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European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2250219

ABSTRACT

Background: Pleural infection has a considerable healthcare burden with an average hospital stay of 14 days. There have been no randomised trials on the use of therapeutic thoracentesis (TT) for initial pleural fluid drainage. Aim(s): To assess the feasibility of a full-scale trial of chest tube vs TT for pleural infection. The primary outcome was defined as the acceptability of randomisation (ad priori defined as successful if >=50% of eligible patients were randomised). Method(s): Adult patients admitted with a pleural effusion related to infection and meeting recognised criteria for drainage were eligible. Participants were randomised (unblinded) to chest tube insertion or TT. Patients were followed up at 90 days. Result(s): From September 2019 and June 2021, 51 patients were diagnosed with complex parapneumonic effusion/empyema. Eleven patients met the inclusion criteria for trial and 10 patients were randomised (91%). The COVID-19 pandemic had a significant impact on recruitment. Patients randomised to TT had a shorter overall mean hospital stay (5.4 days, SD 5.1) compared to the chest tube control group (13 days, SD 6.0), p=0.04. Total number of pleural procedures required per patient were similar, 1.2 in chest tube group and 1.4 in TT group. No patients required surgical referral. Adverse events were similar between the groups with no readmissions related to pleural infection. Data completeness was high with no protocol deviations. Conclusion(s): The ACTion trial met its prespecified feasibility criteria for patient acceptability. The suggestion that TT can reduce hospital length of stay requires further investigation.

2.
Thorax ; 77(Suppl 1):A26, 2022.
Article in English | ProQuest Central | ID: covidwho-2263734

ABSTRACT

S38 Figure 1ConclusionsOmicron infection was associated with less severe illness compared to Delta infection across three separate measures of severity. COVID-19 vaccination was independently associated with lower in-hospital disease severity, regardless of variant. Lower severity of Omicron combined with the ability of vaccine to further reduce severity may result in reduced pressure on healthcare services;however, the increased transmissibility of Omicron and potential for higher numbers of infections, particularly in elderly patients, may mitigate these benefits.Please refer to page A208 for declarations of interest related to this .

3.
Thorax ; 77(Suppl 1):A28-A29, 2022.
Article in English | ProQuest Central | ID: covidwho-2263733

ABSTRACT

S41 Figure 1ConclusionsWhile SARS-CoV-2 infection was a large component of hospitalised aLRTD, non-SARS-CoV-2 infection caused 56% of respiratory infection hospitalisations overall. Measured incidences of non-SARS-CoV-2 pneumonia and NP-LRTI were higher than pre-pandemic UK estimates. Given public health interventions to reduce all infective aLRTD implemented during this year, these higher estimates likely reflect highly comprehensive surveillance although there may have been a true higher non-SARS-CoV-2 disease incidence. These results demonstrate the significant burden of acute respiratory infection on healthcare systems. Broader efforts to prevent and manage all forms of adult aLRTD should be prioritized in addition to current COVID-19 prevention efforts.Please refer to page A209 for declarations of interest related to this .

4.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2263732

ABSTRACT

Background: Acute Lower Respiratory Tract Disease (aLRTD) includes pneumonia, non-pneumonic lower respiratory tract infection (NP-LRTI), heart failure (HF) and chronic respiratory disease exacerbation (CRDE). COVID19 has affected aLRTD disease burden. Few studies estimate total aLRTD burden, and subgroup distribution may have changed. Aim(s): To describe the frequency of individual aLRTD components and determine the impact of COVID19 on aLRTD disease. Method(s): A prospective cohort study of all adults >=18y admitted to either acute care hospital in Bristol, UK, from Aug 20-Jul 21. Patients were included if presenting with signs/symptoms or a clinical/radiological diagnosis of aLRTD. Result(s): 9243 aLRTD hospitalisations occurred: 5161 pneumonia, 2636 NP-LRTI, 1990 HF, 4144 CRDE, and 198 undifferentiated aLRTD cases. Overlap was common (Fig1): 31% HF and 83% CRDE events occurred in association with pneumonia or NP-LRTI. Hospitalisation rates corresponded with COVID-19 incidence over time. 41% hospitalisations were associated with positive SARS-CoV-2 test. Non-COVID19 aLRTD hospitalisations showed less variation over time. Discussion(s): aLRTD is a complex matrix with significant overlap between CRDE, HF and pneumonia/NP-LRTI. COVID19 disease in hospitalised adults was a large component of total aLRTD during this pandemic year;however, non-COVID19 aLRTD caused considerable disease burden.

5.
Food Policy ; 103(68), 2021.
Article in English | CAB Abstracts | ID: covidwho-1520964

ABSTRACT

This paper explores the role of food policy at the municipal level because municipalities are assuming a growing role in food policy reform. Adopting a framework of municipal foodscapes, we set out an embedded case study of the Oldham Educational Catering service, located within the Metropolitan Borough of Oldham in Greater Manchester, England. Through this prism we consider the potential of a foundational economy approach to embed food more firmly in the civic remit and highlight the role of new municipalism in enacting this approach in the public domain. To illustrate these arguments, we argue that the public plate, particularly the provision of school meals, offers an important way to stimulate transformative food agendas at the municipal level. To progress this political agenda, however, multilevel action is needed at national and regional levels as well as within municipalities themselves to stimulate sustainable foodscapes. Recognising the foundational status of food, as illustrated by its criticality during the Covid-19 pandemic, can lead to more progressive and consequential food policy reform.

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