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1.
BMJ Supportive & Palliative Care ; 12(Suppl 2):A57, 2022.
Article in English | ProQuest Central | ID: covidwho-1874684

ABSTRACT

BackgroundThe CQC recommends palliative care units benchmark their controlled drug prescribing against similar units. We gathered prescribing data across Wessex to enable units to meet this aim, as well as comparing prescribing of other common end of life drugs.MethodsWe collected data on the first ten deaths to occur in January 2021 from specialist palliative care units (SPCUs) and hospital palliative care teams (HPCTs) across Wiltshire, Dorset and Hampshire. Data was collected from two time points (24 hours and 5 days before death) concerning the prescribing of opioids, benzodiazepines, adjuvant analgesics and other anxiolytics.Results21 units participated: 8 HPCTs and 12 SPCUs. Data for 210 patients 24 hours before death and 144 patients 5 days before death. 73% of patients on regular opioid 24 hours before death (39% under HPCT, 88% SPCU, 82% community), oral morphine equivalent dose range 10–800 mg, mean dose 88 mg (69 mg HPCT, 99 mg SPCU). 59% on regular benzodiazepine 24 hours before death (35% under HPCT, 76% SPCU, 55% community), midazolam equivalent dose range 5–70 mg, mean dose 17.8 mg (15.2 mg HPCT, 18.3 mg SPCU). 34% of patients received Levomepromazine in the 24 hours before death (20% under HPCT, 43% SPCU) and 6% Haloperidol. 19% of patients received adjuvant analgesics 24 hours before death, compared to 27% five days before.ConclusionThis project enabled the participating units to meet the CQC recommendation. It highlighted wide variation amongst prescribing at the end of life;possible explanations for this include differences between specialist and generalist settings in terms of staff experience and patient cohort. We acknowledge the limitations of our small sample size and the possible influence of COVID-19. It may be helpful in future to repeat with larger numbers in order to draw more generalisable conclusions about end of life prescribing.

2.
BMJ Open Diabetes Res Care ; 9(2)2021 12.
Article in English | MEDLINE | ID: covidwho-1598547

ABSTRACT

INTRODUCTION: Early diagnosis of prediabetes based on blood sampling for the oral glucose tolerance test (OGTT) is crucial for intervention but multiple barriers hinder its uptake. This study aimed to assess the feasibility and precision of a self-administered capillary OGTT for type-2 diabetes mellitus (T2DM) in high-risk individuals. RESEARCH DESIGN AND METHODS: Participants with history of gestational diabetes or prediabetes were recruited in primary care. Due to their prediabetic status and previous diagnosis of gestational diabetes mellitus, a proportion of participants had previous experience doing OGTT. They self-administered the capillary OGTT and concurrently their venous glucose samples were obtained. They filled a questionnaire to collect their demographic information, views of their capillary OGTT, and their preferred site of the test. RESULTS: Among 30 participants enrolled in this feasibility study, 93.3% of them felt confident of performing the capillary OGTT themselves, and 70.0% preferred the test at home. Older, less educated participants found it less acceptable. Mean capillary glucose values were significantly higher than venous glucose values, with mean difference at 0.31 mmol/L (95% CI 0.13 to 0.49) at fasting, and 0.47 mmol/L (95% CI 0.12 to 0.92) 2 hours post-OGTT. Capillary and venous glucose measurements were correlated for fasting (r=0.95; p<0.001) and 2-hour-post-OGTT (r=0.95;p<0.001). The Fleiss-Kappa Score (0.79, p<0.0001) indicated fair agreement between the two methods. The capillary OGTT had excellent sensitivity (94.1%) and negative predictive value (NPV=91.7%) in identifying prediabetes or T2DM status, vis-a-vis to venous glucose samples. CONCLUSION: Self-administered capillary OGTT is feasible and acceptable, especially among younger adults, with excellent sensitivity and NPV compared with plasma-based OGTT.


Subject(s)
Diabetes, Gestational , Prediabetic State , Adult , Blood Glucose , Diabetes, Gestational/diagnosis , Feasibility Studies , Female , Glucose Tolerance Test , Humans , Prediabetic State/diagnosis , Pregnancy
3.
JB JS Open Access ; 5(2): e0050, 2020.
Article in English | MEDLINE | ID: covidwho-1033201

ABSTRACT

On February 8, 2020, Singapore raised its Disease Outbreak Response System Condition (DORSCON) level to Orange, indicating that coronavirus 2019 (COVID-19) was a severe disease with high human transmissibility. Using lessons learned from the severe acute respiratory syndrome (SARS) outbreak in 2003, the orthopaedic surgery department at Singapore General Hospital, a tertiary-level referral center, was prepared to handle this pandemic through business-continuity planning. The business that we are referring to is the "business" of orthopaedic surgery, encompassing clinical care, education, research, and administration. There is a lack of literature detailing business-continuity plans of surgical departments during pandemics, with new guidelines being developed. A large proportion of orthopaedic work, such as cases of fracture and infection, cannot be postponed. Even elective surgeries cannot be postponed indefinitely as it could result in detriment to the quality of life of patients. The aim of this article is to detail the business-continuity plans at our institution that allowed the delivery of essential musculoskeletal care through personnel segregation measures during the COVID-19 pandemic. Strategies to ensure the provision of timely medical intelligence, the reduction of nonessential ambulatory visits and surgical procedures, ensuring the safety and morale of staff, and continuing education and research efforts were paramount. As the COVID-19 pandemic unfolds, our posture needs to constantly evolve to meet new challenges that may come our way. Our existing business-continuity plan is not perfect and may not be applicable to smaller hospitals. There is conflict between envisioned normalcy, remaining economically viable as an orthopaedic department, and fulfilling training requirements, and educating the next generation of orthopaedic surgeons on the one hand and the need for segregation, workload reduction, virtual education, and social distancing on the other. Orthopaedic surgeons need to strike a balance between business continuity and adopting sustainable precautions against COVID-19. We hope that our experience will aid other orthopaedic surgery departments in adapting to this new norm, protecting their staff and patients, managing staff morale, and allowing the continuation of musculoskeletal care during the COVID-19 pandemic.

4.
Bone Jt Open ; 1(6): 222-228, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-940050

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges to healthcare systems worldwide. Orthopaedic departments have adopted business continuity models and guidelines for essential and non-essential surgeries to preserve hospital resources as well as protect patients and staff. These guidelines broadly encompass reduction of ambulatory care with a move towards telemedicine, redeployment of orthopaedic surgeons/residents to the frontline battle against COVID-19, continuation of education and research through web-based means, and cancellation of non-essential elective procedures. However, if containment of COVID-19 community spread is achieved, resumption of elective orthopaedic procedures and transition plans to return to normalcy must be considered for orthopaedic departments. The COVID-19 pandemic also presents a moral dilemma to the orthopaedic surgeon considering elective procedures. What is the best treatment for our patients and how does the fear of COVID-19 influence the risk-benefit discussion during a pandemic? Surgeons must deliberate the fine balance between elective surgery for a patient's wellbeing versus risks to the operating team and utilization of precious hospital resources. Attrition of healthcare workers or Orthopaedic surgeons from restarting elective procedures prematurely or in an unsafe manner may render us ill-equipped to handle the second wave of infections. This highlights the need to develop effective screening protocols or preoperative COVID-19 testing before elective procedures in high-risk, elderly individuals with comorbidities. Alternatively, high-risk individuals should be postponed until the risk of nosocomial COVID-19 infection is minimal. In addition, given the higher mortality and perioperative morbidity of patients with COVID-19 undergoing surgery, the decision to operate must be carefully deliberated. As we ramp-up elective services and get "back to business" as orthopaedic surgeons, we have to be constantly mindful to proceed in a cautious and calibrated fashion, delivering the best care, while maintaining utmost vigilance to prevent the resurgence of COVID-19 during this critical transition period. Cite this article: Bone Joint Open 2020;1-6:222-228.

6.
J Vasc Interv Radiol ; 31(6): 869-875, 2020 06.
Article in English | MEDLINE | ID: covidwho-42072

ABSTRACT

This paper describes country-wide special measures undertaken for interventional radiology staff during the current coronavirus disease 2019 (COVID-19) pandemic. Although each interventional radiology service around the world faces unique challenges, the principles outlined in this article will be useful when designing or strengthening individual practices and integrating them within wider hospital and national measures. Moving beyond the current outbreak, these measures will be useful for any future infectious diseases which are likely to arise.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Radiology, Interventional/methods , COVID-19 , Humans , Singapore
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