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Aims: Children and adolescents were affected in various ways by the measures due to COVID-19 pandemic. The aims of this study were to investigate and compare the effects on mental health across age, to identify latent class trajectories of emotional and behavioural problems over 12-months and to examine the association of classes of trajectories with baseline demographic and clinical predictors. Method(s): Children (n = 1854) and adolescents (n = 1243) from the general population were assessed baseline, at 6-, 9-, and 12-month follow-up. They were eligible if they were residents in Austria, Germany, or Switzerland, were parents/caregivers of a child aged between 7 and 10 years or adolescents >=11 years, had sufficient German language skills and provided informed consent. Results and Conclusion(s): Significant age-effects were found regarding type and frequency of problems. While children had the largest increase in aggressive behaviours, adolescents reported the largest increase in emotional problems. Sociodemographic variables, exposure to and appraisal of COVID-19, psychotherapy before COVID-19 and parental mental health significantly predicted change in problemscores (F >= 3.69, p <= .001). Using growth mixture modelling, a oneclass solution was detected for the trajectory of aggressive behaviours and a two- and three-class solution for withdrawn/depression and anxiety/depression. A substantial proportion of children and adolescents experienced age-related mental health problems during the different stages of the COVID-19 pandemic. These results suggest that psychological problems of specific sub-groups should be monitored over the longer-term and interventions to improve communication, emotion regulation, and appraisal style should be offered to risk groups.
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Objectives: Several populations are at greater risk of severe COVID-19 due to inadequate responses to COVID-19 vaccines. Many of these individuals, and their caregivers, continue practicing varying degrees of social isolation to avoid SARS-CoV-2 infection. Following the end of lockdowns, the behaviors and impacts of continued isolation on the quality-of-life of high-risk populations remain poorly understood. This study describes the main avoidance and protective behaviors and ongoing impacts experienced by adults and caregivers of adults at high-risk of severe COVID-19. Method(s): Four virtual focus groups (April-July 2022) were conducted with individuals at high-risk of severe COVID-19, or caregivers, recruited via a convenience sample from patient panels. A discussion guide of open-ended questions was prepared based on COVID-19 guidance documents and a literature review. For qualitative analyses, an inductive approach was used for behaviors, deductive for impacts. A pre-defined codebook was updated throughout as needed. Salient concepts were defined as those mentioned by >=30% of participants or in every focus-group session. Result(s): Fourteen participants were interviewed (12 patients, 2 caregivers). Participants highlighted continued behaviors greatly impacting their quality-of-life. Avoidance behaviors (staying home, avoiding bystanders, avoiding shopping facilities and gatherings, using delivery services, family protection [43%-64%]) and protective behaviors (masking [79%], vaccination [57%]) were reported. Negative impacts included family relationship impacts (71%), collapse of social relationships (57%), difficulties accessing healthcare (43%), anxiety, fear, loneliness and depression (36%-50%), and impacts on employment/finances (36%). Positive impacts included the advent of telehealth (57%) and recognizing family importance (36%). Lack of trust in authority (57%) and hoarding of medications (36%) were negative general impacts of the COVID-19 pandemic highlighted. Concepts reported by patients and caregivers were similar. Conclusion(s): Individuals at high-risk of severe COVID-19 and their caregivers maintained avoidance and protective behaviors similar to those reported during lockdowns. This study highlights the continued burden experienced by high-risk populations.Copyright © 2023
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Introduction: Lung cancer is third most common cancer and highest cause of cancer death in the UK. COPD and smoking are known cancer risk factors so early intervention is essential. Incidence is higher in areas of deprivation where early presentation is less likely and outcomes poorer. Middlesbrough has some of the highest areas of deprivation. Aim(s): To evaluate diagnostic value of CT screening pilot in detecting lung cancer and follow-up outcomes for patients with incidental finding of pulmonary nodules. Method(s): Between March 2019 - December 2022 17 GP practices in Middlesbrough were invited to offer non-contrast CT thorax to asymptomatic COPD patients eligible for review, aged 50-75 with 20 pack year history and QCancer risk >5%. Pulmonary nodules followed up as per BTS guidelines. This pilot was conducted in partnership and with support from the Northern Cancer Alliance. Result(s): 407 patients referred for CT, 312 met the criteria and enrolled. 5 (1.6% conversion rate) lung cancers, also 1 renal cancer diagnosed. 51 (17%) had features of pulmonary nodules or groundglass opacities and selected for follow up. 2 died from COVID infection before follow-up CT. 32 (62.8%) discharged after followup CT revealed stable appearances or resolution, follow-up CT still outstanding for 2. 4 (7.8%) selected for further follow-up of sub-solid, new or increasing nodules. 2 (3.9%) received radiological diagnosis of lung cancer and referred for radiotherapy, 1 underwent surgical resection revealing lung tumourlets and 1 referred for surgical resection of enlarging nodule. Conclusion(s): Pulmonary nodules consisted significant part of the CT screening pilot findings in COPD patients with significant further conversion rate to lung cancer diagnosis after follow-up. Therefore, CT screening of high-risk population in deprived areas has a role in detecting lung cancer and identifying pulmonary nodules, with a proportion of those later diagnosed as early lung cancer. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.
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Objectives: Efforts to combat COVID-19 have largely focused on vaccination and non-pharmaceutical interventions to decrease hospitalization and death and to reduce transmission. First generation COVID-19 direct-acting antivirals (DAAs) are only authorized for high-risk patients to reduce individual risk of disease progression. However, DAAs can also impact transmission by reducing viral load, thereby shortening the duration of infectivity. Next generation oral DAAs in development may have safety profiles that are amenable to broader eligibility and use. This analysis estimates the economic and clinical impact of increasing the utilization of DAAs to treat COVID-19. Method(s): A susceptible-infected-recovered-susceptible model was developed to estimate COVID-19-related outcomes based on DAA uptake. Cost-savings modeled included reduced healthcare utilization amongst individual patients and, importantly, potential savings attributable to reduced transmission. Cost inputs included treatment acquisition costs, adverse events, healthcare utilization, and productivity losses based on published literature. One million individuals were assessed with clinical and economic outcomes estimated for DAA adoption by risk level. Result(s): The model projects 402,330 new infections per 1 million individuals annually, leading to 6,000 hospitalizations and 107 deaths. By increasing DAA use by 10% in the high-risk population and 20% in the standard-risk population, infections decreased to 312,000, with 1,800 fewer hospitalizations and 34 fewer deaths. Decreases in medical encounters were driven by reduction in transmission (77% of the decrease) and reduction in severity amongst those treated (23% of the decrease). Among deaths averted, 72% were attributable to the reduction in transmission. Overall, costs decrease by 23.5% with increased treatment. Conclusion(s): This study is among the first to model the potential population-level impact of DAAs in reducing infectivity and transmission, a factor currently under-emphasized in the literature. New DAAs under development with potentially improved safety profiles may expand the uptake of treatment and substantially reduce the clinical and economic burden of COVID-19.Copyright © 2023
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Objectives: Clinical Practice Research Datalink (CPRD) Aurum contains primary care electronic health records, including vaccinations and nearly complete capture of SARS-CoV-2 PCR test results between August 2020-March 2022. Our objective was to build code lists to define a cohort of persons diagnosed with COVID in England using routinely collected health data. Method(s): Persons aged 1 year or older were indexed on first COVID diagnosis from August 1, 2020 - January 31, 2022. We developed SNOMED code lists to define high risk of severe disease: 1) National Health Service's (NHS) list of highest risk conditions;2) PANORAMIC trial inclusion criteria;3) UK Health Security Agency (UKHSA) clinical risk groups. COVID vaccinations were defined as of December 1, 2021 using medical and product codes. Code lists were developed using wildcard search terms which were reviewed by multiple independent reviewers, and inclusion/exclusion was determined by consensus. All lists for diagnoses were reviewed by a UK physician. Result(s): We identified 2,257,907 people diagnosed in primary care with COVID;46% were male and mean age was 34 years, comparable to governmental data for the same period reporting 47% of cases in England were male and mean age was 34 years. We identified 12% at high risk of severe disease using the NHS definition, 31% using the PANORAMIC trial criteria, and 10% using the UKHSA clinical risk groups. Among adults, 86.1% had >=1 and 80.2% had >=2 COVID vaccine doses (2% and 0.2% lower than official reports, respectively). Conclusion(s): This cohort represented the age and sex distribution of COVID cases, and the COVID vaccination coverage, in England through January 2022. Definitions were built using reproducible methods that can be leveraged for future work. The high capture of COVID vaccinations supports the use of this cohort to examine clinical and societal benefits of COVID vaccination in England.Copyright © 2023
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Intro: Since November 2021, gradual changes in non-pharmaceutical interventions (NPI) had begun in consideration of the socio-economic cost and the high rate of COVID-19 vaccination. As an effort to monitor the COVID-19 situation and the effect of NPIs, regular risk assessment for COVID-19 has been conducted based on the input from the external advisory committee. This paper examines the correlation between the risk assessment results and other indicators, such as the incidence of COVID-19, public perception, community mobility, and the government policy from November 2021 to May 2022. Method(s): For weekly regular risk assessment of COVID-19, the data were collected from the National Infectious Disease Surveillance System website, which included incidence, mortality, and % of severe cases. Other indicators were from regular surveys on perceived risk among the public, community mobility from the Google website, and the government's response policy from The Oxford Stringency Index. The level of risk was classified into five levels from very low to very high. The level of COVID-19 risk and its correlation with the COVID-19 incidence, risk perception, community mobility, and government policy were examined. Finding(s): The result of the correlation analysis showed the highest positive correlation between the risk level and risk perception (r=0.86, CI 0.72-0.94). This indicates that the actual risk level and the risk perceived by the public are similar. Among the incidence-related indicators, the number of new severe cases of COVID-19 per week showed the highest correlation with the risk level (r=0.62, CI 0.33-0.80). Conclusion(s): The high correlation between the weekly severe cases and the overall COVID-19 risk level suggests that Korea's COVID-19 policy priority was mainly at protecting the high-risk populationCopyright © 2023
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Background: As of December 2022, SARS-CoV-2 coronavirus resulted in over 6 million deaths worldwide.[1] It was realized early into the pandemic, that COVID-19 significantly impacts the Cardiovascular system. [2] Patients with pre-existing cardiovascular comorbidities were particularly at higher risk of adverse outcomes during their hospitalizations. [3] Similarly, it can be safe to assume patients with adult congenital heart disease (ACHD) should considered a high-risk population for the development of severe COVID infection with increased rates of significant cardiovascular complications. Objective(s): Based on this reasoning and the paucity of data available on this topic using a large database, we sought to investigate the outcomes of patients with ACHD who were admitted to the hospital with COVID-19. Method(s): The National Inpatient Sample database for 2020 was queried to identify adult hospitalizations with a primary diagnosis of COVID-19 and a secondary diagnosis of ACHD using International Classification of Diseases - 10 Clinical Modification (ICD-10-CM) codes. The primary outcome studied was inpatient mortality, while secondary outcomes included inpatient complications, mean length of stay (LOS), and total hospital charge (THC). Multivariate logistic and linear regression analyses were used to adjust for possible confounders and analyze the variables. Result(s): Out of 1,050,045 COVID-19 hospitalizations registered, 2,425 (0.23%) had ACHD as a secondary diagnosis. Encounters with ACHD who were hospitalized with COVID-19 had significantly higher adjusted odds of inpatient mortality (Adjusted Odds Ratio [aOR]: 1.4, [95% CI: 1.05-1.88], p=0.022), Longer LOS (Mean 2.4 days, [95% CI: 1.35-3.40], p <0.001), and higher Total Hospital Charges (Mean $53,000, [95% CI: 20811-85190], p <0.001). A Forrest plot (Figure 1) demonstrates a graphical representation of the multivariate analysis of the significant in-hospital complications when adjusted for patient demographics, comorbidities, and hospital characteristics. Conclusion(s): Among COVID-19 hospitalizations, those with a history of congenital heart diseases had significantly worse outcomes in terms of in-hospital mortality, sepsis;the need for endotracheal intubation, mechanical ventilation, and vasopressors;developing acute kidney injury and pulmonary embolism, in addition to the longer length of stay, and higher total hospital charges. [Formula presented]Copyright © 2023
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Background: Shenzhen, a city of immigrants in South China, has a low HCV incidence rate of 19.47 per 100,000. To eliminate HCV in this low prevalence region, it may be efficiency to collaborate with the communities to screen HCV in high risk population. There are 849 Community Health Centers up to now in Shenzhen. The study aimed to evaluate the model of HCV elimination in high-risk population with Community Health Centers. Method(s): The Shenzhen Medical Association assigned hepatologists to educate Primary Care Physicians (PCPs) of 13 Community Health Centers in Bao'an District from 2021.6-2022.6. The PCPs need to take HCV knowledge tests before and after the training. Only when all the questions are answered correctly can the test be passed. Then they recommend the high risk population, e.g., PWID, pricking wound, iatrogenic exposure, to do the HCV antibody test and transfer the patients with HCV-Ab (+) to the hepatologist of Shenzhen Bao'an People's Hospital. Result(s): 151 PCPs participated in HCV knowledge education, the pass rate improved from 15.2% to 53.8% after the training. The high risk population screening number in Community Health Centers improved from 192 (a year before) to 300, even affected by the lockdown of COVID-19. The HCV antibody positive rate in high risk population is 4% (12/300), higher than the hospital population (0.8%, Shenzhen Bao'an People's Hospital), the blood donor (0.3%, Shenzhen Blood Center). The HCV-Ab positive patients in communities transferred to Shenzhen Bao'an People's Hospital, where the rate of DAA treatment is improved from 36.6% (a year before) to 64.1%. Conclusion(s): It is an efficient way to achieve HCV elimination earlier to screening in high risk population through PCPs in low prevalence region. Expanding this model to other Community Health Centers in Shenzhen may accelerate HCV elimination. (Figure Presented).
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Background: The COVID-19 vaccines were developed unprecedentedly and have proven safe and efficacious in reducing transmissibility and severe infection. The impact of mRNA-based COVID-19 vaccines on atrial arrhythmias (AA) incidence is unknown. Objective(s): To analyze the incidence of AA after COVID-19 vaccination in patients with a cardiac implantable electronic device (CIED). Method(s): BIOTRONIK Home Monitoring data and Medicare claims data from CERTITUDE patients implanted with a CIED between 2010-20 were utilized to identify recipients of one or more doses of the COVID-19 vaccine in 2021. Those who had influenza vaccination in 2020 were also identified in the same cohort as a control. From remote monitoring data, the number of atrial high rate events (AHR) and % burden of AA in the three months post-vaccination was compared to the preceding three months using Wilcoxon signed rank test. Kruskal-Wallis test was used for group difference comparisons. New AF diagnosis was determined from ICD-10 diagnosis codes in Medicare claims. Result(s): First and 2nd doses of COVID vaccine (50% Pfizer, 47% Moderna, and 3% J&J) were administered to 7757 and 6579 individuals with a CIED (age 76.2 (+/-9.0) y, 49% males), respectively. In the same cohort, 4723 (61%) individuals received the influenza vaccine. A statistically significant increase in the number of AHR episodes and % burden of AA was noted in the three months post-vaccination compared to the preceding three months after the 1st and 2nd doses of the COVID-19 vaccine (Figure). No such association was noted following influenza vaccination. In subgroup analysis, AHR episodes increased significantly in age groups >70 and men. Post-vaccination increase in AHR episodes was more significant in those without a pre-vaccination history of AHR episodes (mean increase of AHR 6.9+/-88.4, p<0.001) and was non-significant in those with a preceding history of AHR (p=0.8). Among the 764 patients with no AF diagnosis in claims preceding the first COVID-19 vaccine, 87 (11.4%) developed a new AF diagnosis or AHR event in the first three months post-vaccination. Conclusion(s): We report a small but significant increase in the number of CIED-detected atrial arrhythmias following vaccination for COVID-19 but not influenza, specifically in men and age >70 years. Acknowledging the immense public health benefit of COVID-19 vaccines, our results should prompt increased awareness of evaluating for AF in this high-risk group following vaccination. [Formula presented]Copyright © 2023
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Background: People living with HIV are at greater risk of complications associated with influenza, SARS-CoV-2 and pneumococcus than the general population and BHIVA guidelines recommend vaccinating all patients against these infections. The purpose of this audit was to determine the uptake of these vaccines, and factors associated with uptake, to inform vaccine delivery models. Method(s): All patients who received HIV care in our service at the end of November 2022 were included. Demographic data were collected from the service database, clinical data and pneumococcal vaccine (Prevenar-13) status were obtained from clinical records and COVID-19 and flu vaccine (2021) uptake was obtained from the Vaccine Management Tool (VMT). At the time of audit all patients were recommended to have received at least 3 doses of a SARS-CoV-2 vaccine. Caldicott approval was received for this work. Result(s): There were 364 patients known to the service of which one was excluded as clinical information was not available. Sixty-seven percent had received flu vaccine, 88% >= one dose of COVID-19 vaccination, 76% at least 3 doses of COVID-19 vaccination and 88% had received Prevenar-13. Three percent had received no vaccines and 60% had completed all vaccines. Uptake of both flu and COVID-19 vaccines were lower in the following groups: <50 years old (51% and 62% respectively), urban residence (65%, 71%), higher deprivation scores (51-65%, 64-75%) less time in HIV care (57%, 70%), those not on ART (13%, 25%), CD4 <200 cells/mm3 (40%, 50%), detectable viral load (33%, 42%), those out of care (23%, 23%) and those known to the harm reduction service (33%, 33%). There was higher uptake of Prevenar-13 in all groups. Uptake of all vaccines was high in those with comorbidities. Conclusion(s): The high uptake of Prevenar-13 in higher risk groups suggests that the model of vaccine delivery, opportunistic and pro-active recall for inhouse vaccination, is more effective for protecting those at highest risk for poor outcomes and for those for whom access is challenging compared to the centralised national recall system at designated Vaccine hubs. Vaccination resourcing, planning and delivery should consider the needs of specific risk groups to ensure best outcomes.
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Introduction: Barrett's esophagus (BE) is a metaplastic change in the distal esophagus in which squamous epithelium is replaced by columnar epithelium with goblet cells. Chronic gastroesophageal reflux disease (GERD) is strongly linked to the development of BE, which is a known precursor lesion to esophageal adenocarcinoma (EAC). There is no universal guideline for BE screening, however AJG suggest a single screening endoscopy in patients with chronic GERD symptoms and 3 or more addition risk factors, such as male sex, age > 50 years, white race, tobacco smoking, obesity and family history of BE or EAC. Within the Veteran's Affair (VA) hospital in Northport, New York, many veterans possess multiple risk factors for BE. Residents in VA primary care clinic are diligent in colorectal cancer screening, yet there is concern for limited offerings for BE screening. Our project aims to study the barriers to BE screening within a high-risk veteran population. Method(s): This is a survey-based study. A total of 36 internal medicine residents working in VA primary care clinic were asked to fill out a survey regarding their perspective towards BE screening. The results of the survey are compiled in Table. Result(s): 36 residents within the clinic completed the survey. As shown in Table, 35 out of 36 residents expressed that the primary care clinic does not screen for BE adequately. 30 residents expressed uncertainty regarding referral criteria for BE screening, 24 residents revealed having never referred patients for BE screening. When asked about barriers regarding BE screening, consensus polling showed that there is a lack of resident education surrounding indications for screening. Other common barriers include lack of transportation for veterans to appointments, the COVID 19 pandemic, and lack of health literacy within the veteran population. Conclusion(s): Although there is no established guideline for BE screening, per AJG there is recommendation for a one-time screening endoscopy in susceptible population. VA patients pose a high-risk population that appears to have low screening rates. Patients appear to be placed on long term PPIs without re-assessment and endoscopic screening despite possessing multiple risk factors for BE. Our survey shows that within our resident cohort there is concern for lack of awareness regarding screening criteria for BE. With the initiation of this project, we hope to increase awareness of BE screening within the resident group and improve health outcomes within veteran population. (Table Presented).
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Background: With NHS PrEP now available for those at risk, we aimed to identify missed opportunities for people newly diagnosed with HIV who attended sexual and reproductive health (SRH) services, and to determine the HIV outcomes associated with people acquiring HIV with previous or recent PrEP use. Method(s): A retrospective observational study reviewed all new HIV diagnoses from the last 2 years to see if they were eligible for PrEP and offered in SRH services. Data was collected using electronic medical records on HIV outcomes - virological suppression, resistance and antiretroviral choice. Result(s): There were 74 new HIV diagnoses. 41 people were eligible but only 10 were known to have accessed PrEP at our services. 21% were heterosexual and of black ethnicity - it was not possible to ascertain whether they were eligible for PrEP from the notes. Of the 10 people with recent PrEP use, 2 stopped due to side effects;headaches, vomiting, fatigue and renal toxicity concerns. For the remaining adherence concerns were reported - taking event based dosing (EBD) incorrectly and difficulty accessing services. 80% of people achieved virological suppression. 90% were put on a second generation integrase or protease inhibitor. No one developed nucleoside reverse transcriptase inhibitor (NRTI) resistance. 6 people eligible for PrEP had attended SRH services but not given PrEP. 2 attended during the IMPACT trial being full and referred to IwantPrEPnow. 2 attended during COVID where baseline bloods were done with follow up but subsequently tested positive. 2 people refused PrEP with 1 deeming themselves to be low risk. Conclusion(s): Our data highlights several missed opportunities for starting same-day PrEP which potentially may have prevented HIV acquisition. If PrEP is not issued on the day, adequate follow up must be ensured. Reassuringly those who acquired HIV with recent PrEP use have achieved good virological control without NRTI mutations. Counselling on potential side effects, EBD dosing and ongoing HIV risk are essential. Despite NHS PrEP available over 2 years, our data shows we are still failing to meet the demand of PrEP not only in men who have sex with men but also in other key at risk groups.
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Coronavirus disease 2019 (COVID-19), as a public health emergency, is a serious threat to human health. Cancer patients have a high risk of being infected with COVID-19. As one of important means of cancer treatment, radiotherapy has become an important alternative to surgery during the epidemic of COVID-19. The radiotherapy department of Peking Union Medical College Hospital ensured the smooth development of radiotherapy work on the setup of prevention and control systems for COVID-19 by establishing admission strategies for cancer patients, disinfection, isolation, daily management measures, scientific exploration, and clinical practice. In this paper, the associated strategies are summarized and analyzed, which can provide experience and reference for radiotherapy treatment under public health emergencies.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.
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[Background] The epidemic of coronavirus disease 2019 (COVID-19) seriously affects the psychological status of medical staff who directly face the risk of the disease. [Objective] This study investigates the prevalence and related factors of depression, anxiety, and insomnia among medical staff during the COVID-19 pandemic. [Methods] From February 13 to March 1, 2020, a network questionnaire survey was conducted among 482 medical staff selected by convenience sampling. A self-designed questionnaire was used to investigate the basic demographic information and COVID-19-related questions. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI) were used to estimate the prevalence of depression, anxiety, and insomnia among the medical staff. Stepwise multiple linear regression analysis was performed with PHQ-9 score, GAD-7 score, and ISI score as dependent variables. Multivariate logistic regression analysis (forward-conditional method) on depression, anxiety, and insomnia as dependent variables was performed with basic demographic information and COVID-19-related questions as independent variables. [Results] Among the surveyed medical staff, the prevalence rates of depression, anxiety, and insomnia were 14.3%, 11.2%, and 23.2%, respectively. There were no significant differences in the prevalence rates among different age, gender, local risk level, and occupation groups and those aiding Hubei Province or not. The medical staff who directly contacted fever or diagnosed patients had more serious depression (b=1.73, 95%CI: 0.79-2.66) and insomnia (b=2.43, 95%CI: 1.48-3.39) and a higher risk of insomnia (OR=1.89, 95%CI: 1.21-2.96). The medical staff whose current protective measures cannot prevent infection had more serious depression (b=1.72, 95% CI: 0.65-2.80), anxiety (b=1.75, 95% CI: 0.76-2.75), and insomnia (b=1.73, 95% CI: 0.63-2.82), and had a higher risk of depression (OR=1.97, 95% CI: 1.11-3.49), anxiety (OR=3.00, 95%CI: 1.64-5.46), and insomnia (OR=1.79, 95%CI: 1.08-2.96). [Conclusion] During the COVID-19 epidemic, the risks of depression, anxiety, and insomnia among selected medical staff are increased compared with the non-epidemic period. Occupational exposure to high-risk groups and protective measures would significantly affect mental health of medical staff.Copyright © 2021, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.
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Background/Aims The Fracture Liaison Service (FLS) identifies patients >50 who have sustained a fragility fracture (FF). These patients need prompt assessment and decision on appropriate treatment for osteoporosis in order to reduce their risk of sustaining further FFs. Without treatment, 1/5 patients can go on to have a further FFs which carry significant risk to mortality and morbidity. Zoledronate is a bone agent that halves the risk of another FF. Patients with a neck of femur fracture (#NOF) present as one of the most at-risk groups for a further FF. These patients are generally elderly and frail and attendance to outpatient hospital appointments are difficult. Therefore, transforming the FLS from an out-patient-based service, to one that is streamlined to systematically identify and opportunistically treat patients whilst they are still in hospital means delivering timely, effective and efficient patient-centred care. Methods We used various Plan-Do-Study-Act cycles to aim to deliver Zoledronate to>=90% of appropriately assessed in-patients >60 who have had a #NOF within a year of commencing QIP. Results PDSA cycle 1-Involvement of ortho-geriatrician: P-Improve working relationship with ortho-geriatrician with an interest in bone health over a 6-month period;D-Regular meetings with wider MDT;S-Priority of bone health assessments made greater through ward round documentation;A-Expand knowledge throughout the wider ortho-geriatrician team. PDSA cycle 2-Timing of Zoledronate delivery: P-Literature review regarding delivery of Zoledronate timing;D-Discuss as MDT;SNo evidence to suggest delay in fracture healing if given on day 7;AAdopted process and communicated. PDSA cycle 3-FLS team on the wards as a result of PDSA cycle 2 not improving treatment outcomes: P-FLS nurses to join ortho-geriatrician ward round twice-weekly for 3- month trial period;D-Bank holidays and spike in Covid cases presented a challenge. Solution: Improvement of MDT relationships;S-At the end of the trial period an increase in patients who received treatment was shown and proved our prediction;A-Adaptation to documentation in FLS to streamline and reduce duplication. Conclusion The ability to deliver Zoledronate to>=90% of appropriate patients with a #NOF as an inpatient was reached after 8 months of initiating QIP. Furthermore, maintaining this was consistently achieved throughout the following year and beyond. A few of the main reasons for this included earlier drug delivery, having a dedicated ortho-geriatrician as part of the FLS, and the FLS team attending the wards. A prompt bone health assessment of patients has enabled appropriate treatment to be delivered efficiently. The delivery of Zoledronate as an in-patient has meant that a significantly greater proportion of patients receive treatment, and sooner, in comparison to awaiting an outpatient assessment (that they may not attend). Therefore, this QIP has demonstrated time- and cost-effective management of patients with #NOF requiring Zoledronate.
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Background: The COVID-19 pandemic caused millions of deaths, its impact lessened with effective vaccines and treatments. The subsequent monkeypox outbreak posed another global threat, disproportionately affecting men who have sex with men (MSM), with concerns around increasing community stigma. Vaccinating at risk groups is vital in minimising COVID-19 and monkeypox transmissions and adverse sequalae. Our HIV clinic serves a diverse population in a deprived area with a large immigrant population and high level of co-morbidities, associated with poorer outcomes. We explored factors associated with COVID-19 and monkeypox vaccine uptake. Method(s): We reviewed COVID-19 vaccine first, second and third/booster uptake and first smallpox vaccine among MSMs attending our HIV clinic. Monkeypox vaccination is a two-dose course. Initial limited vaccine availability meant first monkeypox vaccine was prioritised for all eligible patients;we therefore analysed first monkeypox vaccination uptake. 186 MSM PLWH were identified. 164 were included in our analysis;22 were excluded due to insufficient vaccination information. Data was recorded contemporaneously in patients' records. COVID-19 vaccine uptake was verified using NHS Summary Care Record and London Care Record. Data on age and ethnicity was collected. Result(s): Demographics: Age: mean 42.9 years, 49% <=40 years, 51% >40 years Ethnicity: 55% White, 26% Black, 5% Asian, 2% mixed, 7% other, 4% not stated COVID-19 vaccination uptake reached statistical significance between age groups: <=40y 53%, >40y 80% (p = 0.001) and ethnicities: White 73%, Black 50%, Asian 67% (p = 0.026). Monkeypox vaccination uptake did not reach significance: <40y 26%, >40y 29%;ethnicity: White 31%, Black 24%, Asian 33%. Additionally, COVID-19 vaccinated patients were not statistically significantly more likely to accept monkeypox vaccination. Conclusion(s): Monkeypox vaccination uptake was similar across ages and ethnicities. However, monkeypox vaccination uptake was considerably lower than COVID-19 vaccination. Further work is needed to identify and engage at risk groups and address obstacles affecting monkeypox vaccination in marginalised communities. Lessons from COVID vaccination campaigns should be employed to reach unvaccinated high-risk MSMs. (Table Presented).
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Background: Mining companies must implement management sys-tems dedicated to health and safety at work to prevent the transmission of SARS-CoV-2 among their workers, however, the literature on this is scarce. Aim(s): To describe a multimodal strategy for the management of health and safety at work, to address the risk of COVID-19 in large mining. Method(s): Descriptive cross-sectional study, carried out in a large mining company. A management system was structured that considered administrative measures, of an environmental nature, risk screening, and management of risk cases within the company. The data analysis was done using descriptive statistics. Result(s): The administrative measures resulted in 8,116 (34%) workers at the site being suspended from their usual work. Risk screening before entering the site identified 450 suspected cases that were referred to their home. In the case management procedure, 1,073 people were classified in some of the risk groups. 10 cases of workers with PCR were detected in the follow-up period. Environmental measures were not very sensitive. Conclusion(s): These results shed light on the importance of implementing a multimodal strategy, adapted to the local reality, in preventing the spread of SARS-CoV-2 in the period under study, at the mining site intervened.Copyright © 2022, Sociedad Chilena de Infectologia. All rights reserved.