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Background/Aims During the COVID-19 pandemic we were unable to provide regular outpatient services for patients with chronic rheumatic diseases. A ''backlog'' of 6812 patients without an allocated follow-up appointment accrued by September 2021. We quantified this cohort and analysed attempts to deliver care remotely (using video, telephone, and electronic remote management forms (RMFs)). Methods We selected a 12-month ''window'' (May 2020-May 2021) and analysed the number of patients awaiting follow-up during this period. This was initially 3259 patients out of the total backlog 6812. We revisited the number of patients remaining in that cohort on four occasions between September 2021 and September 2022: at baseline, then at 1-, 2-, 6- and 12-month intervals. Each audit cycle was conducted using the same methodology. Alongside usual follow up pathways, (face to face, video or telephone), we implemented remote management forms (RMFs) for different disease groups which were designed by the department;they contained a triage questionnaire, including calculation of disease severity scores, and questions about medications. These were sent out by clinicians to some patients in lieu of a telephone, video or face to face appointments. Data from RMFs was stored in a secure database for clinician review. Data analysis performed in Microsoft Excel and R (version 4.2.1). Results The number of patients without allocated follow-up appointments reduced from 3259 to 326 between Sep-21 and Sep-22. This is a 90% reduction in the backlog over a 12-month period, with a 71% reduction achieved by 6 months. There was a significant, progressive reduction in the number of patients over time (p<0.001 - Chi-square test for trend). Of the 1956 RMFs completed between Sep-21 - Mar-22, only 261 patients recorded a previous appointment date. 154/261 (59%) were completed by patients waiting in the ''window'' of May-20 - May- 21. This indicates a preferential use of RMFs targeting backlog patients. Between 2-8% of the total backlog patients were managed using RMFs based on available data. Conclusion We have significantly reduced the size of our backlog of outpatient follow-up due to COVID-19 over a 12-month period. In-addition these results likely underestimate the effect of RMFs due to this dataset being incomplete. Remote management made a sizeable contribution to this reduction, meaning some of this reduction was achieved without face-to-face encounters. The use of 1956 forms over a 6- month period shows robust integration of our RMFs into outpatient services disrupted by COVID-19 and provides evidence for remote management as a useful tool in outpatient management, with relevance to areas such as Patient Initiated Follow Up pathways. Further work is needed to clarify where remote management is best deployed and which patient groups benefit most from this.
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Background: Kidney dysfunction is a prevalent disease that leads to many complications over time, such as hypertension, heart disease, and death. ACEI/ARBs are known to be renoprotective. However, few studies describe the association between ACEI/ARB use and kidney dysfunction in patients with SARS-CoV-2 infection. Purpose(s): To explore the association between patients with SARS-CoV- 2 and kidney dysfunction in patients taking an ACEI/ARB. We hypothesize a negative association between patients with SARS-CoV-2 taking an ACEI/ARB and kidney dysfunction. Method(s): A retrospective query between March 2020 and April 2021 was performed in patients 18 years and older who tested positive for SARSCoV- 2 using a polymerase chain reaction test. Patients were divided into two groups: Kidney dysfunction and no kidney dysfunction. Kidney dysfunction was defined as any diagnosis of chronic kidney disease or acute kidney injury. Primary outcomes were all-cause mortality and hospitalization rate. Secondary outcomes included myocardial infarction (MI), hypotension, intubation, vasopressor use, ventricular tachycardia, and ventricular fibrillation. We used multivariate logistic regression to adjust for baseline characteristics. Result(s): We identified 996 patients with kidney dysfunction and 22,106 without kidney dysfunction who tested positive for SARS-CoV-2. The incidence was 258 (25.9%) for ACEI/ARB use in patients with kidney dysfunction. Adjusted odds ratio (OR) for patients with kidney dysfunction was 5.705 (95% Confidence Interval [CI]: 4.554-7.146;p<0.001) for hospitalization, 0.895 (95% CI: 0.707-1.135;p<0.361) for patients taking ACEI/ARB, and 0.529 (95% CI: 0.333-0.838;<0.007) for mortality in patients with kidney dysfunction who took ACEI/ARB. All secondary outcomes had significantly greater adjusted OR (p<0.001), except for MI (p<0.339), ventricular tachycardia (p<0.697), and ventricular fibrillation (p<0.060). Conclusion(s): To date, the benefits of ACEI/ARB in SARS-CoV-2 patients have been controversial. While ACEI/ARB is known to have renoprotective properties, we did not find a significant association between ACEI/ARB and kidney dysfunction in patients with SARS-CoV-2. However, we found the use of ACEI/ARB in patients with kidney dysfunction to be associated with lower mortality. Therefore, clinicians should continue using this medication for its mortality benefits in patients with kidney dysfunction and its cardioprotective effects.
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COVID-19 has greatly disturbed life in many ways and has changed the way we live. Various surveys have been conducted in different fields, and the teaching-learning process has been affected to a great extent. During this pandemic, various online tools and technologies have been available for guiding students without attending school. Many governments, corporations, and research fields have officially ordered to use of online media for the teaching-learning process. Platforms such as Google Meet, Microsoft Team, and Web-e-X have allowed and arranged for online video conferencing mediums to achieve the goal of the teaching-learning process. However, as mentioned above, there are some serious issues with the online teaching-learning process. These include problems with continuous network bandwidth during sessions, physical and mental presence in the class, difficulties handling mathematics classes, and the potential for non-sense activities that may disturb the entire class. In order to discover knowledge, I am using a new approach to data mining technology called CRISP-DM. This study addresses the effectiveness of online teaching mode and learning and the challenges faced by students and teachers who are taking online classes during COVID-19. According to this study, 88.2% of students did not have proper internet or technology facilities, 58.30% of students were not satisfied with online learning, 85.3% of students complained about eyesight issues from taking online classes on devices, and 50.01% of students were unable to manage university affairs © 2023 Manmohan Singh, Vinod Patidar, Shaheen Ayyub, Anita Soni, Monika Vyas Dharmendra Sharma and Amol Ranadive. This open-access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license
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The importance of trust in government amid health emergencies has become apparent, especially given its impact on health behavior. Yet scholars often treat trust simplistically, measuring it at one point in time and in a unidimensional way. We use a unique series of surveys carried out during the first year of the pandemic to examine changing trust in different government actors over time and then link relative trust to compliance with expert-recommended health behaviors. We find that trust in government declined during this period, with especially large declines for federal and state relative to local government. We find somewhat steeper declines among women, Black Americans, the less educated, and Republicans. Finally, we find that trust in state governments and local health officials was positively associated with protective health behaviors, especially among Republicans, and that trust in the federal government was associated with a lower likelihood of such behaviors.
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Introduction: This retrospective study attempted to assess the recruitability of the lungs that were affected by acute respiratory distress syndrome (ARDS) due to COVID-19. This was done with the combined use of transpulmonary pressure monitoring (to limit the stress), measurement of end-expiratory lung volume (EELV) (to measure the actual volume gain and be within limits of strain), electrical impedance tomography (EIT), and compliance (to diagnose overdistension). Recruitment was judged clinically by an increase in the SpO2 values. Methods: Retrospective data from the charts and progress sheets were collected from 27 patients admitted to the intensive care unit (between February 2021 and June 2021) with a ratio of arterial Partial pressure of oxygen (PaO2 in mmHg) to fractional inspired oxygen (FiO2) < 150 (i.e., PaO2/FiO2 < 150) with a diagnosis of ARDS. The esophageal pressure was monitored using the polyfunctional nasogastric tube (Nutrivent (TM)). The end-expiratory volume was measured using the Carescape R860 (GE Healthcare) by the nitrogen multiple breath wash-out/wash-in (EELV) at a positive end-expiratory pressure of 5. EIT measurements were performed using the Pulmo Vista 500. We performed a recruitment maneuver using the "staircase maneuver. " Results: As per the results of our study, we found that almost 2/3rd (66.7%) of the patients affected with COVID lungs affected with ARDS were recruitable. Conclusion: The results of our study again make us believe that majority of COVID-19 lungs affected with ARDS may be recruitable in the earlier stage of the illness (within the 1st week of ARDS). Thus, in such patients, safe, monitored lung recruitment should be attempted to improve oxygenation rather than directly proning the patient, which is fraught with its own set of complications.
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Background. The COVID-19 Community Research Partnership (CCRP) is a large multicenter healthcare system-based study of the COVID-19 pandemic, including factors impacting risk of infection and hospitalization. The CCRP includes a subset of immunocompromised (IC) participants with varying vaccination status over time. Methods. We conducted an observational cohort study of 2,515 IC and 41,941 non-IC CCRP participants who contributed electronic health record data and daily electronic surveys to self-report COVID-19 symptoms, test results, and vaccinations from April 2020 to March 2022. The IC population included those with stem cell transplant, HIV, cancer, autoimmune disease, or solid organ transplant. The latter 3 must have also had an active systemic therapy to meet the IC condition (e.g. chemotherapy, immune modulator, steroid). Logistic regression was used to investigate risk of COVID-19 and hospitalization among IC participants and according to vaccine status within viral variant time periods (pre-delta, delta, omicron). Results. IC conditions included cancer (51%), autoimmune (41%), solid organ/ stem cell transplant (9%), and HIV (7%). The IC group was older and had more comorbidities. 95% of vaccine recipients received an mRNA vaccine. More vaccine breakthrough infections occurred in the IC group than non-IC group (36.1% vs 29.5%, p< 0.001). IC participants were less likely to remain COVID-19 free over time if vaccinated but not boosted (Fig 1A). However, after receiving a booster there was no difference in COVID-19 cases between the groups (Fig 1B). IC participants were more likely to be hospitalized with COVID-19 (OR 2.85;95% CI 1.69-4.76), but vaccination reduced risk for hospitalization (OR 0.26;95% CI 0.08-0.8). Receipt of a booster dose reduced risk of COVID-19 among IC participants during the delta wave (IRR 0.52;95% CI 0.28-0.94) but not during omicron. However, during omicron risk of hospitalization in the IC group was reduced by a booster dose (OR 0.13;95% CI 0.02-0.72). Conclusion. IC individuals were at increased risk for COVID-19 hospitalizations and breakthrough infections. After receiving a booster, IC participants were conferred the same level of protection from infection as their non-IC counterparts, highlighting the importance of boosters for these individuals. (Figure Presented).
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Banks play an integral role in the financial system of any country which directly affects its economic status and growth. The major roles of banks include accepting deposits from its customers, using those deposits to lend money to the borrowers in return for some interest, granting credits, discounting on bills etc. But the main source of profit for the banks is the interest it receives from lending money to the borrowers. And in a scenario of global pandemic like Covid-19, the number of people requiring financial aid from the banks has increased drastically. But a major problem faced by these banks is the failure of timely loan repayment by the borrowers. So, to tackle this problem, banks now a days use some models to predict the possibility of loan repayment from the borrower. Factors like annual income, employment status, home ownership, current debt etc are taken into consideration to categorize the loan request as bad loan or not. So, this paper basically aims to develop a similar model, but using ensemble machine learning algorithm of Random Forest Classification. And perform a comparative analysis with the model (Decision Tree Classification) that are currently in use. After complete implementation of all the models it was concluded that Random Forest Classifier Outperformed Decision Tree Classifier in terms of accuracy. © 2022 IEEE.
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A project must complete in foreordained time and quality as per the limited budget. Therefore risk management of every project is necessary to get success. The most important step in project risk management is to identify the risk creating factors. In this study, risk factors are categorized in two main groups as external and internal factors. Each individual group consists of numerous factors. Here risk evaluation of construction project is invested by the proposed PERT (program evaluation and review techniques), CPM (Critical Path Method) and project management with fuzzy logic techniques. Fuzzy PERT (FPERT) and fuzzy CPM (FCPM), which has most utility in the fuzzy project production management and shall, supported to analyze the risk factor of a project. With definite activity intervals, classic PERT and CPM hike are examined. A survey of fuzzy set theorem in risk management has been discussed in this paper. Throughout this paper, we have observed here fuzzy set theory has many applications in most areas of Risk Management and research on fuzzy set theory in risk management has grown-up in recent years. FCPM and FPERT are extensively used in many fields now-a-days. Many problems are being solved by using FCPM and FPERT methods. These methods are useful to the decision makers. This research shows the project completion time 19.3 months and the project is started since January 2020. This Major Bridge project in Orissa, India, may be affected because of COVID-19 and might get extended further in view of unavoidable circumstances.
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SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: We present two cases of symptomatic post-COVID eosinophilic pneumonia responsive to steroids. CASE PRESENTATION: Case 1: A 73-year-old gentleman with underlying asymptomatic rheumatoid arthritis (RA), was admitted with COVID pneumonia for which he received tocilizumab, remdesivir, and 12 days of dexamethasone. His course was complicated by MRSA pneumonia and bacteremia, so was discharged on IV Vancomycin. Six days post discharge, he redeveloped respiratory distress. Labs showed a WBC 18,000 and proBNP 2828. A chest CT revealed bilateral ground-glass opacities, worsening right upper lung airspace disease and bilateral pleural effusions. Despite receiving Furosemide, Vancomycin, and Ceftazidime, he required high-flow nasal cannula oxygenation (HFNC). Bronchoscopy demonstrated thick right bronchial secretions. BAL fluid revealed 7% eosinophils and grew MRSA. Case 2: A 70-year-old gentleman with extensive smoking history, emphysema, psoriasis, Guillain-Barré syndrome and a recent hospitalization for COVID pneumonia was discharged on a steroid taper. He returned 23 days post discharge in respiratory distress requiring HFNC, 5 days after discontinuing steroids. The chest CT revealed worsening fibrosis and bronchiectasis. Intravenous Levofloxacin and Vancomycin resulted in no clinical improvement. Bronchoscopy showed inflamed bronchi with secretions and BAL analysis revealed 6% eosinophils. For both patients, BAL was negative for fungi and PJP and CTA ruled out PE. Both patients were started on Prednisone with a prolonged taper. They improved clinically with decreased oxygen requirements to 4L nasal cannula and dramatic decrease in subjective dyspnea within 48 hours of starting steroids. DISCUSSION: The differential diagnosis for the clinical deterioration and worsening radiographs in both patients includes bacterial/fungal superinfection, PE, post-COVID-ILD and eosinophilic pneumonia. For the first patient, his RA was inactive. His BAL was positive for MRSA but did not improve until steroids were initiated. Neither of the patients were stable for VATS biopsy. Eosinophilic pneumonia is defined as pulmonary infiltrates with peripheral blood eosinophilia =500/ml, BAL eosinophils > 5% or eosinophilic infiltration on lung biopsy [1]. Both of our patients had >5% BAL eosinophils. Potentially, prolonged COVID-ILD stimulates T-Helper-2 cells, causing the release of IL-4/5/13 with recruitment of eosinophils. Studies report post-COVID-ILD biopsies show organizing pneumonia and fibrosis but have not yet been associated with eosinophilia. In both patients, we observed eosinophilia on BAL. It can be hypothesized that a delayed inflammatory response mediated by eosinophils play a role. CONCLUSIONS: Pulmonary eosinophilic pneumonia is a complication of post-COVID-ILD and can be successfully managed with steroids. Reference #1: De Giacomi F, Vassallo R, Yi ES, Ryu JH. Acute Eosinophilic Pneumonia. Causes, Diagnosis, and Management. Am J Respir Crit Care Med. 2018 Mar 15;197(6):728-736. doi: 10.1164/rccm.201710-1967CI. PMID: 29206477. DISCLOSURES: No relevant relationships by farrukh ahmad No relevant relationships by Deborah Markowitz No relevant relationships by Dhiraj Shah No relevant relationships by Garima Singh No relevant relationships by Aakriti Soni
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Background: Infammatory arthritis is associated with signifcant morbidity and costs to the NHS, social care, and wider economy. Early diagnosis and treatment are essential to reduce the impact of the disease. Therefore, it is important that referrals for a new infammatory arthritis are appropriately triaged to be seen in the early infammatory arthritis (EIA) clinic so that they can be seen and started on disease modifying anti-rheumatoid drugs (DMARDs) without delay. The British Society of Rheumatology guidance for infammatory arthritis states that patients must be seen within three weeks of referral and started on DMARDs within six weeks. Objectives: To evaluate how effectively people referred with a new EIA are currently being triaged. To evaluate whether we are meeting the national standards. Methods: We performed a retrospective review of the medical notes of all new patients who were seen in the EIA clinic from 01/09/21-31/11/21. During this same time period, we will also reviewed all the patients who had been newly diagnosed and started on a DMARD in the other Rheumatology clinics (e.g., general rheumatology, vasculitis). We collected data on referral date, referral source (e.g., GP), date of clinic assessment, clinic type (e.g., EIA clinic or other Rheumatology clinic), diagnoses made, days' wait from referral to assessment and days' wait from referral to commencing DMARD. We then calculated the conversion rate (percentage of referrals triaged to the EIA clinic that have an EIA) and detection rate (percentage of new EIA patients that are seen in the EIA clinic (as opposed to in non-urgent clinics)). The standard for conversation rate (CR) was 50% and for detection rate (DR) was 95%. Results: Of all the patients seen in the EIA clinic (n=73), 36 had a new diagnosis of an EIA, giving a CR of 49%. Of all the new diagnoses of EIA made during that time-period (n=53), 36 were appropriately triaged to be seen in the EIA clinic, giving a detection rate 68%. Those new referrals who had been appropriately seen in the EIA clinic had an average of 5 weeks wait from referral to assessment/commencement of DMARD. In contrast, those new referrals who had been seen in other clinics had an average of 10 weeks from referral to assessment/commencement of DMARD. A previous audit performed before the COVID-19 pandemic (01/11/19-01/01/20) showed a CR of 25% (115 patients seen in EIA clinic, 29 new diagnoses) and a DR of 69% (29 new diagnoses, 20 seen in EIA clinic). Conclusion: Those patients with a new EIA who are appropriately seen in the EIA clinic do not meet the national guidance for being seen within three weeks of referral but do meet the guidance for starting a DMARD withing six weeks. However, those new EIA who are seen outside the EIA clinic do not meet either of these standards, with a delay of 10 weeks to be seen/started on a DMARD. Given that only 68% of people with a new EIA are being correctly triaged to be seen in the EIA clinics, it highlights that there is a need for an improvement in the triage process (currently being done manually by Rheu-matologists). Interestingly, when comparing our findings to the audit done pre-COVID-19 pandemic, the CR has improved whilst the DR has stayed steady. The next steps include exploring using additional data collected from patients electronically to improve the CR/DR rates, as well as artificial intelligence informed modelling.
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Background:Today the whole world is facing the outbreak of Covid-19 disease. People were forced to remain imprisoned in their home, be it a service class, farmer, businessman or student. Due to Covid-19 Pandemic era, schools and colleges are closed. Every student is feeling stressed and waiting for permanent treatment of this disease so that the conditionsbecomes suitable and the studies shall begins in normal pace again. This study is aimed to assess the perceived stress among medical under graduate students and their methodstocopeup this stress in their own way. Materials and Methods: This cross-sectional observational online study was done in august 2020. Participants were MBBS undergraduate Students, whose perceived stress and coping strategies related to Covid-19 era, were assessed using an online questionnaire(Cohen's PSS 10 scale) through Google forms. Total PSS Score was categorised into three parts as low, moderate and high. Coping measures were categorised separately according to their responses. Results: A total of 145 students took part in study. Mean±SD of total perceived stress score was found to be 21.703± 6.564, for male 20.61 and for female 23.21. Stress level was found more in females as compared to male participants. They used different typesof measures for coping out the perceived stress due to covid-19conditions. P-value of correlation of PSS with coping and lifestyle pattern was found to be 0 .440 and 0.011 respectively. Conclusion:This study indicates that,in all 71.03 % medical students were in moderate level of perceived stress, where 42.07% were males and 28.96% were females. They opted various measures to cope up the stress which leads to change in their lifestyle pattern. Mostly, students reported sleep cycle disturbancewhich further increased their stress level. Hence there is amuch needed demand of current time to take immediate action to reduce stress level in medical students.
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Background: Lockdown is an emergency situation which has confined people to their homes, states and country. Individuals felt insecure and worried about their financial matters and their mental health was affected at some point of time during the corona virus pandemic lockdown. Aim: The study aimed to assess the effect of lockdown on mental health between the general population and covid-19 frontline health care workers. Material and Methods: The survey was conducted from July to October 2020 using DSM -5 Self-Rated level 1 cross-cutting symptom measure -Adult scale, circulated through social media platform (Google forms). In this study, 180 participants were enrolled. Hindi version of the measure was used to assess the psychological impact on the participants and a score of 0 was considered as NO and was taken as a Negative response and scores 1 to 4, were considered as YES and were taken as a positive responses. Result: A total of 180 responses were obtained during the survey, amongst them 36.67% were male and 63.33%were female. Frontline healthcare workers were 51.67% and among the Non-health care workers, unemployed were 10%, Student were 17.78%, and the remaining working were 56.67%. As per DSM 5 Crosscutting symptoms scores, the most common reported psychological symptoms were Anxiety 81.11%, Depression 52.78%, Sleep problems 29.44%, and Substance use 25%,. The comparison between both the groups was not statistically significant (p>0.001). However, non-healthcare workers experienced more psychological symptoms. conclusion: The covid-19 lockdown was associated with poor mental health across individuals.the lockdown was observed to be a stressful situation that could have precipitated psychological symptoms like anxiety, stress, depression, and sleep disturbance in the individuals.
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Introduction: Cardiovascular complications of novel SARS-CoV-2 infection remain poorly understood with outcomes limited to index hospitalizations. Methods: This retrospective cohort study included patients with proven COVID-19 who received care at a single hospital network in Massachusetts from March 11, 2020 to May 23, 2020 and received an electrocardiogram (ECG) within 24 hours of hospital presentation. We investigated mortality and cardiovascular complications within 90 days from initial COVID-19 diagnosis. Data were electronically ed and confirmed by manual chart review. Results: A total of 1,744 patients tested positive within the hospital network during the study period. Nearly half of them (49.3%) were hospitalized and 15.5% died within 90 days. A total of 278 patients received an ECG within 24 hours, representing 23.6% of all hospitalized patients. These patients were disproportionately older (38.5 vs 58.1% over the age of 60, p < 0.01), male (49.6 vs 56.2%, p = 0.05), and white (48.1 vs 56.2, p < 0.01). Admission ECGs demonstrating ischemic changes (STelevations, ST-depressions, and T-wave inversions) or new arrhythmias (atrial fibrillation/flutter, bradyarrhythmia, supraventricular tachycardia) were identified among 10.1% and 9.0% of the patients, respectively. Heart failure and cardiomyopathy were rare findings (<1%). After adjusting for age, sex, and past medical history, ischemic changes or new-onset arrhythmias were associated with nearly five-times greater risk of death (OR: 4.9;95% CI 1.7-14.4). Conclusions: In this retrospective study among hospitalized adults with a proven COVID-19 infection, admission ECGs demonstrating ischemic changes or new-onset dysrhythmia predict a higher risk of death in the short-term.
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Background Fewer routine childhood vaccinations have been given during the COVID-19 pandemic compared with January to April 2019.1 The COVID vaccination programme has brought into light a massive wave of concern internationally about vaccination hesitancy thus risking global public health strategies. Are more parents choosing not to access childhood immunisations because of concerns about attending clinical settings, or are they questioning the principles of vaccination in general? Objectives To improve local routine childhood vaccination rates by identifying parental barriers behind vaccination hesitancy. To share this learning with local child health professionals who support families with decision making around childhood vaccination. Methods A sample survey was performed in the children's outpatient department at St Mary's hospital on 26th & 27th November 2020. It involved a 5-minute open-question discussion with parents regarding their views on routine childhood vaccination, the flu and COVID vaccines. Confidentiality and anonymity were maintained during data collection and analysis. All data was gathered by a single paediatric junior doctor to minimize collection bias. The results were shared with the local child health integrated care team (Connecting Care for Children) at the weekly multi-professional meeting. Results 27 families were approached. All parents agreed to participate. All children were up to date with their immunisations. Most common parental comments in favour of routine vaccinations included the 'protection of my child from serious illnesses', 'protection of others who cannot be vaccinated', and 'following the national paediatric guidelines'. 23 out of 27 children were eligible for flu vaccination with only 35% (8 out of 23) having received it. Up to 30% of parents in the unvaccinated children group said that the flu vaccine 'was not necessary', with 22% supporting that they 'weren't offered' or 'weren't aware' their children could have it. 30% of parents were in favour of the COVID vaccine and said they have 'trust in science', it is 'the only way to come back to a normal life', and that 'the risk of having it outweighs the risk of not having it'. Those who were negative (44%) or undecided (26%) said that this vaccine is 'too new to be trusted', there are 'unknown long term side effects', it's 'not tested on all age groups', and 'there are unknown ingredients'. Parents in the negative/undecided group said that only time could change their mind. Also, if they were to have another baby they would now think twice before vaccinating their child with the routine immunisations. Conclusions This sample survey has revealed diverse parental views regarding vaccination. Worryingly our results indicate that the arrival of the COVID vaccine has made some parents more reluctant to access routine childhood vaccines. Sharing our results locally has supported child health professionals to address these concerns with families when discussing vaccination. We recommend conducting this survey across other Trusts to assess whether this trend reflects the majority of the population and can be used to address vaccination hesitancy on a national scale.
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Background The Covid-19 pandemic forced organisational change onto healthcare services. Health care professionals have been challenged by the rapidly evolving situation, significant capacity issues, anxiety from patients, and risks to personal health. Safe assessment of febrile children in primary care became unclear and potentially a risky situation. Objectives To support primary care professionals to safely assess febrile children during the pandemic, and to help parents safely navigate a disrupted health system, an information bundle was co-produced and distributed to GPs and families across an inner-city area. Methods Connecting Care for Children (CC4C) is a collaborative that supports the delivery of integrated child health services. Through established primary and secondary care networks, CC4C was able to listen to primary care colleagues practicing in the pandemic, and to understand their clinical worries and needs. Similarly, CC4C used its network of patient champions to hear what families were grappling with. With this understanding, the CC4C team was able to initiate the development of supportive child health resources. A Primary Care and Community Resource Pack for use during the Covid-19 pandemic was co-produced by general and infectious disease paediatricians, local GPs, and junior doctors. The resource bundle included: . Guidance for assessing febrile children in primary care . Advice for minimising the risk of Covid-19 transmission during face-to-face assessment . Answers to frequently asked questions . Information about when Covid-19 tests are indicated A sample group of GPs provided feedback to an initial draft, and their suggestions were incorporated into the guideline. Resources for GPs to distribute to parents and carers were also included in the bundle: . a flow-chart to aid decision making about school attendance based on a child's symptoms . when to seek medical attention based on their child's clinical condition. Patients and citizens were involved in the development of the 'Should I Send my Child to School' flowchart, providing suggestions to make the guidance clearer. During the second wave of the pandemic, new resources were added including: . information about Paediatric Multisystem Inflammatory Syndrome . the new Covid-19 variants Results The resource pack was distributed to GPs across a large inner-city population, and two adjacent regions requested permission to use the resources. Resources from the bundle are available online at: www.cc4c.imperial.nhs.uk/our-experience/ common-paediatric-questions. Elements of the bundle were shared widely on social media, reaching audiences across the country- the FAQs for GPs document was seen by over 1,000 Twitter users and shared by 28;the 'Should I Send my Child to School' flowchart was seen by over 1,700 users. GPs provided positive feedback and felt that the bundle offered reassurance, was an 'extremely helpful resource on how they can safely assess their paediatric patients this winter' and a 'must-read for primary care physicians'. Conclusions Co-designing and co-producing a child health resource pack with both primary care colleagues and parents and carers enabled the development of resources that were useful and supportive to all those caring for children and young people during the Covid -19 pandemic.
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Background: Many patients with rheumatic disease require immunosuppressive medication putting them at high risk of COVID-19 infection. Reduced staffing in rheumatology due to redeployment to COVID-19 work, limited out patient capacity and patient vulnerability have had a major impact on our ability to review our patients to assess their condition and treatment (by face-to-face, video or telephone consultations). Novel strategies are essential to safely and effectively treat patients with rheumatic disease whilst minimising their risk of exposure to COVID-19 infection. Objectives: The objective was to develop a digital solution to help deliver safe, efficient and effective care for patients with rheumatic diseases. The aim was to produce a system that allowed us to integrate data recorded directly by patients with information held in our electronic health records to provide a virtual review of care. Methods: An online questionnaire was used to collect clinical information, including validated disease activity measures, to conduct a remote assessment in 175 patients awaiting follow-up appointments. This assessment was integrated within our electronic health records (EHR). The questionnaire contained measures of disease activity (DAS28 or BASDAI);patient reported outcomes;patient preferences regarding the urgency and type of appointment;any recent problems or changes in medication. This information was imported into a database for clinician review, together with previous clinical records and results of relevant investigations, to inform clinical decisions and to decide on the safest and most appropriate timing for follow-up. Report letters were sent to the patient and their primary care providers. Results: Of the 175 patients (149 with RA and 26 with AS), 108 patients (89/149 [60%] with RA [mean age=64;female=65%] and 19/26 [73%] with AS [mean age=45;female=54%]) submitted responses over a 6-week period based on which clinical decisions were made. The mean questionnaire completion time was 19 minutes for RA responders and 16 minutes for AS responders. Non responders (67/175 [mean age=61;female=63%]) remained on our list of patients awaiting follow-up arrangements to be made. Sixty-nine responders (64%) had stable disease therefore did not require any changes to their treatment and were offered an appointment within the next 6 months, of whom 12 (11%) requested face-to-face follow-up. Of the remaining 39 -with less stable disease -requiring more rapid follow-up assessment, 22 patients (56%) required a face-to-face consultation to consider treatment change. So far 9 of these patients have had follow-up, of whom 6 necessitated treatment escalation (Methotrexate increase n=2;anti-inflammatory increase n=2;intramuscular steroid n=1;anti-TNF escalation n=1). Thirty-nine patients (36%) provided feedback on the process of completing the questionnaire, 85% of whom used a mobile phone and the remainder used a computer or tablet. The majority (70%) found it “extremely easy” or 'somewhat“extremely difficult” 0%. Conclusion: We have created and tested a system of remote clinical management for patients with RA and AS. Amongst the 108 responders, just 31% required a face-to-face appointment, with treatment changes made accordingly. With a backlog of 3,800 awaiting allocation to follow-up appointments, remote clinical management will allow us to safely and efficiently prioritise patients requiring urgent follow-up for treatment optimisation. We will integrate this system into our standard care pathway beyond the COVID-19 pandemic to streamline our service, deliver effective care and provide evidence to support the use of costly biologic drugs.1 We plan to investigate the barriers for non-responders.