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[This corrects the article DOI: 10.1016/j.bea.2022.100054.].
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Background: With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. Research question: We explored GPs' perspectives on digital remote care's main benefits and challenges. Method(s): GPs across 20 countries completed an online questionnaire between June and September 2020. GPs' perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. Result(s): In our survey 1605 respondents participated. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and the accompanying legal frameworks. Main challenges included patient's preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues and regulatory weaknesses. Conclusion(s): At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how. Lessons learned during the emergency phase can inform the stable adoption of virtual care solutions and co-design processes and platforms that are technologically robust, secure, and supported by a long-term strategic plan.
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IntroductionThis study aimed, first, to audit the appropriateness of surgical referrals to an acute surgical unit for urgent assessment and, second, to devise a screening tool for use in the emergency department to categorise patients into those who need an urgent surgical review and those who can be seen in an ambulatory setting within the next few days.MethodsThe first phase of the study was an audit of surgical referrals between 1 and 18 February 2020 to check the appropriateness of the surgical referral. In the second phase, a tool was designed to screen patients who did not require urgent surgical review and could be seen in the ambulatory clinic. A prospective questionnaire study was conducted from 1 February to 24 March 2020 with patients who were admitted to an acute surgical ward. Based on responses to the screening tool, patients were given the outcome of whether they can be discharged and seen in an ambulatory clinic. The accuracy of the screening tool outcome was assessed and compared with actual patient discharge outcomes by the surgical team evaluating patients' electronic medical records.ResultsIn the first audit of referrals to the acute surgical ward, 206 patients were referred to the acute surgical unit and seen by the senior surgeon. Of these, 142 (68.9%) were discharged on the same day with or without follow-up in the ambulatory surgical clinic. In the prospective questionnaire phase of the study, 98 patients completed the questionnaire. The most common presentation was abdominal pain (n=60) followed by urological symptoms (n=11), symptoms of hernia complication (n=10), abscess (n=7), testicular pain (n=2) and trauma (n=2). Of the patients discharged on the same day, 50% were given ambulatory care appointments and 50% were discharged with no further follow-up. The sensitivity and specificity of the screening tool were 100% and 60.7%, respectively;the overall accuracy was 88.4%.ConclusionA large proportion of patients who are referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool used for acute surgical referral had reasonable sensitivity and high specificity to screen patients who can be seen in ambulatory clinics. At the same time, it identified patients who were unwell and required urgent surgical admission.
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Aim/Introduction: Although 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography/Computed Tomography (PET/ CT) is not routinely used for diagnosis of COVID- 19 infections, we incidentally detected lung lesions in few patients, who were referred for some other indications. The study aimed to explore a cut off value of standardized uptake values (SUV) of 18F-FDG PET/ CT in predicting active COVID-19 infection in both symptomatic and asymptomatic patients referred to our department for various oncologic indications. Material(s) and Method(s): We retrospectively analysed PET/CT studies performed from March 2020 to August 2021 done at our department, who underwent 18F-FDG PET/CT for various oncological indications. PET/CT scans were reviewed by 2 experienced nuclear medicine physicians. At first, only HRCT chest was reviewed to ascertain inclusion of the patient. CT severity score and COVID-19 Reporting and Data System (CORADS) criteria were calculated from HRCT chest. PET/CT images were reviewed and SUVmax were recorded in lung parenchyma and mediastinal blood pool and SUV ratios (SUVR) between them were calculated. Result(s): A total of 85 patients were identified and divided into 3 groups based on clinical symptoms and reverse transcription-polymerase chain reaction (RT-PCR) results * Group A- patients with symptoms of COVID- 19 and positive RT-PCR- (n=51) * Group B- patients with symptoms of COVID-19 and a negative RT-PCR- (n=13) * Group Cpatients with no symptoms of COVID-19 - (n=21). SUVR of these 3 groups (2.67+/-1.21 vs 1.86+/-0.8 vs 1.42+/-0.53 respectively) showed significant statistical difference (p<0.05). Moderate correlation was obtained between SUVR and CT severity score (r= 0.43, p<0.05), thereby correlating towards prognosis. The area under the curve (AUC) obtained for different cut-off values of SUVR was 0.74 (95% CI- 0.55-0.97, p<0.05). A SUVR cut-off value of 1.87 yielded a specificity of at least 74.3% and a sensitivity of at least 68%. Conclusion(s): An SUVR cut off value of 1.87 can yield a specificity of at least 74.3% and a sensitivity of at least 68%. HRCT chest and 18F-FDG PET/CT plays a complementary role in determining active COVID-19 infection. SUVR of pulmonary lesions can be considered as an important prognostic indicator for active COVID-19 infections.
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Background The COVID-19 pandemic has highlighted shortfalls in the delivery of vaccine programmes to older migrant groups. Guidelines exist, however, little is known around care pathways and engagement of these older cohorts in routine vaccinations in primary care, including catch-up programmes. We explored the views of primary care professionals around barriers and facilitators to catch-up vaccination in adult migrants (defined as foreign born;18+ years) with incomplete or uncertain vaccination status. Methods We did a qualitative interview study with purposive sampling and thematic analysis in UK primary care (50 practices included nationally;1 hour qualitative interviews) with 64 primary care professionals (PCPs): 48 clinical staff including GPs, Practice Nurses and healthcare assistants (HCAs);16 administrative staff including practice managers and receptionists (mean age 45 years;84.4% female;a range of ethnicities). Results Participants highlighted direct and indirect barriers to catch-up vaccines in adult migrants who may have missed vaccines as children, missed boosters, and not be aligned with the UK's vaccine schedule, from both a personal and service-delivery level, with themes including: lack of training and knowledge of guidance around catch-up vaccination among staff;unclear or incomplete vaccine records;and lack of incentivization (including financial reimbursement) and dedicated time and care pathways. Adult migrants were reported as being excluded from many vaccination initiatives, most of which focus exclusively on children. PCPs noted that migrants expressed to them a range of views around vaccines, from positivity to uncertainty, to refusal. Conclusions Vaccine uptake in adult migrants could be improved through implementing new financial incentives, strengthening care pathways and training, and working directly with local community groups to improve understanding around the benefits of vaccination at all ages. Key messages There are direct and indirect barriers to catch-up vaccines in adult migrants who may have missed vaccines as children, missed boosters, and not be aligned with the UK’s vaccine schedule. Primary care teams have a key role to play in implementing WHO’s new Immunization Agenda and to better consider catch-up vaccination to under-immunised groups across the life-course.
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Background Social distancing policies to reduce transmission of covid-19 also reduced children's exposures to endemic respiratory viruses. We aimed to examine the impact of the covid-19 pandemic on lower respiratory tract infections in under 5s presenting to primary care in England. Methods Longitudinal trends analysis using electronic health records from a nationally representative primary care database. Our target population was children aged <5 years registered with a primary care practice from January 2015 to March 2021. Our main outcome was total weekly contacts with primary care for a lower respiratory tract infection (LRTI). We defined three pandemic phases from March 2020 - March 2021: i) first national lockdown (late March to early June 2020), ii) childcare settings reopened and second national lockdown with schools open (mid-June to mid-December 2020) and iii) third national lockdown with schools closed (late December 2020 to end of March 2021). We compared outcomes during each of the three phases with corresponding calendar weeks during pre-pandemic years 2015 to 2019. Results Our study population included 843 020 children <5 years who had 1 076 181 contacts with primary care for LRTIs. During the first phase (first lockdown) there were falls of 79.3% (95% CI: 73.6 to 84.5) from an average of 28 547 primary care contacts for LRTI in 2015 - 2019 to 5915 in 2020;there was a 78.9% (95% CI: 73.7 to 83.9) fall in phase two (childcare settings reopened and second lockdown) from 107 873 to 22 792 contacts;and a 77.7% (95% CI: 73.5 to 81.4) fall in phase three (third lockdown) from 57 200 to 12 764 contacts. Conclusions Children under 5 in England had fewer contacts with primary care for LRTIs during the covid-19 pandemic. This change likely reflects lower prevalence of respiratory illness due to fewer social contacts. This may impact on future health service use as these children have had less exposure, and therefore may have less immunity, to respiratory diseases. Key messages • Children under 5 had fewer contacts with primary care for lower respiratory tract infections during the covid-19 pandemic in England likely due to the restrictions in place to reduce social contacts. • The falls in lower respiratory tract infections during the covid-19 pandemic in under 5s may mean they have less immunity to respiratory viruses which may impact upon their future health service use.
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: The novel coronavirus has infected over 609,848,852 individuals throughout the world with a total death of over 6.5 million since its outbreak in December 2019. Since then many therapeutic options have been approached and tested in clinical trials as well to find a potential cure or preventive therapy for the COVID-19 disease. This review summarizes the potential therapeutic options currently available for the treatment of COVID-19 including lopinavir-ritonavir, Hydroxychloroquine, Remdesivir, Ribavirin, dexamethasone, interferon, antibodies, Tocilizumab, Azithromycin, Piperacillin-tazobactam, Moxifloxacin, Ivermectin, Nitazoxanide, Baricitinib, and Arbidol. This study briefly discusses the clinical trials and encompasses the dosage, efficacy, adverse drug reactions, and possible mechanism of action of the potential treatment candidate where applicable. The growing number of reported cases posits an exigent need for a suitable therapy for the prevention and cure of this disease. Therefore, the study aims to provide vital information on each drug to highlight the latest scientific research that could be helpful for better prevention/treatment of COVID-19 disease.
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Purpose: Immunocompromised hosts are at risk for severe complications or death from SARS-CoV-2 infection. Few studies describe the clinical features, outcomes and treatment strategies in this population across multiple sites. Method(s): A multi-center retrospective analysis from academic medical centers in the Midwestern US was conducted for hospitalized patients with SARS-CoV-2 infection. Data was collected electronically using standardized intake and 28-day follow up case report forms. The centers included Northwestern University, University of Nebraska, Cleveland Clinic, University of Chicago, Indiana University and University of Kansas. Result(s): The cohort included 272 patients hospitalized from March 2020 to November 2021. Demographics are in Table 1. Mean admission was 6.84 +/- 6.42 days after symptom onset. The most commonly reported symptoms were cough (71.4%), dyspnea (59.6%), fatigue (55.3%), fever (54.9%), and diarrhea (43.9%). Admission CXR had pneumonia in 31.6%;63% with multifocal or patchy opacities. 87 patients had a chest CT;72 (82.7%) showed pneumonia. 97 patients (36.1%) required ICU admission. Treatments included remdesivir (58.5%), dexamethasone (54.4%), convalescent plasma (3.0%), IL-6 inhibitor (4.5%). Immunosuppression management included holding (44.2%) or decreasing (26.6%) the dose of antimetabolite. 76 patients (28.3%) had documented bacterial co-infection, in blood (34.1%), lung (30.6%) and urine (30.6%). 6 (2.2%) patients experienced rejection within 30 days and 8 patients (3.0%) developed CMV viremia. 26 patients (9.7%) died by day 28. Conclusion(s): This cohort had high rates of ICU admission (36.1%), bacterial coinfection (28.3%), rehospitalization (31.5%) and mortality (9.7%).
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With severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an emergent human virus since December 2019, the world population is susceptible to coronavirus disease 2019 (COVID-19). SARS-CoV-2 has higher transmissibility than the previous coronaviruses, associated by the ribonucleic acid (RNA) virus nature with high mutation rate, caused SARS-CoV-2 variants to arise while circulating worldwide. Neutralizing antibodies are identified as immediate and direct-acting therapeutic against COVID-19. Single-domain antibodies (sdAbs), as small biomolecules with non-complex structure and intrinsic stability, can acquire antigen-binding capabilities comparable to conventional antibodies, which serve as an attractive neutralizing solution. SARS-CoV-2 spike protein attaches to human angiotensin-converting enzyme 2 (ACE2) receptor on lung epithelial cells to initiate viral infection, serves as potential therapeutic target. sdAbs have shown broad neutralization towards SARS-CoV-2 with various mutations, effectively stop and prevent infection while efficiently block mutational escape. In addition, sdAbs can be developed into multivalent antibodies or inhaled biotherapeutics against COVID-19.
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Carbon footprint (CF) is a measure of greenhouse gas emissions generated from daily human-induced activities as carbon dioxide equivalent. This study is an attempt to represent a consumption-based CF study from the scope of transportation, electricity, and waste generation for University of the Punjab (PU), Lahore under the WRI/WBCSD greenhouse gas protocol corporate standards. Data acquired through fieldwork, questionnaire surveys, direct sampling, and existing records for the year 2019-20 suggested that electricity is the greatest contributor of CO2 emissions at 59%, followed by transportation at 36%, and waste generation at approximately 5%. The total CF(CO2_eq) generated from different sources is about 18360.62MT for one year. The recent COVID-19 lockdown has offered inimitable prospect to compare the carbon footprint of one of the largest higher education institutes of Pakistan before and during this pandemic. The data can serve for tracking, assessing, and setting goals for greenhouse gas emission reduction programs in future. © 2022 Global NEST.
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Since the emergence of coronavirus disease–2019 (COVID-19) outbreak, every country has implemented digital solutions in the form of mobile applications, web-based frameworks, and/or integrated platforms in which huge amounts of personal data are collected for various purposes (e.g., contact tracing, suspect search, and quarantine monitoring). These systems not only collect basic data about individuals but, in most cases, very sensitive data like their movements, spatio-temporal activities, travel history, visits to churches/clubs, purchases, and social interactions. While collection and utilization of person-specific data in different contexts is essential to limiting the spread of COVID-19, it increases the chances of privacy breaches and personal data misuse. Recently, many privacy protection techniques (PPTs) have been proposed based on the person-specific data included in different data types (e.g., tables, graphs, matrixes, barcodes, and geospatial data), and epidemic containment strategies (ECSs) (contact tracing, quarantine monitoring, symptom reports, etc.) in order to minimize privacy breaches and to permit only the intended uses of such personal data. In this paper, we present an extensive review of the PPTs that have been recently proposed to address the diverse privacy requirements/concerns stemming from the COVID-19 pandemic. We describe the heterogeneous types of data collected to control this pandemic, and the corresponding PPTs, as well as the paradigm shifts in personal data handling brought on by this pandemic. We systemically map the recently proposed PPTs into various ECSs and data lifecycle phases, and present an in-depth review of existing PPTs and evaluation metrics employed for analysis of their suitability. We describe various PPTs developed during the COVID-19 period that leverage emerging technologies, such as federated learning, blockchain, privacy by design, and swarm learning, to name a few. Furthermore, we discuss the challenges of preserving individual privacy during a pandemic, the role of privacy regulations/laws, and promising future research directions. With this article, our aim is to highlight the recent PPTs that have been specifically proposed for the COVID-19 arena, and point out research gaps for future developments in this regard. Author
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The COVID-19 pandemic has brought attention back to its spread in medical staff. A survey-based study was conducted to combine general information related to COVID-19 exposures, acceptances, vaccines received, and side effects. The majority (62.3%) of healthcare professionals had acquired COVID-19 infection from hospital environment (51.5%) mainly who treated (64%) COVID-19 patients. 54% healthcare respondents expressed 'high acceptance' towards COVID-19 vaccines. 88% received COVID-19 vaccination. The majority of healthcare personnel received SinoPharm (65%). 82.3% did not acquire COVID-19 post-vaccination. 38% mild side effects were observed from vaccination. Following were the general side-effects: myalgia (18.2%), the feeling of sickness (16%), fever (15.6%), dizziness (7.8%), joint pain (7.4%), chills (4.8%), and flu (4.8%). Following were the common neurological side-effects reported: headache (18.2%), fatigue (16.5%), muscle pain (16%), numbness/tingling (3%), and migraine (2.6%). Nausea and diarrhoea were reported in only 3.5% of respondents. Bad taste was reported in only 3% of respondents. The 1.7% reported rash and itching. The majority of the healthcare professionals did not report significant side effects related to neurological, gastroenterological, skin and oral categories. To assess the vaccines' potential for substantial and long-term or chronic effects, more study with a larger sample size and a longer follow-up time is required.
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The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is still unravelling, and is expected to last for an indefinite time. The historical experience with similar pandemics in the past, and the nature of the viral illnesses as such, explains that not only the mental illnesses worsen in the existing patients during pandemics the new diagnoses increase as well and outlive the pandemic itself. This not only has profound effect on the wellbeing of the survivors of pandemics, the healthcare workers, and the general public alike, the financial implications and restructuring of the social fabric cannot be over stated. There is an urgent need to identify these risks and start planning to devise and implement strategies for effective mental health damage prevention and control.
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BACKGROUND: The Coronavirus disease (COVID-19) pandemic has shaken the world. So far, CT has emerged as main stay of imaging whereas the local data on radiographic features of COVID-19 is sparse. METHODS: Prospective study includes 402 chest X rays (CXRs) of 105 patients presenting with symptoms of COVID-19. The nature of abnormality, distribution and lung zone involvement was documented. Following British Society of Thoracic Imaging (BSTI) guidelines, CXRs were grouped into classic/ probable COVID-19, indeterminate, non-COVID-19 and normal categories. The lung involvement was scored according to modified Radiographic Assessment of Lung Edema (RALE) scoring. The follow up radiographs were assessed for disease progression and improvement. RESULTS: Seventy-six males and 29 females with mean age of 50 years were included in our study. 47 out of 105 baseline radiographs were categorized as classic/ probable COVID-19, 26 as indeterminate, 7 as Non-COVID-19 and 25 as normal. 75 patients were positive and 30 were negative on RT-PCR testing. The sensitivity of CXR in diagnosing COVID-19 is 84%. The worsening radiographic features and higher RALE score correlates with longer hospital stay, ICU admissions and mortality. The ground glass opacities and consolidations in peripheral distribution involving bilateral mid and lower zones are the predominant findings of COVID-19 in Pakistani population. CONCLUSIONS: Combination of bilateral peripheral ground glass opacities and consolidations are the cardinal feature of COVID-19 on CXRs. The diagnostic categories described by BSTI correlates with PCR results in Pakistani population. The worsening radiographic findings correspond to poor prognosis;hence serial radiographs can be used for assessing disease course.
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The modern practice of anesthesia is challenged with highly complex operating room environment and ever increasing number of tasks requiring the anesthesiologist’s undivided instantaneous attention. Automation of repetitive tasks and risky procedures, coupled with clinical decision support, helps to improve safety and reduce stress. Varying degrees of progress have been made in developing robots to undertake various individual components of the anesthesiologist’s multifaceted clinical practice;some semi-autonomous drug delivery systems have reached the stage of obtaining regulatory approvals, whereas fully or semi-automatic mechanical robots undertaking a few procedures are still under research. The current COVID-19 pandemic has highlighted the need to innovate machines to perform mechanical tasks avoiding proximity to the patient’s airway to protect the anesthesia staff from catching infection. This editorial presents a snapshot of the current status of these devices, and attempts to envisage a roadmap for further development. © 2021 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
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OBJECTIVES: We investigated the impact of COVID-19 and national pandemic response on primary care antibiotic prescribing in London. METHODS: Individual prescribing records between 2015 and 2020 for 2 million residents in north west London were analysed. Prescribing records were linked to SARS-CoV-2 test results. Prescribing volumes, in total, and stratified by patient characteristics, antibiotic class and AWaRe classification, were investigated. Interrupted time series analysis was performed to detect measurable change in the trend of prescribing volume since the national lockdown in March 2020, immediately before the first COVID-19 peak in London. RESULTS: Records covering 366 059 patients, 730 001 antibiotic items and 848 201 SARS-CoV-2 tests between January and November 2020 were analysed. Before March 2020, there was a background downward trend (decreasing by 584 items/month) in primary care antibiotic prescribing. This reduction rate accelerated to 3504 items/month from March 2020. This rate of decrease was sustained beyond the initial peak, continuing into winter and the second peak. Despite an overall reduction in prescribing volume, co-amoxiclav, a broad-spectrum "Access" antibiotic, prescribing rose by 70.1% in patients aged 50 and older from February to April. Commonly prescribed antibiotics within 14 days of a positive SARS-CoV-2 test were amoxicillin (863/2474, 34.9%) and doxycycline (678/2474, 27.4%). This aligned with national guidelines on management of community pneumonia of unclear cause. The proportion of "Watch" antibiotics used decreased during the peak in COVID-19. DISCUSSION: A sustained reduction in community antibiotic prescribing has been observed since the first lockdown. Investigation of community-onset infectious diseases and potential unintended consequences of reduced prescribing is urgently needed.
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Transfer Learning (TL) opens new possibilities of detection of disease through radiography as compared to conventional machine learning as well as deep learning methods. The extraction of features through pre-trained Convolutional Neural Networks (CNN) and the tuning of the fully connected layers of the CNN model is the core for the development of a transfer learning pipeline. The present study investigates the diagnosis of COVID-19 through X-ray images by means of three TL models, namely Inception V3, VGG-16, and the VGG-19 for feature extraction along with heuristically fine-tuned fully connected layers. It was demonstrated through this preliminary work that both the VGG-16 and VGG-19 tuned pipelines could achieve a train and test classification accuracies of 99.8% and 94%, respectively. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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OBJECTIVES: The objectives of the study were to investigate access to free school meals (FSMs) among eligible children, to describe factors associated with uptake and to investigate whether receiving FSMs was associated with measures of food insecurity in the UK using the Coronavirus (COVID-19) wave of the UK Household Longitudinal Study. STUDY DESIGN: The study design was cross-sectional analyses of questionnaire data collected in April 2020. METHODS: Six hundred and thirty-five children who were FSM eligible with complete data were included in the analytic sample. Accessing a FSM was defined as receiving a FSM voucher or a cooked meal at school. Multivariable logistic regression was used to investigate (i) associations between characteristics and access to FSMs and (ii) associations between access to FSMs and household food insecurity measures. All analyses accounted for survey design and sample weights to ensure representativeness. RESULTS: Fifty-one percent of eligible children accessed a FSM. Children in junior schools or above (aged 8+ years) (adjusted odds ratio [AOR]: 11.81; 95% confidence interval [CI]: 5.54, 25.19), who belonged to low-income families (AOR: 4.81; 95% CI: 2.10, 11.03) or still attending schools (AOR: 5.87; 95% CI: 1.70, 20.25) were more likely to receive FSMs. Children in Wales were less likely to access FSMs than those in England (AOR: 0.11; 95% CI: 0.03, 0.43). Receiving a FSM was associated with increased odds of recently using a food bank but not reporting feeling hungry. CONCLUSIONS: In the month after the COVID-19 lockdown, 49% of eligible children did not receive any form of FSMs. The present analyses highlight that the voucher scheme did not adequately serve children who could not attend school during the lockdown. Moreover, more needs to be done to support families relying on income-related benefits, who still report needing to access a food bank. As the scheme may be continued in summer or in a potential second wave, large improvements will be needed to improve its reach.