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1.
Early Intervention in Psychiatry ; 17(Supplement 1):268, 2023.
Article in English | EMBASE | ID: covidwho-20244649

ABSTRACT

Aims: During the pandemic, youth were particularly vulnerable to experiencing financial hardship, education and employment disruption, and mental health impacts. Ensuring governments and services are prepared to support youth during future outbreaks or novel pandemics should be a key priority. This work aimed to explore youth experiences during COVID-19 and gather youth opinions on government responses to inform planning, policy, and decision-making for future pandemics. Method(s): Youth (ages 15-25) from Ireland and two provinces in Canada (British Columbia and Ontario) were interviewed at three time points during the COVID-19 pandemic. A thematic analysis was conducted using an inductive approach. This research was primarily youth-led and developed. Result(s): Across all three time points, youth experienced mental health and service uptake challenges, with mixed views on pandemic response. Opportunities for personal and societal growth were identified, with desire for incorporating youth voices into governmental decision making processes. Youth offered recommendations for effectively communicating accurate information, prevention of misinformation, and expressed needs regarding service accessibility throughout the pandemic and beyond. Conclusion(s): This work provides insights into the opinions of young people on government and information sharing during the progression of the COVID-19 pandemic. Recommendations were developed to ensure youth are consulted and represented in future pandemics.

3.
Journal of Cystic Fibrosis ; 21:S121, 2022.
Article in English | EMBASE | ID: covidwho-1996786

ABSTRACT

Objective: To assess if current practices in bone health monitoring and treatment at a specialist regional cystic fibrosis (CF) centre are in line with current European CF guidelines. Methods: An audit of bone health of all adolescents and adults atWolfson CF centre UK was conducted. Data was gathered between December 2020 and November 2021 from medical records which included timing of last DEXA scan and if it had been within last 5 years, DEXA scan T/Z scores, vitamin D status and bisphosphonate use. Results: 237 individuals were identified, 106 female with a median age of 30 (±15) years. DEXA scans had been conducted in the last 5 years for 70% of the clinic. Of thosewho had a DEXA scan (n = 199), 53% were conducted on time in line with guidelines and 27% were overdue by more than 3 years. Median Z scores were −0.7 (±1.9) at the spine, −0.4 (±1.63) at the neck of femur, −0.6 (±1.5), total femur, and −0.4 (±1.75) total body. CF-related low bone mineral diseasewas present in 0.4–11% of clinic depending on the site of the Z score. 80% of the clinic had had vitamin D levels checked within the last year, with 47% being classed as sufficient (≥75 nmol/L). However, only 3% were classed as deficient with levels below 25 nmol/L. Bisphosphonate treatmentwas indicated in 19% of individuals. However, this had happened in just half of this group. 46% used oral medication, 54% intravenous. Conclusion: The majority of individuals had DEXA scans on time and repeated within 5 years. However, roughly a quarter of individuals were overdue by ≥3 years. Vitamin D levels should be checked at least annually as a minimum and this occurred in the majority of the clinic. There was a very low proportion of vitamin D deficiency but improved monitoring is needed, especially in those with vitamin D insufficiency. Although these results suggest that more robust measures could be in place for bone health monitoring and treatment, the coronavirus pandemic would have had an effect.

4.
He Kupu ; 7(1):8-14, 2022.
Article in English | Web of Science | ID: covidwho-1925271

ABSTRACT

Student teachers completing their field practice placement in early childhood education during the Covid-19 pandemic in Aotearoa New Zealand found themselves unable to attend their early childhood education and care centres during centre lockdowns in 2021. In order to continue to meet field practice placement learning outcomes, many student teachers, alongside their teaching teams devised innovative ways to connect with children and parents at home that enabled children, parents and whanau (extended family) to contribute their ideas and experience. As lecturers in early childhood education, the authors have been impressed by students' use of digital technologies. One digital technology that was particularly engaging for the children and their families, were student-created online videos and online meetings. The authors contend that the value of posting videos goes beyond extending individual learning experiences of children, and opens up possibilities for parent involvement and the consolidation of children's learning. This article will explore the potential of student-created videos as a teaching tool to promote the continuation of learning beyond the centre environment.

5.
British Journal of Diabetes ; 21(2):305, 2021.
Article in English | EMBASE | ID: covidwho-1737428

ABSTRACT

Introduction: Glucagon-like peptide 1 receptor agonists (GLPIRAs) are increasingly used in the management of type 2 diabetes. There is uncertainty surrounding their use during acute hospitalisation and few data for inpatient outcomes - especially during COVID-19 infection. Methods: Electronic records of all patients using GLPIRAs at the point of hospital admission during the COVID-19 second wave were obtained. Data were collected on COVID-19 status, inpatient glycaemic control, continuation of GLP1RA or reason(s) for discontinuation. Glycaemic control was determined by the number of Good Diabetes Days (GDD), defined as days with no values <4 mmol/L and <1 value >11 mmol/L and >2 tests/day. Results: 101 patients fulfilled the inclusion criteria. 43% of these had GLP1RAs discontinued on admission. Positive COVID-19 infection was seen in 14, and 12 of these were treated with dexamethasone. In those with COVID-19 infection, GLP1RAs were discontinued in 71% compared with 38% without COVID (p=0.12). GDD were seen in 19% of total hospital days in COVID-19 positive patients and 47% in COVID-19 negative patients (p<0.001). In COVID-19 positive patients, continuing GLP1RA was associated with poorer glycaemic control than discontinuation (11% vs 20%, p=0.32). In COVID-19 negative patients, glycaemic control was no different in those continuing and discontinuing treatment (48% vs 45% GDD, p=0.44). Discontinuation of treatment with GLP1RAs on admission to hospital was common. In COVID-19 positive patients, this may be due to reduced efficacy in the context of treatment with highdose steroids but no difference in glycaemic outcomes was seen in non-COVID admissions.

6.
QJM ; 114(11): 773-779, 2022 Jan 05.
Article in English | MEDLINE | ID: covidwho-1612642

ABSTRACT

BACKGROUND: The Acute Medical Unit (AMU) provides care for unscheduled hospital admissions. Seven-day consultant presence and morning AMU discharges have been advocated to improve hospital bed management. AIMS: To determine whether a later time of daily peak AMU occupancy correlates with measures of hospital stress; whether 7-day consultant presence, for COVID-19, abolished weekly periodicity of discharges. DESIGN: Retrospective cohort analysis. METHODS: : Anonymised AMU admission and discharge times were retrieved from the Profile Information Management System (PIMS), at a large, urban hospital from 14 April 2014 to 31 December 2018 and 20 March to 2 May 2020 (COVID-19 peak). Minute-by-minute admission and discharge times were combined to construct a running total of AMU bed occupancy. Fourier transforms were used to determine periodicity. We tested association between (i) average AMU occupancy and (ii) time of peak AMU occupancy, with measures of hospital stress (total medical bed occupancy and 'medical outliers' on non-medical wards). RESULTS: : Daily, weekly and seasonal patterns of AMU bed occupancy were evident. Timing of AMU peak occupancy was unrelated to each measure of hospital stress: total medical inpatients (Spearman's rho, rs = 0.04, P = 0.24); number of medical outliers (rs = -0.06, P = 0.05). During COVID-19, daily bed occupancy was similar, with continuation of greater Friday and Monday discharges than the weekend. CONCLUSIONS: : Timing of peak AMU occupancy did not alter with hospital stress. Efforts to increase morning AMU discharges are likely to have little effect on hospital performance. Seven-day consultant presence did not abolish weekly periodicity of discharges-other factors influence weekend discharges.


Subject(s)
COVID-19 , Bed Occupancy , Hospitals , Humans , Length of Stay , Periodicity , Retrospective Studies , SARS-CoV-2
7.
European Heart Journal ; 42(SUPPL 1):2030, 2021.
Article in English | EMBASE | ID: covidwho-1554540

ABSTRACT

Background: Peripheral artery disease (PAD) is a major challenge worldwide and endovascular revascularization is an important component of treatment that is affected by COVID-19 restrictions. Purpose: Here, we evaluated the impact of COVID-19 restriction on angioplasty service and outcome of patients undergoing lower limb angioplasty. Methods: Consecutive patients undergoing endovascular revascularisation between August 2018-March 2021 in a UK district general hospital were analysed retrospectively. Indications for angioplasty of all patients were discussed and agreed upon in multi-disciplinary teams. We compared time from referral to angioplasty, patient and procedural characteristics, technical success, peri-procedural complications, and outcome (wound healing, major amputation, target lesion revascularization, death) in patients treated 'before' and after February 2020 (during COVID-19). Results: One hundred nineteen patients were treated 'before' (92% critical limb ischaemia [CLI];60% diabetes mellitus) and 72 were treated 'during COVID-19' (96% CLI;61% diabetes mellitus). While the total monthly number of patients treated did not change, the number of outpatients treated as day cases increased (40% to 72%) and overnight stays for social reasons decreased (16% to 10%). Treatment of hospitalized patients decreased from 44% to 18%. The percentage of outpatients treated at <14 days after referral increased from 39% to 63% and hospitalized patients treated <5 days from 47% to 54%. Neither COVID-19 nor time to procedure affected wound healing (p(log Rank) = 0.451;median time to healing 168±l25 days) and amputation free survival (p(log Rank) = 0.924;median survival 368±l30 days) in all CLI patients significantly. However, amputation-free survival was significantly worse in hospitalized as compared to outpatients (p(log Rank) <0.001;median survival 155±l20 vs 368±l30 days) with similar wound healing in those that survived (p(log Rank) = 0.340;median time to wound healing 168±l25 days). Of note, the known causes of death were sepsis (32%), pneumonia (18%), COVID pneumonia (18%), cardiac (16%) and stroke (8%). Conclusions: Adapting to COVID-19 restriction we maintained a safe and effective angioplasty service while shortening waiting times. Very high mortality rates in patients after hospitalization indicated that CLI need to be treated much earlier and more aggressively to avoid disease progression requiring hospitalization.

8.
Diabetic Medicine ; 38(SUPPL 1):49-50, 2021.
Article in English | EMBASE | ID: covidwho-1238407

ABSTRACT

Background: Hyperglycaemia during admission with covid- 19 is associated with worse outcomes. Dexamethasone is used in severe covid-19. The national guidance suggests using prn quick acting insulin followed by twice daily intermediate acting insulin (0.3 units/kg) if blood glucose continues >12 mmol/L. Aim: To evaluate insulin requirements in inpatients with covid-19 and treated with steroids. Methods: Four rapid iterative quality improvement cycles evaluated the strategy for initiating insulin for patients with persistent hyperglycaemia (>11 mmol/L) and given steroids in an inner city teaching hospital trust. We identified consecutive referrals to the inpatient diabetes team. Exclusions include <7 days of steroids course, admission to intensive care or intravenous insulin. Electronic records were reviewed. Results are mean±SD. Results: Thirty-two referrals identified (63% male), type 2 diabetes 78%/22% no history of diabetes, 66 ± 11 years old, weight 90 ± 24 kg, HbA1c 75 ± 2.8 mmol/mol. covid-4C score 11/21 indicating high-risk patients. Seven days cumulative dexamethasone (or equivalent) dose was 48±23 mg. Admission glucose was 11.5 ± 5.7 mmol/L peaking on day 2 of steroids course (15.2 ± 4.4 mmol/L) and declining to nadir of 11.7 ± 4.2 mmol/L on day 6. Total daily insulin requirements rose rapidly from 0.07 ± 0.18 units/kg (day 1) to a peak of 0.72 ± 0.8 units/kg (day 4) and nadir of 0.64±0.7 units/kg (day 7). Conclusions: We found insulin requirements suggested in the national guidance to be a conservative estimate. In our cohort it is more than doubled in a short period of time requiring rapid titration. Learnings from this work informed the rapid adaptation of the local guidance by advocating early introduction of scheduled intermediate acting insulin when pre-steroids blood glucose is ≥11 mmol/L.

9.
Wellcome Open Research ; 6:38, 2021.
Article in English | MEDLINE | ID: covidwho-1231592

ABSTRACT

Background: Acute respiratory distress syndrome (ARDS) is a severe critical condition with a high mortality that is currently in focus given that it is associated with mortality caused by coronavirus disease 2019 (COVID-19). Neutrophils play a key role in the lung injury characteristic of non-COVID-19 ARDS and there is also accumulating evidence of neutrophil mediated lung injury in patients who succumb to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: We undertook a functional proteomic and metabolomic survey of circulating neutrophil populations, comparing patients with COVID-19 ARDS and non-COVID-19 ARDS to understand the molecular basis of neutrophil dysregulation.

10.
British Journal of Diabetes ; 20(2):81-83, 2020.
Article in English | Web of Science | ID: covidwho-1005150
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