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1.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880167
2.
British Journal of Surgery ; 108(SUPPL 6):vi151, 2021.
Article in English | EMBASE | ID: covidwho-1569604

ABSTRACT

Aim: To improve the safety of tracheostomy and laryngectomy patients within a UK-based regional head and neck unit. Method: This audit was conducted against standards taken from the National Tracheostomy Safety Project (NTSP). Inclusion criteria were all patients with a tracheostomy or laryngectomy on the ward, there were no exclusion criteria. Data was collected per inpatient episode for a one month period pre- and post- implementation of each intervention (1st March to 31st May 2020). Results: Pre-intervention results showed that none of the 19 neckbreathing inpatients during March 2020 had a bedhead sign or emergency algorithm displayed, however all patients had required bedside equipment and the only unavailable ward equipment was capnography. Laminated bedhead signs and algorithms were implemented and 33% neck-breathing patients had signs displayed during April 2020. Further intervention in May 2020 to educate ward staff led to 90% of patients having a bedhead sign displayed and 80% having an algorithm displayed. Conclusions: Overall, our unit has very high standards of care for neckbreathing patients. The use of bedhead signs and emergency airway algorithms is an integral part of providing safe care for neck-breathing patients and all members of staff are responsible for their use. The COVID-19 crisis has impacted on the number of elective procedures being performed which has impacted upon the numbers for the post-intervention arms of our audit. Reduced staffing due to sickness during the pandemic may have contributed to the substandard results.

3.
Journal of Clinical Oncology ; 39(15):3, 2021.
Article in English | Web of Science | ID: covidwho-1538120
4.
Archives of Disease in Childhood ; 106(SUPPL 1):A208-A209, 2021.
Article in English | EMBASE | ID: covidwho-1495065

ABSTRACT

Background Children and young people (CYP) are increasingly attending acute paediatric services due to mental health difficulties. 50% of all mental health problems are established by 14 years of age and 75% by 24 years. Underinvestment in mental health has been a longstanding concern, amplified by the COVID-19 pandemic through extra stress caused by prolonged school closures, social isolation and a lack of access to usual support services. In 2020, the Royal College of Paediatrics and Child Health highlighted that suicide is now the leading cause of death in England and Wales for children aged 5-19 years, emphasising the need to prioritise and improve mental health. Paediatricians must develop the knowledge and skills to identify, support and make appropriate referrals for common mental health problems. HEEADSSS is a well-known psychosocial screening tool with eight domains, used to identify potential or actual harm. Objectives Establish whether CYP within the West Midlands, UK are receiving adequate psychosocial assessments on hospital admission and whether healthcare professionals are signposting to relevant services. The primary outcome was the percentage of CYP with documented evidence of being offered a HEEADSSS assessment. Methods A regional prospective audit across nine hospitals was performed for three days per week from 4st -31st January 2021. A standardised proforma was used to gather information from medical records of all CYP aged >12 years admitted to paediatric wards. Pooled data were analysed using Microsoft Excel. Results 231 patients were included. The median age was 14 years old (range 12-17 years). 163(71%) were female. 202 (87%) had no known communication difficulties. 53(23%) were known to CAMHS and 43(19%) to social care. 78/231 (34%) were admitted with mental health as the presenting complaint. 35/231(15%) were documented to be given the opportunity to be spoken to alone;29(82%) accepted. No department had a psychosocial screening tool embedded in the admission document. 158/231(69%) had less than half of the eight domains completed. The median was 1.5 (range 0-8). Home and education/ employment were most frequently asked (37-42%). Eating/exercise, drugs, safety, sexual activity and other activities were the least frequently asked (14-27%). The proportion of those with a concern identified when asked ranged from 18%-39%. However, in self-harm, depression and suicide, only 85/231 (37%) were asked, with concern identified in 87%. 78 patients were admitted for mental health;28(39%) had less than half the domains completed (median 5, range 0-8). Drug use 46/78(59%), safety and sexual activity (both 38/78 (49%)) were inconsistently documented in this group, with concerns identified in 20-26% of those asked. 90/231(39%) were referred to CAMHS, social care, counselling, online or other support services. 16/77(21%) patients with a concern documented in at least one domain were not referred onwards. Conclusions This study demonstrates poor implementation of the HEEADSSS tool on admission, across a wide geographical area. Increased utilisation of a psychosocial screening tool would provide more opportunities to CYP to discuss their psychosocial health and receive appropriate support, in line with national guidance standards. Further work is underway addressing barriers to using HEEADSSS, considering electronic or embedded tools and signposting to relevant services.

5.
HIV Medicine ; 22(SUPPL 2):103, 2021.
Article in English | EMBASE | ID: covidwho-1409337

ABSTRACT

Background: Outreach is essential to Integrated Sexual Health Services (ISHS). POW is a sex worker (SW) project that supports vulnerable men and women in the sex industry in an inner city area. The ISHS outreach team have provided ISHS at a weekly drop in service at POW premises, a monthly migrant SW clinic and an Off-Street service in saunas, massage parlours, homes and working flats. Due to the current Covid-19 pandemic ISHS has adapted to still provide this service via a weekly clinic within the ISHS hub. They provide education, contraception, condoms, STI and BBV screening and treatment. The aim was to review the characteristics of the individuals accessing the POW outreach clinics. Method: A retrospective review of notes from 1st January 2019 to 31st December 2019 was undertaken. Data was collected on demographics, STI screening, contraception and vulnerable factors such as recreational drug use, safeguarding issues, sexual assaults and domestic violence. Results: 77 individuals were identified, of whom, 35% (27) were new to the clinic. 5% (4) Male and 95% (73) Female. Ages ranged from 19-59 years. 4% Bisexual, 5% MSM and 91% Heterosexual. Table 1 summarises the findings. Women were high risk for pregnancy (Table 1) with a maximum of 6 terminations and 13 pregnancies in 1 individual alone. Condom use among all SW was 63%. 1 individual was commenced on pre exposure prophylaxis (PrEP). Conclusion: Sex workers (SW) remain a vulnerable, stigmatised group with high sexual health needs. Multiple attendances are sometimes required before an individual will trust the team enough to access testing, contraception or safe sex education. An outreach team dedicated to SW, spending time and effort building trusting relationships with these individuals has been key to the success of POW outreach clinics. Having a link POW worker for the specific communities such as the Romanian community, translating teaching sessions and leaflets has improved attendance and testing. Strong partnership working has been key to effectively supporting the needs of this vulnerable group. (Table Presented).

6.
Kidney International Reports ; 6(4):S231-S232, 2021.
Article in English | EMBASE | ID: covidwho-1198729

ABSTRACT

Introduction: Research findings list financial barriers to living organ donation as a potentially significant reason why individuals choose not to act as living organ donors. Past Alberta Health Services (AHS) salary replacement and benefit programs only partially addressed salary loss for living organ donors. The purpose of the wage replacement policy was (i) To lower known financial barriers to Living Donor Kidney Transplants (LKDTs) among eligible Alberta Health Services employees, and (ii) To increase the number of LDKTs through full wage replacement for eligible AHS employees during post-donation recovery. Methods: The Kidney Health Strategic Clinical Network and AHS Human Resources explored the feasibility of a policy intended to shield AHS employees from income loss during post-operative recovery from living organ and surgical bone marrow donation. In March 2018, AHS Executive Leadership Team endorsed a policy working group to develop a wage replacement policy. The AHS Living Organ Donor Wage Replacement Policy became effective January 21, 2019, which provides full wage replacement for eligible AHS employees during post-procedure recovery of 12 weeks (organ donation) or 7 days (surgical bone marrow donation). Results: Based on the 2018 average AHS annual salary of $90,000 and assuming a 12-week convalescence, estimates predicted wage replacement costs of $20,769 per living organ donated by an employee. Based on the living kidney donation rate in Alberta (2011-2016) and the number of eligible AHS Employees (2018), it was predicted 3 of AHS’ 100,000 employees would serve as living organ donors per year. Predicted annual organizational cost: $62,307. Between January 19, 2019 and November 1, 2020, the number of employees accessing the policy exceeded the initial predictions of 3 AHS staff (unable to report specific dollar savings vs. number of staff given N<10), even in light of the COVID-19 pandemic where most LDKTs were postponed for several months ending June 2020. Conclusions: This policy was successfully implemented to limit AHS employees’ loss of income during post-operative recovery from living organ and surgical bone marrow donation, and uptake exceeded initial projections without putting significant financial strain on AHS. Conflict of Interest: All funding provided as in-kind support through Alberta Health Services

8.
American Journal of Obstetrics and Gynecology ; 224(2):S590-S590, 2021.
Article in English | Web of Science | ID: covidwho-1141135
9.
American Journal of Obstetrics and Gynecology ; 224(2):S650-S651, 2021.
Article in English | Web of Science | ID: covidwho-1140967
10.
American Journal of Obstetrics and Gynecology ; 224(2):S560-S561, 2021.
Article in English | Web of Science | ID: covidwho-1140962
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