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OBJECTIVE: Pregnant women with gestational diabetes mellitus (GDM) are 50% more likely to develop type II diabetes (T2D) within 6 months to 2 years after giving birth. Therefore, international guidelines recommend it is best practice for women diagnosed with GDM to attend screening for T2D 6-12 weeks postpartum and every 1-3 years thereafter for life. However, uptake of postpartum screening is suboptimal. This study will explore the facilitators of and barriers to attending postpartum screening for T2D that women experience. STUDY DESIGN: This was a prospective qualitative cohort study using thematic analysis. METHODS: A total of 27 in-depth, semistructured interviews were conducted over the telephone with women who had recent GDM. Interviews were recorded and transcribed, and data were analysed using thematic analysis. RESULTS: Facilitators of and barriers to attending postpartum screening were identified at three different levels: personal, intervention, and healthcare systems level. The most common facilitators identified were concern for their own health and having the importance of screening explained to them by a health professional. The most common barriers identified were confusion over the test and COVID-19. CONCLUSION: This study identified several facilitators of and barriers to attending postpartum screening. These findings will help to inform research and interventions for improving rates of attendance at postpartum screening to reduce the subsequent risk of developing T2D.
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Background: The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods: A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results: Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39-70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective Pâ¯<â¯.001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non-Protected Elective Surgical Unit (0.42% vs 3.2% Pâ¯<â¯.001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19-positive patients. COVID-19 infection, ageâ¯>â¯70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion: This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.
ABSTRACT
Aim: The COVID-19 pandemic has caused unprecedented healthcare challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self contained Protected Elective Surgical Units (PESU) were developed to mitigate against infection related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of PESUs can result in significant reduction in risk. Method: A retrospective observational study of consecutive patients from 18 specialties, undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and PESU transmission rates. Results: Between 15th March 2020 and 14th March 2021, 9,925 patients underwent surgery, 6,464 (65.1%) elective, 5,116 (51.5%) female and median age 57 (39-70). 69.5% of all procedures were performed in PESUs. Overall, 30-day post-operative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective p<0.001). PESU post-operative transmission was significantly lower than non-PESU (0.42% vs 3.2% p<0.001), with an adjusted likely in-hospital PESU transmission of 0.04%. The 30-day all-cause mortality was 1.7%, and 14.6% in COVID-19 positive patients. COVID-19 infection, age >70, male gender, ASA >2 and emergency surgery were all independently associated with mortality. Conclusions: This study has demonstrated the value of PESUs in minimising COVID-19 viral transmission and associated mortality with additional relevance to protected elective services going forward (possibilities of reduced cancellations due to bed shortages and transmission of other nosocomial infections).
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Study Objective: With COVID-19 cases and fatalities increasing nationally, health officials implemented policies and restrictions to keep the positivity rate in check. In California, a statewide stay at home order was issued on March 19, 2020 and again on December 7, 2020. The objective of this study was to assess the impact each stay at home order had on ED utilization. Methods: We conducted a multi-center, retrospective study among adult patients (≥18 years) presenting to two emergency departments (urban level 1 trauma center and suburban academic hospital with combined annual census of ∼80,000). We compared ED utilization over a two-week period both prior to and following each statewide stay at home order (March and December, 2020), as well as similar periods in 2019. We calculated the percent change in ED volume and admissions for each. Results: Prior to the first stay at home order, there were only 70 confirmed COVID-19 cases in the county, compared to 94,169 cases prior to the subsequent stay at home order. Compared to 2019, ED volume and admissions during the two-week period following the initial stay at home order decreased by 30.7% and 28.4%, respectively. Following the second stay at home order, ED volume was only down 12.4% from 2019, while admissions were up 4.4%. Similarly, compared to the two week period prior to the initial stay at home order, ED volume and admissions decreased by 22.8% and 14.0% in the following 2-week period, respectively. However, ED volume and admissions remained similar following the second stay at home order, with an increase by 0.8% in ED visits and 1.6% increase in admissions between the two weeks before and after the order began. Conclusion: This study of ED utilization trends during the COVID-19 pandemic demonstrated that ED volume and admissions decreased dramatically during the initial stay at home order. However, despite the large differences in the number county-wide positive cases, ED utilization and admissions were largely unaffected by the second stay at home order.
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From March 2020, the Mathematics Support Centre at University College Dublin, Ireland, and the Mathematics Education Support Hub at Western Sydney University, Australia, moved wholly online and have largely remained so to the point of writing (August 2021). The dramatic and swift changes brought on by COVID-19, in particular to fully online modes of teaching and learning including mathematics and statistics support (MSS), have presented students and tutors with a host of new opportunities for thinking and working. This study aims to gain insight both from students and tutors about their experience of wholly online learning and tutoring in the COVID-19 era. In this sense, it represents a 'perspectives' study, the idea being that before we examine specific aspects of this experience, it would be best to know what the issues are. Employing a qualitative analysis framework of 23 one-on-one interview transcripts with tutors and students from both institutions in Australia and Ireland, we identified five key themes as central to the shared experiences and perspectives of tutors and students. In this study, we discuss three of these themes in relation to the new normal with the intention of supporting MSS practitioners, researchers and students going forward. The themes describe the usage of online support, how mathematics is different and the future of online MSS. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the Institute of Mathematics and its Applications.
ABSTRACT
The dramatic changes brought on by the COVID-19 pandemic have changed the way in which mathematics and statistics support is offered. Students and staff have been presented with new opportunities and challenges. One-on-one interviews were conducted late in 2020 with 23 students and staff who had experience with fully online mathematics and statistics support. The interviewees were from University College Dublin, Ireland, and Western Sydney University, Australia. Utilising thematic analysis, five themes around online mathematics and statistics support common to both universities were identified. In this paper the three themes related to connection are explored;they are pedagogical changes, social interaction, and appreciation of mathematics and statistics support. These themes highlight the need felt by both students and staff for mutual connection. The paper concludes with a discussion on the repercussions of this study for future considerations of effective online mathematics and statistics support. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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Pandemic COVID-19 has put unprecedented pressure on NHS providers to offer non face-to-face consultation. This study aims to assess acceptability of patients and clinicians towards teleconsultation in oral and maxillofacial surgery compared with an expected face-to-face assessment. 340 telephone clinic patient episodes were surveyed over the initial 7-week period of pandemic-related service restriction. Appointment outcomes from a further 420 telephone consultations were additionally scrutinised. A total of 59.1% of patients expressed a strong preference for teleconsultation with only 13.1% stating a moderate or strong preference for face-to-face assessment. Diagnostic accuracy was highlighted as a concern for both clinicians and patients due to inherent inability to conduct a traditional clinical examination, notable in 43.5% of qualitative comments. Logistical concerns, communications needs and other individual circumstances formed the other emerging themes. The majority of remote consultations (59.5%) were outcomed as requiring further review. A total of 29.3% of patients were discharged. These findings suggest that the increasing use of remote follow-up in carefully selected subgroups can facilitate efficient and acceptable healthcare delivery. Although 'in-person' clinical appointments will continue to be regarded as the default safe and gold standard management modality, OMFS departments should consider significant upscaling of teleconsultation services.