ABSTRACT
Background: From September 2021, Health Care Workers (HCWs) in Wales began eceiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence o. new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to understand booster vaccine uptake and subsequent breakthrough in this high-risk population. Methods: We conducted a prospective, national-scale, observational cohort study of HCWs in Wales using anonymised, linked data from the SAIL Databank. We analysed uptake of COVID-19 booster vaccinations from September 2021 to Februari 2022, with comparisons against uptake of the initial primary vaccination schedule. We also analysed booster breakthrough, in the form of PCR-confirmed SARS-Cov-2 infection, comparing to the second primarJ dose. Cox proportional hazard models were used to estimate associations for vaccination uptake and breakthrough regarding staff roles, socio-demographics, household composition, and other factors. Results: We derived a cohort of 73,030 HCWs living in Wales (78% female, 60% 18-49 years old). Uptake was quickest amongst HCWs aged 60 + years old (aHR 2.54, 95%Cl 2.45-2.63), compared with those aged 18-29. Asian HCWs had quicker uptake (aHR 1.18, 95%Cl 1.14-1.22), whilst Black HCWs had slower uptake (aHR 0.67, 95%Cl 0.61-0.74), compared to white HCWs. HCWs residing in the least deprived areas were slightly quicker to have received a booster dose (aHR 1.12, 95%Cl 1.09-1.15), compared with those in the most deprived areas. Strongest associations with breakthrough infections were found for those living with children (aHR 1.52, 95%Cl 1.41-1.63), compared to two-adult only households. HCWs aged 60+ years old were less likely to get breakthrough infections, compared to those aged 18-29 (aHR 0.42,<br />95%CI 0.38-0.47). Conclusion: Vaccination uptake was consistently lower among black HCWs, as well as those from deprived areas. Whilst breakthrough infections were highest in households with children. creativecommons.org/licenses/by/4.0/).<br />(c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license
ABSTRACT
Keywords: Pelvic Health Physiotherapy, Telehealth, Service Delivery Purpose: During COVID-19 pelvic health physiotherapy had to change the delivery mode of their appointments to primarily telehealth provision compared to the previous service delivery of all face to face appointments. It was perceived that telehealth would provide equitable results in symptom improvement as measured by the Clinical Global Improvement Scale (CGIS) on discharge via this assessment and treatment method, this is despite not being able to perform an objective assessment of the pelvic floor muscle as would be done in previous service delivery. The aim of the service evaluation was to identify if pelvic health physiotherapy was as affective via telehealth as previous service delivery for patients referred with Urinary Incontinence (UI) and Pelvic Organ Prolapse (POP). Methods: Patients were included if they had only received physiotherapy via telehealth from the 1st April 2020 and were referred with POP or UI. On discharge between September 1st 2020 and March 31st 2021 patients were verbally asked the CGIS which requests people to rate their improvement on a 7 point scale from “very much better” to “very much worse”. The data was collated and compared against results of the CGIS obtained during a previous audit in 2019/2020 for patients presenting with POP and UI. Descriptive statistics were used to analyse the data. Results: There were a total of 118 that fitted the inclusion criteria. The mean number of appointments was 6.9 compared to 3.3 appointments with previous service delivery. There were 29% of patients who reported that they were “very much improved” following treatment via telehealth compared to 42% with previous service delivery. 30% of patients reported that they had “minimal” or “no improvement” from physiotherapy via telehealth compared 19% with previous service delivery. Conclusion(s): Whilst there is a proportion of patients that found telehealth beneficial for the treatment of UI and POP, data shows in comparison to previous service delivery that less patients reported that they were very much better from physiotherapy and more patients reported that they had minimal improvement or no improvement with a telehealth predominant service. Telehealth was also deemed to be less efficient with on average patients required twice the number of appointments compared to previous service delivery. With physiotherapy being the recommended first line management for patients presenting with UI and POP (Nice Guideline 123) it cannot be recommended that this is delivered predominantly via telehealth. Impact: With redevelopment of service delivery in a post COVID environment it must be taken into consideration that for patients presenting with POP and UI that being able to perform a comprehensive objective assessment may influence the outcome of patient treatment. There is a percentage of patients that responded well to treatment via telehealth and the option to provide this method of service delivery is important to maintain and can be part of the shared decision making process. However the results of the service evaluation show that patients perceptions of symptom improvement as measured via the CGIS with pelvic health physiotherapy via telehealth is not as effective as previous service delivery. Funding acknowledgements: No funding was provided to complete this service evaluation
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Introduction Healthcare workers are at a substantially increased risk of being infected by COVID-19 patients. However, risk of being infected is depending on the critical phase of the pandemic, patients with COVID-19 might not be the absolute source of infection. Health workers could also be exposed to infected colleagues, infected family members, lives in communities of active transmission, or infected contacts during crowded events such as wedding reception and religious gathering. Objectives To explore the epidemiology data of COVID-19 infection among health care workers at Malaysia Hospitals especially on patterns of transmission and characteristics. Methods A cross-sectional surveillance study among infected COVID-19 healthcare workers working at Malaysia government hospitals. Results 1608 healthcare staffs at hospitals have been notified with COVID-19 infection in year 2020. By proportion, nursing occupation contribute up to 40.5%, followed by medical doctor (20.8%), healthcare assistant (9.7%), medical doctor assistant (9.1%), medical specialist (3.2%) and hospital administrative assistant (2.8%). Most of cases were reported from Sabah (39.8%), Selangor (27.5%), Wilayah Persekutuan Kuala Lumpur & Putrajaya (6.7%), Sarawak (6.0%), Perak (5.6%) and Johor (4.7%). By gender, seven out of ten infected healthcare staffs were female and majority of them have no comorbidity (87%). In addition, rate of COVID-19 infection among healthcare workers was proportionately increased with rate of COVID-19 infection among community. Investigation by health authorities found 43.2% of COVID-19 infection cause by community, 36.3% occurred between staff to staff and 17% occurred between patients to staff. Conclusion Preponderance of infection has occurred within hospital environment. Occupational Safety and Health Unit should set up a good engagement with healthcare staff and effective strategies to protect and support the health, safety and wellbeing of staff through deep-rooted assessment of standard practice procedure especially in nursing and care activities. Digital contact tracing could improve contact tracing within hospital setting.
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We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.