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OBJECTIVE: The ai/m of this study was to compare the self-reported confidence of novices in using a smartphone-enabled video otoscope, a microscope and loupes for ear examination and external ear canal procedures. METHOD: Medical students (n = 29) undertook a pre-study questionnaire to ascertain their knowledge of techniques for otoscopy and aural microsuction. Participants underwent teaching on ear anatomy, examination and procedural techniques using a microscope, loupes and smartphone-enabled video otoscopes. Confidence and preference using each modality was rated using a Likert-like questionnaire. RESULTS: After teaching, all modalities demonstrated a significant increase in confidence in ear examination (p < 0.0001). Confidence in using the smartphone-enabled otoscope post-teaching was highest (p = 0.015). Overall, the smartphone-enabled video otoscope was the preferred method in all other parameters assessed including learning anatomy or pathology (51.72 per cent) and learning microsuction (65.51 per cent). CONCLUSION: Smartphone-enabled video otoscopes provide an alternative approach to ear examination and aural microsuction that can be undertaken outside of a traditional clinical setting and can be used by novices.
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Otoscopes , Students, Medical , Humans , Otoscopy/methods , Self Report , SmartphoneABSTRACT
Background: Household overcrowding is associated with increased risk of infectious diseases across contexts and countries. Limited data exist linking household overcrowding and risk of COVID-19. We used data collected from the Virus Watch cohort to examine the association between overcrowded households and SARS-CoV-2.
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Introduction: Increased transmissibility of B.1.1.7 variant of concern (VOC) in the UK may explain its rapid emergence and global spread. We analysed data from putative household infector - infectee pairs in the Virus Watch Community cohort study to assess the serial interval of COVID-19 and whether this was affected by emergence of the B.1.1.7 variant.
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We conducted a survey exploring the experiences of NHS hospital acute medicine services in England during the 1st wave of the COVID-19 pandemic. Responses were collected from 26th May to 8th July 2020. The results of 91 sites are presented. The total number of patients referred to the medical take for assessment and admitted from the medical take decreased from pre-pandemic levels compared to peak COVID-19 activity. The total number of acute medical beds decreased, however critical care beds increased by 162%. We report the median timeline from first admission of COVID-19 to when baseline critical care capacity was reached. We found regional variation across the results. These findings can assist healthcare leaders prepare for future pandemics.
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Introduction: Efficiency in health care delivery is increasingly important as health care services look to recover from the COVID-19 pandemic. Day-case elective surgery can help keep hospital beds free and reduce the risk of nosocomial infection. We aimed to investigate outcomes for day-case and overnight stay elective pediatric tonsillectomy in England. Method: Data on tonsillectomies in patients aged ≤18 years were extracted from the Hospital Episodes Statistics (HES) data set from April 1, 2014, to March 31, 2019. HES contains data for all National Health Service-funded hospital admissions in England. Data were categorized as those seen as day cases and those that involved an overnight stay. Primary outcome was readmission within 30 days of discharge. Multilevel logistic regression modeling was used to explore the relationship between tonsillectomy, day-case surgery, and 30-day readmission. Covariates included age, sex, year, indication for operation, additional procedures (eg, adenoidectomy), and surgical technique (coblation). Results: A data set of 156,942 tonsillectomy procedures across 133 hospital trusts (centers) was identified over a 5-year period. Of these procedures, 88,354 (56.3%) were daycase procedures. Patients who were seen for day-case surgery were significantly older, with 39.8% of 0- to 4-year-olds seen as a day case compared with 73.1% of 15- to 18-year-olds. Patients with hypertrophy, obstructive sleep apnea, or adenoid involvement were much less likely to have day-case surgery than those without (70.8% vs 46.6%, respectively). The lowest rates of readmission were in patients aged 5 to 7 years and patients with hypertrophy, adenoid involvement, or obstructive sleep apnea. Centers that had higher day-case rates have lower 30-day readmission for infection. Conclusion: Our study provides further evidence of the safety of day-case tonsillectomy surgery for the majority of paediatric patients.
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Introduction: Strategies for tracheostomy use in COVID-19 patients have varied between hospitals and changed over time as the pandemic progressed. The objective of our study was to determine the outcomes of patients undergoing tracheostomy for COVID-19 in England using administrative data. Method: This was a retrospective observational study using the Hospital Episode Statistics (a mandatory administrative data set for National Health Service hospitals). Patients aged ≥18 years who had a diagnosis of COVID-19 during a hospital stay in England that was completed between March 1, 2020, and September 30, 2020, were included. Primary outcomes analyzed were having a tracheostomy inserted, in-hospital mortality, and length of stay. Multilevel logistic regression was used to model the relationship between tracheostomy insertion and in-hospital mortality with covariates including age, sex, deprivation, ethnicity, frailty, comorbidities, and date of discharge (alive or following death). Linear regression model was used to explore the association with length of stay and tracheostomy. Results: There were 117,438 patients who had a diagnosis of COVID-19 during this time period. Of the 11,606 (9.9%) patients admitted to critical care, initial analysis has identified 921 (7.9%) with a tracheostomy. Predictors of having a tracheostomy inserted included age 40 to 69 years and Asian and Black ethnicity. In the critical care population, patients with a tracheostomy had a higher in-hospital mortality rate and longer lengths of stay. Tracheostomy rates increased during the first 5 months of the pandemic (March to July 2020), and there was significant regional variation in the tracheostomy use. Conclusion: There was increased use of tracheostomy in England as more was learned about the disease, although there was still variation between centers in how it was used. In analyzing all patients who had hospital admissions for COVID- 19 in England, we have been able to identify the factors that influenced patients having tracheostomies and the clinical indicators that were predictive of mortality.
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Introduction We developed a national survey to capture how respiratory departments in England adapted during the first wave of the COVID-19 pandemic and to develop lessons which can be applied to subsequent planning. Methods A link to the online survey, hosted on a secure platform in an NHS England and Improvement account, was sent by email to all NHS trusts in England with known respiratory departments. The survey was open for 43 days during August and September 2020. The survey included sections on COVID patient numbers, bed capacity, workforce, delivery of respiratory support, equipment, diagnostic and interventional services, and follow-up for patients discharged. Results 58 (43.9%) responses were received. Workforce-42 sites (72.4%) changed their respiratory consultant rota, for example, by changing to 12 hours shifts and overnight resident on calls. 24 sites (41.4%) stated that respiratory consultants had been removed from the general medical rota. Respiratory Support-CPAP was used in a variety of clinical environments including closed bays (in 36 sites) and closed wards (19 sites), and was primarily used as a bridge to ventilation (46 sites), to prevent intubation (48 sites) and as a ceiling of care (47 sites). Equipment-28 (48.3%) of units reported a shortage of at least one respiratory medical consumable (most commonly non-vented NIV masks (16 units) and CPAP machines (12 units)). Diagnostic and interventional services-Bronchoscopy and EBUS services were suspended in 16 (27.6%) and 10 (17.2%) sites respectively and continued for cancer patients only in 24 (41.4%) and 27 (46.6%) sites respectively. Follow up-12 units (20.7%) did not offer follow up to patients with COVID related pneumonia at 6 weeks. Conclusion This national survey shows the significant changes made, and challenges faced, by respiratory departments during the first wave of the COVID-19 pandemic. We identified some areas where there were deviations from best practice and some positive changes that should be continued. The lessons drawn from the survey results can assist in future COVID-19 planning.
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BACKGROUND: As a response to the acute strain placed on the National Health Service during the first wave of coronavirus disease 2019 in the UK, a number of junior doctors including ENT trainees were redeployed to other clinical specialties. This presented these trainees with novel challenges and opportunities. METHODS: A qualitative study was performed to explore these experiences, undertaking semi-structured interviews with ENT trainees between 17th and 30th July. Participants were recruited through purposeful sampling. Interview transcripts underwent thematic analysis using Dedoose software. RESULTS: Seven ENT trainees were interviewed, ranging from specialty trainee years four to eight ('ST4' to 'ST8') in grade. Six core themes were identified: organisation of redeployment, utilisation of skill set, emotional impact of redeployment, redeployed team dynamics, concerns about safety and impact on training. CONCLUSION: The ENT trainees' experiences of redeployment described highlight some important lessons and considerations for future redeployments.