A REVIEW OF THE MANAGEMENT OF PELVIC INFLAMMATORY DISEASE AT A COMMUNITY CLINIC COMPARING PRACTICES BEFORE AND DURING THE COVID-19 PANDEMIC

Background Pelvic inflammatory disease (PID) usually results from infection ascending from the endocervix. The British Association for Sexual Health and HIV guidelines state that the diagnosis of PID should be considered in women under 25 with recent onset, bilateral lower abdominal pain and local tenderness on bimanual examination where pregnancy has been excluded. They recommend testing for chlamydia, gonorrhoea and mycoplasma genitalium. Method Electronic patient records were reviewed to identify episodes coded C5A during the last six months of 2019 and 2020. 46 patients were identified in 2019 and 43 in 2020. The following were recorded: demographics, symptoms, sexual history, examination findings, investigations, treatment, partner notification, follow-up. Results The age range of the 89 patients was 18-62, 51% were aged 25-34. Patients came from a range of ethnicities reflecting the diverse population. All patients were tested for chlamydia and gonorrhoea, none for mycoplasma genitalium. A pregnancy test was not performed in 19/89 (21%) patients. Documentation of examination findings was sometimes absent. Follow-up was recorded in 8/89 (9%) cases. Results were similar in 2019 and 2020, although ceftriaxone administration was more common pre-pandemic. Key results are summarised in the accompanying table 1. Conclusions PID management in 2019 and 2020 was similar. Increased testing for mycoplasma could guide antibiotic therapy. The importance of pregnancy testing in women presenting with lower abdominal pain should be highlighted to clinicians. Telephone calls could be used to facilitate follow-up appointments. (Figure Presented).

Covid constraints on care: the impact of COVID-19 on decision-making for people at the end of life and the experiences of healthcare professionals and bereaved carers

IntroductionPeople are living longer with terminal illness, increasing the need for good palliative care. Projections indicate rising home deaths;accelerated by the COVID-19 pandemic but dying at home is reliant on informal carers.AimsTo identify the impact of the COVID-19 pandemic on hospice services from the perspectives of staff and bereaved carers, exploring decision-making for place-of-care and informal caring.MethodScoping reviews explored (1) place of end of life care, and (2) informal caring during the pandemic. Online interviews are being conducted with healthcare professionals in England (n=10) and Scotland (n=10) and bereaved carers who experienced Marie Curie services during lockdown in England (n=10) and Scotland (n=15-20). Once completed by January 2022 and thematically analysed key findings will drive a ‘knowledge exchange’ discussion with policy makers in England and Scotland.ResultsThe reviews and preliminary interview findings indicate the pandemic has put greater pressures on those accessing palliative care services. Decisions were influenced by the media;‘fear of contracting’ or ‘spreading the virus’ are evident in preferences for ‘home-based care. Social distancing, wearing of PPE and shielding restricted practical and emotional support that carers feel enable a good home death. The literature suggests that many carers adjusted to the altered methods of social connection and communication, but interview data suggests concerns about wellbeing especially where ‘grief’ was put ‘on hold’, delaying the bereavement process.ConclusionFindings will identify key considerations for policy and practice change around the future of hospice services if the move to community continues and how we develop and deliver hospice community based services to meet need.ImpactThis research will seek to inform Government policy and Marie Curie services to enable evidence based change and inform future research priorities.