ABSTRACT
In the UK, approximately 3 million people are malnourished or at risk of malnutrition. Malnutrition is a major public health issue with costs the NHS over £19 billion per year in England alone. We know 93% of malnutrition happens in peoples own homes, 5% in care homes and 2% in hospital. It is also understood that 30% of inpatients are at higher risk of becoming malnourished in hospital. 1 As many departments, demand for dietetic services has outweighed capacity, in part due to improved rates of nutritional risk screening across the organisation. The Trust uses an internal validated nutritional screening tool but community partners largely use MUST (Malnutrition Universal Screening Tool). Within our Dietetic team, we identified a number of treatment strategies needed to ensure timely care, patient empowerment and patient safety with a focus on improved nutrition to help recovery across organisational boundaries from the acute admission and into primary care. Patients who are identified as malnourished or at very high risk of malnutrition, have specialist requirements should have immediate referral to a dietitian. Oral nutritional supplements are now prescribed appropriately whilst in hospital and post discharge in line with national and local guidelines. 4 Communication between different healthcare professionals and settings is essential for the seamless delivery of care2 and hospital teams discharging patients with an identified risk of malnutrition should communicate this in writing to primary care teams3. As a team, we decided to encompass nutrition and dysphagia scores as an inpatient on discharge letters. This was be achieved by working closely with the pharmacy, Speech and Language, catering, nursing and medical teams to develop and implement a clear process for all adult inpatients to improve ward based nutritional care and appropriate prescribing, based on their individual risk of malnutrition. We have developed and implemented a discharge process that provides patients with a nutrition pack (malnutrition pathway leaflets, cover letter +/- Care Homes information) +/- nutritional supplements on discharge. The process was developed with local CCGs, GPs, PCN Pharmacists and community dietetic services. Outcomes measured include;appropriate prescribing, access to snacks and supplements, clinical outcomes including length of stay (LOS), readmission rates and timely access to first line advice. Baseline audit information revealed only 8% of inpatients received the a first line nutrition leaflet, this has increased to 13% just 6 weeks post implementation, patient first line snacks has increased to 5 different categories as choice available has increased. Oral nutritional support (ONS) is now solely prescribed using the agreed ONS pathway. Early indications suggest a direct improvement in patient care and choice. References 1. Brothern A, Simmonds N, Stroud M.2010. Malnutrition Matters: Meeting Quality Standards in Nutritional Care. A report on behalf BAPEN Quality Group 2. ‘A Guide to Managing Adult Malnutrition in the Community’ Last accessed from: on 02.07.2021 3. ‘Pathway for using ONS in the Management of Malnutrition’ Last accessed from:https://www.malnutritionpathway.co.uk/library/ons_pathway.pdf on 29.06.2021 4. ‘Nutritional considerations for primary care teams managing patients with or recovering from COVID-19’ BDA and optimising nutritional prescribing last accessed :. 02.07.21
ABSTRACT
In April 2020, with the realisation that dietetic practice had to change when covering critical care units, a group of specialist dietitians led the development of a hand held digital dietetic record that could be safely use within the critical care unit avoiding the use of paper and it being transferred off the COVID critical care unit. Being digital enabled remote working, decreased footfall and increased safety for patients and staff. This was the first step in a journey that saw the transformation from a paper based system to one that is entirely digital across all dietetic areas within inpatient and outpatient settings and in both in adults and paediatrics by the end of 2020. Together with the introduction of video patient consultations, video conferencing applications and electronic prescribing, our approach to provide dietetic intervention has changed dramatically. It has enabled a dietetic service to embrace remote working which has been helpful during periods of self-isolation e.g. virtual;ward rounds, group sessions, 1:1 education, interviews, training and development. Collaborative working included the newly developed “digital dietetic group” and the “H Digital” trust group and DXC technologies to develop a clinical data capture (CDC) form. The clinical basis followed the layout as advised in the Model and Process for Nutrition and Dietetic Practice1 to ensure that data capture was relevant and followed a standard process. The purpose of the Model and Process is to describe, through six steps, the consistent process dietitians follow in any dietetic intervention. It articulates the specific skills, knowledge and critical reasoning that dietitians deploy, and the environmental factors that influence the practice of dietetics. This does not take away dietitians’ autonomy. Instead, it enables a consistent approach to dietetic care, with the service user at the centre. This completed form was available as a complete ‘dietetic’ digital record. A key objective within the Organisation’s Digital Strategy and it will reduce risks by enhancing clinical effectiveness and patient safety. The wider multi-professional team found dietetic digital records invaluable, to be able to access 24/7 allowing for continuity of care when unable to speak directly to the dietetic team this included alternative feeding regimens and clinical reasoning that subsequently influenced treatment decisions and allowed for patient care out of hours. This led onto working with trust digital team on electronic prescriptions for oral nutritional support and enteral feeds, digital patient lists (for caseloads), digital design of food and fluid charts for the organisation. The enhancement in clinical safety and patient care where is it required has been phenomenal and an exciting journey we are keen to share. The design will enable dietetic outcomes to be collected directly from digital record. References 1. BDA Model and Process 2020 last accessed;https://www.bda.uk.com/uploads/assets/1aa9b067-a1c1-4eec-a1318fdc258e0ebb/2020-Model-and-Process-for-Nutrition-and-Dietetic-Practice.pdf on 2.7.2021
ABSTRACT
Background-aim: With recent emergences in new infectious diseases and their variants, there is a need to develop a faster and more specific analytical tool to detect different respiratory infectious diseases such as SARS-CoV-2 or influenza viruses. Not only their symptoms are similar at early stages, but also, they are both enveloped viruses with several common biological properties, often leading to challenges in disease identification. Among different viral components, nucleocapsid protein or nucleoprotein (NP) is highly conserved, less post-translational modifications possessed, and mostly specific for each infectious disease virus types. Therefore, targeting NP could be more advantageous to the method development, achieving much simpler and robust method with minimal subsequent modifications. This study describes a targeted approach for simultaneous detection of NPs from different respiratory infectious diseases using immunoprecipitation (IP) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). Multiple viruses, SARS-CoV-2, influenza virus A and B types, respiratory syncytial virus, and human coronavirus (HCoV-229E), were selected to show that this method can distinguish different disease viruses. Methods: Sample collected via nasopharyngeal swabs in viral transport media was directly subjected to IP using Thermo Scientific™ Pierce™ MS-Compatible IP Kit (Streptavidin). The IP purified samples were then digested using SMART Digest™ Trypsin Kits and analyzed by Thermo Scientific™ Vanquish™ MD HPLC system hyphenated to Thermo Scientific™ TSQ Altis MD mass spectrometer. Data processing was performed using TraceFinder™ LDT software 1.0. Results: Combining IP and LC-MS/MS resulted in a highly targeted approach with the high sensitivity and specificity. The method detected sub tens to hundreds amol of peptides on LC column. Also, it simplified the overall sample preparation process eliminating prior protein precipitation and post sample clean-up. Since the NPs mostly remain unchanged or less modified regardless of variants, the method doesn’t need tremendous alterations once established. Conclusions: This targeted approach can be applied to other enveloped viruses’ detection. Automated IP method is available with KingFisher system so it could lead to a faster turn-around time and higher throughput of the method.
ABSTRACT
The COVID-19 pandemic has exposed crucial flaws in Canada's immigration systems. While the majority of newcomers to Canada reside in urban centres, a substantial minority work and live in rural areas and small towns where crucial immigrant services are far less developed and greater geographical distances hinder efforts to support immigrants. Rural immigrants face distinct challenges, including increased social isolation and economic marginalization, which have only been amplified by the pandemic. Furthermore, the inaccurate perception of immigration as an exclusively urban issue hinders efforts to combat these problems. Building on rural immigration literature, this paper examines the ways in which the pandemic has impacted rural immigrants, including newcomers, refugees, and temporary foreign workers. Findings highlighted include the difficulty of providing immigrant support services in rural areas, the vulnerability of migrant farm workers to illness and isolation, and the lack of awareness and funding for immigration issues in rural areas relative to their urban counterparts. The paper draws on journalism and academic literature from the past year into these issues. In doing so, it demonstrates the need for renewed academic, policy, and rural development practice interests in rural immigration.
ABSTRACT
Big data collected through apps can facilitate large-scale study of diet and lifestyles. Information from the ZOE COVID Study indicates the variety and extent of impacts that the COVID-19 pandemic has had on the diets and lifestyles of adults in the United States and the United Kingdom. Evidence of the impact of the COVID-19 pandemic on health behaviours in the general population is limited. In this retrospective longitudinal study including UK and US participants, we collected diet and lifestyle data pre-pandemic (896,286) and peri-pandemic (291,871) using a mobile health app, and we computed a bidirectional health behaviour disruption index. Disruption of health behaviour was higher in younger, female and socio-economically deprived participants. Loss in body weight was greater in highly disrupted individuals than in those with low disruption. There were large inter-individual changes observed in 46 health and diet behaviours measured peri-pandemic compared with pre-pandemic, but no mean change in the total population. Individuals most adherent to less healthy pre-pandemic health behaviours improved their diet quality and weight compared with those reporting healthier pre-pandemic behaviours, irrespective of relative deprivation;therefore, for a proportion of the population, the pandemic may have provided an impetus to improve health behaviours. Public policies to tackle health inequalities widened by the pandemic should continue to prioritize diet and physical activity for all, as well as more targeted approaches to support younger females and those living in economically deprived areas.
ABSTRACT
Introduction: Pandemics such as COVID-19 create population-wide stressors that create a natural laboratory for acute insomnia research. This study investigated risk factors and estimated rates of acute insomnia disorder in health care workers at the onset of the COVID-19 pandemic. Methods: A Qualtrics survey of more than 2300 health care providers was conducted in a single academic health system on May 15th 2020, comprised of practicing attending physicians, residents and fellows in training, advanced practice providers, and nurses. Six hundred and sixty eight responded (29% response rate). The Research Diagnostic Criteria for Insomnia Disorder was used to diagnose Acute Insomnia Disorder. Results: 573 respondent had no missing data pertaining to sleep, with a mean age of 43.4 + 12.5 years and 72% women. The rate of Insomnia Disorder before COVID-19 was 44.5%, while after COVID- 19 it was 64.0% - a statistically significant increase. 10.2% of persons with Insomnia Disorder before COVID-19 stated it had resolved during COVID-19, while 43.4% of persons who did not have Insomnia Disorder before COVID-19 developed Acute Insomnia Disorder during COVID-19 (χ2=145.2;df=1;P<0.0001). New cases of Acute Insomnia Disorder increased with female gender, advancing age, and less time spent in direct patient care. Conclusion: Insomnia Disorder showed high baseline prevalence before COVID-19, followed by a striking increase in incidence in this sample of tertiary care health care workers. The effects of gender and age were similar to what has been previously published as risk factors for insomnia. The surprising finding that less time spent in direct patient care was associated with more cases of Acute Insomnia Disorder might be related to the poorly understood stresses of working from home during COVID-19.
ABSTRACT
Coronavirus 2019 (COVID-19) has spread across the globe with a concerningly high infectivity resulting in the World Health Organization deeming it a pandemic. It has resulted in thousands of deaths and placed enormous strain on communities, healthcare systems and healthcare workers as they battle shortages of ventilators, supplies, and difficulties in protecting patients and hospital staff alike. Challenges in managing the disease have led to new treatment and management strategies as healthcare teams struggle to adapt. We present the first case of COVID-19 managed in the austere deployed environment of Operation Inherent Resolve in which the patient was treated with dexamethasone, remdesivir, COVID-19 convalescent plasma, positive pressure ventilation, and proning. We discuss some of the inherent and unique challenges of caring for a patient in this resource constrained environment with a brief review of the literature on the treatment and management.
ABSTRACT
Study Objectives: In order to prevent spread of an infectious disease such as COVID-19 widespread testing is needed. However, few communities, particularly in states with large rural and medically underserved populations, have the infrastructure or expertise to start such a testing program especially within a short period of time. Further a standardized approach to screening for the appropriateness of COVID-19 testing is critical to not overwhelming hospital and state resources. Telemedicine offers a method which can standardize screening without limitations of catchment area, county and state borders. Our objective was to evaluate the utilization of a telemedicine screening program by patients outside the usual catchment area of a health care system. Methods: This was a prospective observational study measuring the outcomes of a telemedicine based COVID-19 screening program. The telemedicine health system consists of a single tertiary care hospital on the border of 2 states. The telemedicine screening program was free to the citizens of Georgia and South Carolina. Demographic and location data was collected in the telemedicine app utilized for the telemedicine contacts. Usual catchment area of the telemedicine health system is defined from population health data using patient county of residence. Results: From March 13, 2020 until June 10, 2020, 24,510 telemedicine visits have been completed with 20,165 (82%) from Georgia and 4345 (18%) from South Carolina. 2649 (10.4%) were less than 20 years of age, 3577 (14.6%) were older than 60 years of age and 211 (0.8%) were older than 80 years of age. 15,280 (62%) were male and 9,355 (38%) female. 15,550 (63.4%) of the telemedicine visits were from citizens of the surrounding 4 counties (catchment area) with the remainder (8,960) spread across Georgia and South Carolina. 15,441 (63%) were sent for COVID-19 testing. Correlation of telemedicine visit from rural counties will be added. Conclusion: The rapid development and deployment of a statewide COVID-19 screening program is feasible. Citizens will utilize a telemedicine platform outside their home geographic area for screening services unavailable locally. Geographic borders and traditional hospital catchment areas are less significant when utilizing telemedicine allowing for health care to be delivered to rural and health care-poor communities. [Formula presented]