovir was administered. HIV test was positive with a very low CD4 count. Antiretroviral medications were prescribed. There was no recovery of vision. She was certified as blind, and social services were involved in seeking to provide alterations to her home in view of her severe disability. This case highlights the importance of suspecting HIV in patients with severe or chronic ophthalmic shingles. Images and implications for clinical practice are presented.