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1.
BMJ Supportive and Palliative Care ; 11:A90, 2021.
Article in English | EMBASE | ID: covidwho-2032540

ABSTRACT

Social prescribing is a fundamental aspect of the NHS Long Term Plan. The roll-out of social prescribing is underpinned by the belief that individuals have the capacity to define and solve their own problems and that local communities are rich in social assets, skills and talents which can be tapped into to enhance and improve health and wellbeing. Social Prescribing Link Workers (SPLWs) aim to focus on what matters to each client holistically, looking at social, economic and environmental factors and creating personalised care plans to improve wellbeing linking in to local community resources and assets. This philosophy aligns with both the person centred ethos of hospice care and the Public Health model of Palliative Care. Aims To adopt a partnership approach to develop and deliver social prescribing through hospice partnerships with local VCSE organisations and local PCNs to develop and deliver social prescribing. Commitment to learning and developing together rather than 'doing' social prescribing through service provision, drawing on the strengths of the local community and the partner organisations. Actions•Social prescribers in post fully funded through PCN with commitment for five years - links built with GPs, hospice and other services.•Partnership approach embedded, service launch in March 2020 - impacted by COVID-19 pandemic, an opportunity and a threat. Outcomes•Social prescribing now embedded in local community and GP practices. Over 500 referrals received in year 1: bereavement, end-of-life care plans, carers support identified as some of the key challenges people face.•Data and case studies support difference Social Prescribing is making on individual and system perspective.•NHS Graduate evaluation report completed. Conclusion Involvement in a partnership approach to social prescribing is supporting the hospice in facilitating a public health model to palliative and end-of-life care being adopted as part of the wider system change.

2.
Annals of the Rheumatic Diseases ; 81:1622, 2022.
Article in English | EMBASE | ID: covidwho-2009091

ABSTRACT

Background: Exercise therapy is recommended as frst line treatment for knee osteoarthritis (OA), but it remains to be sub-optimally applied (1). Movement-evoked pain is a potential barrier to exercise adherence, but recent evidence suggests that such pain can be improved by training (2). Walking programs are low-cost, easily adopted and can be performed outdoors which can minimize the risk of SARS-CoV-2 transmission when in a group (3). Objectives: To explore the acute pain trajectories of individuals with knee OA during a 24-week outdoor walking intervention. In addition, to explore the effect of pain trajectories and/or baseline characteristics on retention and adherence. Methods: Individuals with clinical knee OA and bone marrow lesions (BMLs) on magnetic resonance imaging (MRI) were asked to follow a 24-week walking program. Every week consisted of two one hour supervised group sessions at various outdoor locations and one unsupervised session. At the start and end of every supervised group walk, knee pain was self-reported by participants to their trainer using a numerical rating scale (NRS) (0-10). The difference between the NRS pain values was considered as an acute pain change evoked by that walk. At baseline, the most affected knee of each participant was assessed using the Visual Analogue Scale (VAS) pain, the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) pain, stiffness and function, wellbeing (3 questionnaires) and the Osteoarthritis Research Society International (OARSI) recommended strength and performance measures. Results: In total, N = 24 participants started the program of whom N = 7 (29%) withdrew. Pain at the start of each walk decreased from NRS 2.5 (SD 1.6) at the frst walk (N = 24) to NRS 0.9 (SD 0.8) at the fnal walk (N = 17). This pain was estimated to decrease on NRS by-0.04 (95% CI-0.05 to-0.02) per supervised session, p < 0.001 during the frst 12 weeks and-0.01 (95% CI-0.02 to-0.004), p = 0.004 during the second twelve weeks of the program. The number (%) of participants who experienced an acute increase in pain decreased from 11 (45.8%) at the frst walk to 4 (23.5%) at the last walk. At baseline, non-adherent participants (<70% of group sessions) (N = 11) had lower physical performance scores, including the 30s Chair Stand Test (mean 10 (SD 1.7) stands versus mean 12.0 (SD 1.7) stands, p = 0.011), Fast Past Walk Test (1.23 (SD 0.14) meter per seconds (m/s) vs 1.50 (SD 0.20) m/s, p = 0.001), Six Minute Walk Test (418.8 (SD 75.9) m vs 529 (SD 72.6) m, p = 0.002), compared to adherent participants (N = 13). Non-adherent participants also had less severe self-reported symptoms including WOMAC stiffness (90.7 (SD 44.5) mm vs 121.5 (SD 17.0) mm, p = 0.031), compared to adherent participants. During the frst two weeks of walking, acute increases in pain on average (mean ≥0.5 NRS) were reported by a greater number of non-adherent (N = 5 (45.5%)) than adherent participants (n = 4 (30.8%)). Conclusion: This was an exploratory study and results need to be interpreted with caution due to the small sample size. The walking program resulted in clinically important improvements (MCIIs) (≥ 1 on NRS) (4) in start pain and acute pain changes. Improvements in start pain during the frst 12-weeks were comparable to improvements measured in the NEMEX program (2) and may suggest that 12 weeks of exercise is sufficient to achieve MCIIs in pain. Improvements in acute changes in pain were smaller, which may have been related to a foor effect (5). Lower physical performance scores at baseline and more acute increases in pain during the frst two weeks was associated with non-adherence. Participants with these characteristics may beneft from a lighter introduction to exercise.

3.
Journal of Crohn's & colitis ; 16(Suppl 1):i023-i025, 2022.
Article in English | EuropePMC | ID: covidwho-1999022

ABSTRACT

Background Antibody responses following SARS-CoV-2 infection or a single-dose of SARS-CoV-2 vaccine are impaired in patients with inflammatory bowel disease treated with anti-TNF compared to those treated with vedolizumab, a gut-selective anti-integrin α4β7 monoclonal antibody. Here we sought to determine if patients treated with infliximab have attenuated serological and T cell responses and an increased risk of breakthrough COVID-19 infection following primary SARS-CoV-2 vaccination. Methods Anti-spike (S) receptor binding domain (RBD) antibody concentration in 2306 infliximab-treated patients were compared to a cohort of 1045 vedolizumab-treated patients. Our primary outcome was anti-S RBD antibodies 2 to 10 weeks after a second dose of the BNT162b2 or ChAdOx1 nCoV-19 vaccines. Secondary outcomes were anti-spike T cell responses, durability of vaccine responses and risk of breakthrough infections following two doses of vaccine. Results Anti-S RBD antibody concentrations were lower in patients treated with infliximab than in those treated with vedolizumab, following a second dose of BNT162b2 (567.3 U/mL [6.1] vs 4601.1 U/mL [5.3], p <0.0001) and ChAdOx1 nCoV-19 (183.9 U/mL [5.0] vs 789.4 U/mL [3.5], p <0.0001) vaccines (Fig. 1). Vaccination with the BNT162b2 vaccine compared to the ChAdOx1 nCoV-19 was independently associated with a 3.7-fold [95% CI 3.30 – 4.13] higher anti-S RBD antibody concentration (p < 0.0001) (Fig. 2). There were no significant differences in the magnitude of anti-spike T cell responses observed in infliximab- compared with vedolizumab-treated patients after one or two doses of either vaccine. Antibody half-life was shorter in infliximab- than vedolizumab-treated patients following two-doses of BNT162b2 (4.0 weeks [95% CI 3.8 – 4.1] vs 7.2 weeks [95% CI 6.8 – 7.6]) and ChAdOx1 nCoV-19 (5.3 weeks [95% CI 5.1 – 5.5] vs 9.3 weeks [95% CI 8.5 – 10.2], p value < 0.0001). Breakthrough SARS-CoV-2 infections were more frequent (5.8% (202/3467) vs 3.9% (66/1691), p = 0.0032) and the time to breakthrough shorter in patients treated with infliximab than vedolizumab (p = 0.0023) (Fig. 3). Higher anti-S RBD antibody concentrations following a second dose of SARS-CoV-2 vaccine protected against breakthrough SARS-CoV-2 infection: overall, for every 10-fold rise in anti-S RBD antibody level we observed a 0.8-fold reduction in odds of breakthrough infection ([95% CI 0.70 – 0.99], p = 0.035). Conclusion Infliximab was associated with attenuated, less durable vaccine induced anti-S RBD antibody responses and a 50% increase in breakthrough SARS-CoV-2 infection. Further follow-up is required to assess whether third primary doses can mitigate the effects of infliximab on anti-S RBD antibody responses.

4.
Gastroenterology ; 162(7):S-594-S-595, 2022.
Article in English | EMBASE | ID: covidwho-1967337

ABSTRACT

Background : Robust COVID-19 vaccine-induced antibody (Ab) responses are important for protective anti-viral immunity. Data are urgently needed to determine whether vaccineinduced immunity is impacted by commonly used immunosuppressive drug regimens in IBD. Methods: We prospectively recruited 447 adults (90 healthy controls and 357 IBD) at nine UK centres. The IBD study population was established (>12 weeks therapy) on either thiopurine monotherapy (n=78), infliximab (IFX) monotherapy (n=61), thiopurine & IFX combination therapy (n=70), ustekinumab (uste) monotherapy (n=56), vedolizumab (vedo) monotherapy (n=62) or tofacitinib (tofa) monotherapy (n=30). Participants had two doses of either ChAdOx1 nCoV-19, BNT162b2 or mRNA1273 vaccines. The primary outcome was anti-SARS-CoV-2 spike (S1 RBD) Ab concentrations, measured using the Elecsys anti- SARS-CoV-2 spike (S) Ab assay, 53-92 days after second vaccine dose, in participants without prior infection, adjusted by age & vaccine type. Secondary outcomes included proportions failing to generate protective Ab responses (defined cut-off anti-S concentration 15 U/ml, which correlated with 20% viral neutralization). Results: Geometric mean S Ab concentrations (figure 1) were lower in patients treated with IFX (153U/ml;p<0.0001), IFX and thiopurine combination (109U/mL;p<0.0001), tofa (430U/ml;p<0.0001) and uste (561U/ml;p=0.013) compared to controls (1596U/ml). No differences in S Ab concentrations were found between controls and thiopurine monotherapy-treated patients (1020U/ml;p=0.62), nor between controls and vedo-treated patients (944U/ml;p=0.69). In multivariable modelling (figure 2), lower S Ab concentrations were independently associated with IFX (FC 0.10 [95% CI 0.07-0.14], p<0.0001), tofa (0.36 [95% CI 0.19-0.69], p=0.002) and uste (0.56 [95% CI 0.31-1.00], p=0.049), but not with thiopurine (0.77 [95% CI 0.54-1.11], p=0.17) or vedo (1.01 [95% CI 0.61-1.68], p=0.96). mRNA vaccines (3.67 [95% CI 2.72-4.96], p<0.0001) and older age (0.82 [95% CI 0.73-0.91], p=0.0003) were independently associated with higher & lower S Ab concentrations respectively. Protective Ab responses were generated by all thiopurine monotherapy, vedo, tofa and healthy control participants, but not by 11% of patients on IFX monotherapy, 13% on thiopurine & IFX combination therapy and 4% on uste. Conclusions : COVID-19 vaccine-induced Ab responses are significantly reduced in patients treated with IFX, or tofa, and to a lesser extent with uste. No significant reduction was seen in vedo or thiopurine monotherapy-treated patients. Our data suggest that 3rd primary or booster vaccine doses for IBD patients might be tailored to an individual's immunosuppressive treatment. (Figure Presented) (Figure Presented)

5.
CHI Conference on Human Factors in Computing Systems ; 2021.
Article in English | Web of Science | ID: covidwho-1759466

ABSTRACT

Controversial understandings of the coronavirus pandemic have turned data visualizations into a battleground. Defying public health officials, coronavirus skeptics on US social media spent much of 2020 creating data visualizations showing that the government's pandemic response was excessive and that the crisis was over. This paper investigates how pandemic visualizations circulated on social media, and shows that people who mistrust the scientific establishment often deploy the same rhetorics of data-driven decision-making used by experts, but to advocate for radical policy changes. Using a quantitative analysis of how visualizations spread on Twitter and an ethnographic approach to analyzing conversations about COVID data on Facebook, we document an epistemological gap that leads pro- and anti-mask groups to draw drastically different inferences from similar data. Ultimately, we argue that the deployment of COVID data visualizations reflect a deeper sociopolitical rift regarding the place of science in public life.

6.
Policing-a Journal of Policy and Practice ; : 10, 2021.
Article in English | Web of Science | ID: covidwho-1752159

ABSTRACT

This article evaluates the introduction of an online assessment protocol to student officers on a Police Constable Degree Apprenticeship (PCDA) programme in the aftermath of the implementation of the COVID-19 global pandemic lockdown. This evaluation comes from conducting two cycles of action research to examine and improve the provision of an online multiple choice/short question exam which came about as a result of the lockdown, and the necessary withdrawal of university staff from face-to-face contact. The study shows that the introduction of the online exam was successful and contributed to a positive student experience, while providing vital feedback to the programme team to make continual improvements and can be progressed after lockdown and into the 'new normal'.

7.
Crit Care Nurs Q ; 45(2): 107, 2022.
Article in English | MEDLINE | ID: covidwho-1735679
8.
Journal of Crohn's and Colitis ; 16:i023-i024, 2022.
Article in English | EMBASE | ID: covidwho-1722293

ABSTRACT

Background: Antibody responses following SARS-CoV-2 infection or a single-dose of SARS-CoV-2 vaccine are impaired in patients with inflammatory bowel disease treated with anti-TNF compared to those treated with vedolizumab, a gut-selective anti-integrin α4β7 monoclonal antibody. Here we sought to determine if patients treated with infliximab have attenuated serological and T cell responses and an increased risk of breakthrough COVID-19 infection following primary SARS-CoV-2 vaccination. Methods: Anti-spike (S) receptor binding domain (RBD) antibody concentration in 2306 infliximab-treated patients were compared to a cohort of 1045 vedolizumab-treated patients. Our primary outcome was anti-S RBD antibodies 2 to 10 weeks after a second dose of the BNT162b2 or ChAdOx1 nCoV-19 vaccines. Secondary outcomes were anti-spike T cell responses, durability of vaccine responses and risk of breakthrough infections following two doses of vaccine. Results: Anti-S RBD antibody concentrations were lower in patients treated with infliximab than in those treated with vedolizumab, following a second dose of BNT162b2 (567.3 U/mL [6.1] vs 4601.1 U/ mL [5.3], p <0.0001) and ChAdOx1 nCoV-19 (183.9 U/mL [5.0] vs 789.4 U/mL [3.5], p <0.0001) vaccines (Fig. 1). Vaccination with the BNT162b2 vaccine compared to the ChAdOx1 nCoV-19 was independently associated with a 3.7-fold [95% CI 3.30 - 4.13] higher anti-S RBD antibody concentration (p < 0.0001) (Fig. 2). There were no significant differences in the magnitude of anti-spike T cell responses observed in infliximab- compared with vedolizumabtreated patients after one or two doses of either vaccine. Antibody half-life was shorter in infliximab- than vedolizumabtreated patients following two-doses of BNT162b2 (4.0 weeks [95% CI 3.8 - 4.1] vs 7.2 weeks [95% CI 6.8 - 7.6]) and ChAdOx1 nCoV- 19 (5.3 weeks [95% CI 5.1 - 5.5] vs 9.3 weeks [95% CI 8.5 - 10.2], p value < 0.0001). Breakthrough SARS-CoV-2 infections were more frequent (5.8% (202/3467) vs 3.9% (66/1691), p = 0.0032) and the time to breakthrough shorter in patients treated with infliximab than vedolizumab (p = 0.0023) (Fig. 3). Higher anti-S RBD antibody concentrations following a second dose of SARS-CoV-2 vaccine protected against breakthrough SARS-CoV-2 infection: overall, for every 10-fold rise in anti-S RBD antibody level we observed a 0.8-fold reduction in odds of breakthrough infection ([95% CI 0.70 - 0.99], p = 0.035). Conclusion: Infliximab was associated with attenuated, less durable vaccine induced anti-S RBD antibody responses and a 50% increase in breakthrough SARS-CoV-2 infection. Further follow-up is required to assess whether third primary doses can mitigate the effects of infliximab on anti-S RBD antibody responses.

9.
Journal of Crohn's and Colitis ; 16:i022-i023, 2022.
Article in English | EMBASE | ID: covidwho-1722292

ABSTRACT

Background: Robust COVID-19 vaccine-induced antibody (Ab) responses are important for protective anti-viral immunity. Data are urgently needed to determine whether vaccine-induced immunity is impacted by commonly used immunosuppressive drug regimens in IBD. Methods: We prospectively recruited 447 adults (90 healthy controls and 357 IBD) at nine UK centres. The IBD study population was established (>12 weeks therapy) on either thiopurine monotherapy (n=78), infliximab (IFX) monotherapy (n=61), thiopurine & IFX combination therapy (n=70), ustekinumab (uste) monotherapy (n=56), vedolizumab (vedo) monotherapy (n=62) or tofacitinib (tofa) monotherapy (n=30). Participants had two doses of either ChAdOx1 nCoV-19, BNT162b2 or mRNA1273 vaccines. The primary outcome was anti-SARS-CoV-2 spike (S1 RBD) Ab concentrations, measured using the Elecsys anti- SARS-CoV-2 spike (S) Ab assay, 53-92 days after second vaccine dose, in participants without prior infection, adjusted by age & vaccine type. Secondary outcomes included proportions failing to generate protective Ab responses (defined cut-off anti-S concentration 15 U/mL, which correlated with 20% viral neutralization). Results: Geometric mean S Ab concentrations (figure 1) were lower in patients treated with IFX (153U/mL;p<0.0001), IFX and thiopurine combination (109U/mL;p<0.0001), tofa (430U/mL;p<0.0001) and uste (561U/mL;p=0.013) compared to controls (1596U/ml). No differences in S Ab concentrations were found between controls and thiopurine monotherapy- treated patients (1020U/mL;p=0.62), nor between controls and vedo-treated patients (944 U/mL;p=0.69). In multivariable modelling (figure 2), lower S Ab concentrations were independently associated with IFX (FC 0.10 [95% CI 0.07-0.14], p<0.0001), tofa (0.36 [95% CI 0.19-0.69], p=0.002) and uste (0.56 [95% CI 0.31-1.00], p=0.049), but not with thiopurine (0.77 [95% CI 0.54-1.11], p=0.17) or vedo (1.01 [95% CI 0.61-1.68], p=0.96). mRNA vaccines (3.67 [95% CI 2.72- 4.96], p<0.0001) and older age (0.82 [95% CI 0.73-0.91], p=0.0003) were independently associated with higher & lower S Ab concentrations respectively. Protective Ab responses were generated by all thiopurine monotherapy, vedo, tofa and healthy control participants, but not by 11% of patients on IFX monotherapy, 13% on thiopurine & IFX combination therapy and 4% on uste. Conclusion: COVID-19 vaccine-induced Ab responses are significantly reduced in patients treated with IFX, or tofa, and to a lesser extent with uste. No significant reduction was seen in vedo or thiopurine monotherapy-treated patients. Our data suggest that 3rd primary or booster vaccine doses for IBD patients might be tailored to an individual's immunosuppressive treatment.

10.
European Respiratory Journal ; 58:2, 2021.
Article in English | Web of Science | ID: covidwho-1706589
11.
Archivos De Medicina ; 21(2):548-555, 2021.
Article in Spanish | Web of Science | ID: covidwho-1668009

ABSTRACT

Objective: after the declaration of the COVID-19 pandemic, the consequent confinement and teleworking, this research aimed to investigate the adaptation of mental health professionals to online care. Materials and methods: a descriptive cross-sectional study was carried out through the online distribution of surveys, made up of a sociodemographic questionnaire and multiple-choice questions that allowed characterizing the particularities found in online care. The incidental sample consisted of 491 mental health workers. Results: 50% indicated a very high or high adaptation, and only 11% low adaptation. 92.87% performed online care and 91.45% worked from home, totally or partially. The main difficulties were related to technological aspects and domestic interruptions, while the main advantages were related to saving time and expenses, beyond the preventive aspects. Conclusions: given the good adaptation of the therapists and the profitability of this care modality, it is possible that it persists even when face-to-face is re-enabled. In this way, the importance of incorporating online care with its particularities in the training of psychotherapists.

12.
Ind. Pharm. ; : 4-8, 2021.
Article in English | EMBASE | ID: covidwho-1647611

ABSTRACT

The author, a health-care worker at a hospital in Wales, shares his experiences of Long COVID. This long-lasting illness is still little understood, but new research is uncovering some of the recurring symptoms that many patients experience and suggesting better options for treatment for adults and children.

13.
Gastroenterology ; 160(6):S-517, 2021.
Article in English | EMBASE | ID: covidwho-1595566

ABSTRACT

Introduction: Many patients with Crohn’s disease (CD) and ulcerative colitis (UC) require immunosuppressant therapies. There is an established increased risk of infection with these therapies, especially when used in combination. COVID-19 has further focused attention on risk of therapy and infection;in particular risks of intensive care unit (ICU) stay and death. We examined data on immunosuppressant medications, hospital admissions, ICU admission and death in our population-based database in the 10 years immediately prior to COVID-19.Methods: The Lothian IBD Registry (LIBDR) contains an accurate record of all prevalent IBD patients in the NHS Lothian capture area (population 900,000) [1]. Pre-existing databases and electronic health records were linked by community health index (CHI) number, a unique identifier covering 100% of the population, for admissions between 01/01/2010 and 31/12/2019. All admissions <24hour duration were excluded. All diagnosis codes were recorded using the ICD-10 system. Primary care prescription data was recorded using British National Formulary (BNF) codes. Biologic prescribing data was available from secondary care registries. Logistic regression using Cox Proportional Hazards model was used to identify risk factors predicting death or admission to intensive care due to infection following admission for an infection.Results: There were 17,221 non-day case hospital admissions for 4,660 of the 8,381 patients in the LIBDR prevalent cohort in the study period. 2,964 of these admissions for 1,489 patients were for an infection. Respiratory, urinary tract and gastrointestinal infections accounted for almost 75% of infection admissions with no differences between sex or diagnosis. There were 88 admissions to ICU due to infection for 79 patients with respiratory infection being the most common. There were 119 patients who died within 30 days of an admission for infection who had an infection listed on their death certificate. For 1,511 of the admissions, the patient had attended a secondary care IBD clinic within the preceding 18 months. A primary care prescription for steroids, opioids, thiopurines or antibiotics was issued within 90 days preceding 2,236 admissions for infection. 184 patients were on biologic therapy at the time of ITU admission or death. Positive blood cultures (OR 6.02, p<0.001), opioid therapy (OR 3.08, p=0.014) and being underweight (OR 2.61, p=0.003) were predictive of poor outcome while attending secondary care follow up for IBD was protective (OR 0.62, p=0.049). Biologic therapy was not associated with risk of ITU admission or death due to infection.Conclusions: There is a significant burden of infection in the IBD population and it is the most common reason for their admission. Opioid therapy and low body mass index are independent predictors of severity of infection. 1 Jones, G.R. et al. Gut (2019)(Figure presented)

14.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-296341

ABSTRACT

Introduction Shoulder pain is common in primary care but achieving definitive diagnosis is contentious leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (i) to investigate the short- and long-term outcomes (overall prognosis) of shoulder pain, (ii) estimate costs of care, (iii) develop a prognostic model for predicting individuals’ level and risk of pain and disability at 6 months, (iv) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis, and management of shoulder pain. Methods and analysis PANDA-S is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via SMS text or software application (App). Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with ≈15 dyads of patients and their healthcare professional (GP or physiotherapist). Short and long-term trajectories of shoulder pain and disability (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6-months using penalisation methods to adjust for overfitting. The added predictive value of pre-specified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making and perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options. Ethics and dissemination The PANDA-S study has ethical approval from Yorkshire and The Humber – Sheffield Research Ethics Committee, UK (18/YH/0346, IRAS Number: 242750). Results will be disseminated through peer-reviewed publications, social and mainstream media, professional conferences, and the patient and public involvement and engagement group supporting this study, and through newsletters, leaflets and posters in participating sites. Registration details The PANDA-S Study is registered at ISRCTN Number: 46948079 Article summary Strengths and limitations of this study ▪ This cohort study will offer a detailed characterisation of patients presenting with a new episode of shoulder pain in primary care, including short and long-term outcomes. ▪ Detailed, weekly data collection will offer unique insights into the impact of shoulder pain on everyday activity, mood, and work during the first 3 months after presentation. ▪ Clinical assessment will investigate the added predictive value of physical examination tests and ultrasound scan findings, over and beyond self-reported prognostic information. ▪ The use of ‘dyad’ interviews allows for a rich understanding of the views and experiences of clinicians and patients towards shoulder pain management. ▪ The COVID-19 pandemic has impacted on recruitment and data collection, but the study allows an investigation of the pandemic and related (lockdown) measures restrictions on the experience and management of shoulder pain.

15.
European Heart Journal ; 42(SUPPL 1):2528, 2021.
Article in English | EMBASE | ID: covidwho-1553949

ABSTRACT

Introduction: Ischaemic heart disease (IHD) remains the leading cause of mortality globally1. The presence and extent of coronary artery calcification (CAC) is a strong predictor of cardiovascular events, and CAC scoring has been shown to be more predictive of cardiovascular events than other traditional risk assessment scores2. Incidental coronary calcification can be detected and quantified on nongated CT chest scans covering the heart in the field of view3. This finding is typically not reported4 and hence an opportunity to optimise cardiovascular risk assessment and treatment is missed. Purpose:We sought to investigate whether patients presenting to our centre with an acute coronary syndrome (ACS) event had historical CT imaging demonstrating coronary artery calcification. Methods: We retrospectively reviewed case records for all patients referred to our centre for an invasive coronary angiogram following their first known admission with an ACS event. ACS were defined according to contemporary guidelines from the European Society of Cardiology. We reviewed a 3 month period prior to the COVID-19 pandemic (01/01/2019- 31/03/2019). The national imaging database was interrogated to identify previous CT imaging that includes the heart in the field of view. The presence of coronary calcification was confirmed and quantified using an ordinal scoring method previously described3. The clinical radiology reports for the scans were reviewed to determine the frequency of CAC being reported. Demographic information was collected from our electronic patient record including the presence of risk factors for IHD. Prescribed medication prior to admission was also recorded using the on-admission medicines reconciliation documented in the electronic patient record. Results: 385 patients with first presentation of ACS were identified. 75 (19%) had a prior non-gated CT chest imaging. The most common indication for CT was for investigation of possible malignancy. The mean interval from CT imaging to ACS admission was 36 months. CAC was present on 67 (89%) scans. The mean ordinal score was 4.04, corresponding to moderate CAC. The distribution of CAC by coronary artery revealed the majority of disease to involve the left anterior descending artery (Table 1). Only 12/67 (18%) of clinical radiology reports mentioned coronary calcification (Figure 1). Patients with CAC frequently had additional risk factors for IHD. Despite this only 42% were prescribed antiplatelet therapy, and only 45% prescribed a statin. Conclusions: A significant proportion of ACS admissions have evidence of CAC on historical CT scans. This finding is often not reported and the majority of patients with demonstrated coronary artery disease are not prescribed appropriate preventative therapies. Systematic reporting of this finding may have a significant impact on the prevention of acute cardiovascular events. (Figure Presented).

16.
Journal of Clinical Oncology ; 39(28 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1496289

ABSTRACT

Background: At the Rapid Access Diagnostic Unit at Guy's Hospital London, we review patients with vague symptoms that are concerning for malignancy. As part of our response to the COVID-19 pandemic, we developed a virtual triage pathway with the aim to reduce face-to-face appointments and prioritise resources towards patients with an underlying cancer diagnosis. Methods: Patients were triaged by clinicians based on a telephone consultation with the patient and history and blood tests provided in the referral. Those triaged as high risk were either directly booked for investigation ("straight-to-test") or booked for a face-to-face consultation for further history and examination. Low risk patients were either put on a watch-and-wait pathway with a telephone follow-up in 3-4 weeks or discharged back to the GP with a robust plan on symptom management. The patient outcomes were tracked and compared to the outcomes from the face-to-face assessment service used prior to the COVID-19 pandemic (Dec 2016-Feb 2020). Patients triaged as low risk and discharged were tracked to monitor for any subsequent cancer diagnoses. Results: There were 804 referrals triaged between March 2020-January 2021. 75% were triaged to a face-to-face assessment and 18% triaged straight-to-test. 4% were placed on the watch-and-wait pathway and 3% were returned to the GP with advice. In those triaged as high risk, 8.2% were diagnosed with cancer, 54% were diagnosed with a serious-benign condition and 38% with a non-serious or no condition. In the patients triaged as low risk and placed on the watch-and-wait pathway, 14% were brought in for a face-to-face assessment based on their follow-up telephone assessment. None of the patients on the watch-and-wait pathway were found to have a cancer diagnosis, 11% were diagnosed with a seriousbenign condition, and 89% were diagnosed with a non-serious or no condition. There was an overall cancer diagnosis rate of 7.6% compared with a pre-COVID-19 diagnosis rate of 6.6%. Conclusions: The virtual triage pathway effectively risk-assessed patients, with those triaged as high risk having an 8.2% cancer diagnosis rate compared to a 0% cancer diagnosis rate in those triaged as low risk. Furthermore, the virtual triage service had a higher cancer diagnosis rate compared to the pre-COVID-19 face-to-face assessment service. Therefore the virtual triage service provides an efficient pathway for cancer diagnosis in patients presenting with vague symptoms, reducing the number of face-to-face appointments and supporting management of low risk patients in the community.

17.
Clin Otolaryngol ; 47(1): 120-130, 2022 01.
Article in English | MEDLINE | ID: covidwho-1450540

ABSTRACT

OBJECTIVES: To explore the impact of COVID-19 on the management and outcomes of acute paediatric mastoiditis across the UK. DESIGN: National retrospective and prospective audit. SETTING: 48 UK secondary care ENT departments. PARTICIPANTS: Consecutive children aged 18 years or under, referred to ENT with a clinical diagnosis of mastoiditis. MAIN OUTCOME MEASURES: Cases were divided into Period 1 (01/11/19-15/03/20), before the UK population were instructed to reduce social contact, and Period 2 (16/03/20-30/04/21), following this. Periods 1 and 2 were compared for population variables, management and outcomes. Secondary analyses compared outcomes by primary treatment (medical/needle aspiration/surgical). RESULTS: 286 cases met criteria (median 4 per site, range 0-24). 9.4 cases were recorded per week in period 1 versus 2.0 in period 2, with no winter increase in cases in December 2020-Febraury 2021. Patient age differed between periods 1 and 2 (3.2 vs 4.7 years respectively, p < 0.001). 85% of children in period 2 were tested for COVID-19 with a single positive test. In period, 2 cases associated with P. aeruginosa significantly increased. 48.6% of children were scanned in period 1 vs 41.1% in period 2. Surgical management was used more frequently in period 1 (43.0% vs 24.3%, p = 0.001). Treatment success was high, with failure of initial management in 6.3%, and 30-day re-admission for recurrence in 2.1%. The adverse event rate (15.7% overall) did not vary by treatment modality or between periods 1& 2. CONCLUSION: The COVID-19 pandemic led to a significant change in the presentation and case mix of acute paediatric mastoiditis in the UK.


Subject(s)
COVID-19/epidemiology , Mastoiditis/epidemiology , Acute Disease , Adolescent , Child , Child, Preschool , Female , Humans , Incidence , Infant , Male , Pandemics , Prospective Studies , Retrospective Studies , SARS-CoV-2 , Seasons , United Kingdom/epidemiology
18.
Transplant International ; 34:351-351, 2021.
Article in English | Web of Science | ID: covidwho-1396039
19.
City ; 25(3-4):235-254, 2021.
Article in English | Scopus | ID: covidwho-1393045

ABSTRACT

In the context of the COVID-19 pandemic, masks and the act of masking have become emotive subjects for social and political debate. In Brazil, one of the countries most severely affected by the pandemic, the seemingly mundane act of mask-wearing has become part of a deep social, political and economic crisis at the centre of which is the far-right president Jair Bolsonaro. In this paper we explore the politics of (un)masking in Brazil from three vantage points in which the mask serves to dramatise the country’s current moment. Firstly, we trace the connections and disjunctions between the politics of mask-wearing and the genealogies of hygienist policies associated with the modern aspirations of the Brazilian republic. Secondly, we consider how masks are incorporated into the everyday life of the city through popular economies, which reveal the potentialities and limitations of work beyond the modern ideals of waged labour. Finally, we explore the incorporation of masks in urban street-art. We approach graffiti and murals as situated performances of symbolic resistance that contest and reveal the incoherences of Bolsonaro’s anti-science discourse. In tandem, these three perspectives foreground practices of (un)masking that expose long-standing tensions and new contemporary challenges that characterise the politics of a ‘crisis society’. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

20.
Heart ; 107(SUPPL 1):A151-A152, 2021.
Article in English | EMBASE | ID: covidwho-1325160

ABSTRACT

Introduction Ischaemic heart disease (IHD) remains the leading cause of mortality globally1. The presence and extent of coronary artery calcification (CAC) is a strong predictor of cardiovascular events, and CAC scoring has been shown to be more predictive of cardiovascular events than other traditional risk assessment scores2. Incidental coronary calcification can be detected and quantified on non-gated CT chest scans covering the heart in the field of view3. This finding is typically not reported4 and hence an opportunity to optimise cardiovascular risk assessment and treatment is missed. The Society of Thoracic Radiology have previously highlighted that incidental coronary calcification should be reported on CT chest scans5. We sought to investigate patients presenting to our centre with an acute coronary syndrome (ACS) event with historical CT imaging demonstrating coronary artery calcification. Methods We retrospectively reviewed case records for all patients referred to our centre for an invasive coronary angiogram following their first known admission with an ACS event. ACS were defined according to contemporary guidelines from the European Society of Cardiology. We reviewed a 3 month period prior to the COVID-19 pandemic (01/01/2019 - 31/03/2019). The national imaging database in Scotland (PACS) was interrogated to identify previous CT imaging that includes the heart in the field of view. The presence of coronary calcification was confirmed and quantified using an ordinal scoring method previously described3. The clinical radiology reports for the scans were reviewed to determine the frequency of CAC being reported. Demographic information was collected from our electronic patient record (Clinical Portal) including the presence of risk factors for IHD. Prescribed medication prior to admission was also recorded using the on-admission medicines reconciliation documented in the electronic patient record. Results 385 patients with first presentation of ACS were identified (figure 1). 75 (19%) had a prior non-gated CT chest imaging. The most common indication for CT was for investigation of possible malignancy. The mean interval from CT imaging to ACS admission was 36 months.CAC was present on 67 (89%) scans. The mean ordinal score was 4.04, corresponding to moderate CAC. The distribution of CAC by coronary artery revealed the majority of disease to involve the left anterior descending artery (table 1). Only 12/67 (18%) of clinical radiology reports mentioned coronary calcification (figure 2). Patients with CAC frequently had risk factors for IHD (table 2). Despite this only 42% were prescribed antiplatelet therapy, and only 45% prescribed a statin. Conclusions A significant proportion of ACS admissions have evidence of CAC on historical CT scans. This finding is often not reported and the majority of patients with demonstrated coronary artery disease are not prescribed appropriate preventative therapies. Systematic reporting of this finding may have a significant impact on the prevention of acute cardiovascular events.

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