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1.
BMJ Open Respir Res ; 9(1)2022 02.
Article in English | MEDLINE | ID: covidwho-1769925

ABSTRACT

Short-acting beta agonist (SABA) overuse (≥3 canisters annually) is associated with worse asthma outcomes and accounts for the majority of greenhouse gas emissions from asthma inhalers in England. Reducing SABA overuse aligns with the National Health Service long-term plan to optimise asthma treatment while minimising environmental impact, but adoption of local asthma guidelines for a SABA-free maintenance and reliever therapy strategy for step 3 asthma patients is limited. In this Perspective, we describe patient and staff involvement in a codesign process adapted from experience-based codesign (EBCD) principles to develop an implementation-ready intervention within a practice-relevant timescale.The codesigned intervention consists of five pillars: healthcare professional education; implementation of 'gold standard' prescribing practices; targeted asthma reviews; patient education and support; and real-time data monitoring and reporting of asthma care metrics. The codesign process contributed to all pillars and, by identifying potential individual and organisational barriers to implementation, enabled the development of plans to address these barriers.In this Perspective, we reflect on the strengths and weaknesses of our codesign process, outline how EBCD principles can be used in respiratory research and propose actions for patients, health professionals, researchers and funders to develop the potential of EBCD in respiratory research.


Subject(s)
Asthma , Secondary Care , Adult , Asthma/therapy , England , Humans , State Medicine
2.
Int J Environ Res Public Health ; 19(4)2022 Feb 19.
Article in English | MEDLINE | ID: covidwho-1705755

ABSTRACT

Healthcare workers (HCWs) are playing a vital role in the current SARS-CoV-2 pandemic. This study investigated how infection spreads within three local hospitals and an associated fire brigade in Germany by testing employees for the presence of SARS-CoV-2 IgG antibodies over one year. The three observational periods corresponded to the initial three pandemic waves: first wave: June-September 2020, second wave: October 2020-January 2021, and third wave: February-June 2021. We analysed 3285 serum samples of 1842 employees, which represents 65.7% of all employees. Altogether, 13.2% employees were seropositive: 194/1411 HCWs (13.7%) and 49/431 non-HCWs (11.4%) with a clear increase of seroprevalence from the first (1.1%) to the second (13.2%) and third (29.3%) pandemic wave. HCWs presumably had an additional occupational risk for infection in the second and third wave due to an increase of infection pressure with more COVID-19 patients treated, showing possible weak points in the recommended infection prevention strategy.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , COVID-19/epidemiology , Cross-Sectional Studies , Germany/epidemiology , Health Personnel , Hospitals , Humans , Secondary Care , Seroepidemiologic Studies
3.
BMJ Open ; 12(1): e049506, 2022 01 17.
Article in English | MEDLINE | ID: covidwho-1629401

ABSTRACT

OBJECTIVES: Existing UK prognostic models for patients admitted to the hospital with COVID-19 are limited by reliance on comorbidities, which are under-recorded in secondary care, and lack of imaging data among the candidate predictors. Our aims were to develop and externally validate novel prognostic models for adverse outcomes (death and intensive therapy unit (ITU) admission) in UK secondary care and externally validate the existing 4C score. DESIGN: Candidate predictors included demographic variables, symptoms, physiological measures, imaging and laboratory tests. Final models used logistic regression with stepwise selection. SETTING: Model development was performed in data from University Hospitals Birmingham (UHB). External validation was performed in the CovidCollab dataset. PARTICIPANTS: Patients with COVID-19 admitted to UHB January-August 2020 were included. MAIN OUTCOME MEASURES: Death and ITU admission within 28 days of admission. RESULTS: 1040 patients with COVID-19 were included in the derivation cohort; 288 (28%) died and 183 (18%) were admitted to ITU within 28 days of admission. Area under the receiver operating characteristic curve (AUROC) for mortality was 0.791 (95% CI 0.761 to 0.822) in UHB and 0.767 (95% CI 0.754 to 0.780) in CovidCollab; AUROC for ITU admission was 0.906 (95% CI 0.883 to 0.929) in UHB and 0.811 (95% CI 0.795 to 0.828) in CovidCollab. Models showed good calibration. Addition of comorbidities to candidate predictors did not improve model performance. AUROC for the International Severe Acute Respiratory and Emerging Infection Consortium 4C score in the UHB dataset was 0.753 (95% CI 0.720 to 0.785). CONCLUSIONS: The novel prognostic models showed good discrimination and calibration in derivation and external validation datasets, and performed at least as well as the existing 4C score using only routinely collected patient information. The models can be integrated into electronic medical records systems to calculate each individual patient's probability of death or ITU admission at the time of hospital admission. Implementation of the models and clinical utility should be evaluated.


Subject(s)
COVID-19 , Hospital Mortality , Humans , Prognosis , Retrospective Studies , Risk Assessment , SARS-CoV-2 , Secondary Care
4.
BMJ Open ; 11(12): e050847, 2021 12 17.
Article in English | MEDLINE | ID: covidwho-1591619

ABSTRACT

OBJECTIVES: With a growing role for health services in managing population health, there is a need for early identification of populations with high need. Segmentation approaches partition the population based on demographics, long-term conditions (LTCs) or healthcare utilisation but have mostly been applied to adults. Our study uses segmentation methods to distinguish patterns of healthcare utilisation in children and young people (CYP) and to explore predictors of segment membership. DESIGN: A retrospective cohort study. SETTING: Routinely collected primary and secondary healthcare data in Northwest London from the Discover database. PARTICIPANTS: 378 309 CYP aged 0-15 years registered to a general practice in Northwest London with 1 full year of follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: Assignment of each participant to a segment defined by seven healthcare variables representing primary and secondary care attendances, and description of utilisation patterns by segment. Predictors of segment membership described by age, sex, ethnicity, deprivation and LTCs. RESULTS: Participants were grouped into six segments based on healthcare utilisation. Three segments predominantly used primary care, two moderate utilisation segments differed in use of emergency or elective care, and a high utilisation segment, representing 16 632 (4.4%) children accounted for the highest mean presentations across all service types. The two smallest segments, representing 13.3% of the population, accounted for 62.5% of total costs. Younger age, residence in areas of higher deprivation and the presence of one or more LTCs were associated with membership of higher utilisation segments, but 75.0% of those in the highest utilisation segment had no LTC. CONCLUSIONS: This article identifies six segments of healthcare utilisation in CYP and predictors of segment membership. Demographics and LTCs may not explain utilisation patterns as strongly as in adults, which may limit the use of routine data in predicting utilisation and suggest children have less well-defined trajectories of service use than adults.


Subject(s)
Delivery of Health Care , Patient Acceptance of Health Care , Adolescent , Adult , Child , Child, Preschool , Humans , Infant , Infant, Newborn , London/epidemiology , Retrospective Studies , Secondary Care
5.
BMJ Open ; 11(10): e047817, 2021 10 27.
Article in English | MEDLINE | ID: covidwho-1503935

ABSTRACT

INTRODUCTION: Secondhand smoke exposure (SHSe) in childhood is linked with increased morbidity and mortality. Hospital or secondary care contact may present a 'teachable moment' to provide parents with support to change their home smoking behaviours to reduce children's SHSe. There is a lack of robust qualitative evidence around parents and healthcare professionals (HCPs) views on using this teachable moment to successfully initiate behavioural change. We aim to identify and understand what is important to stakeholders with a view to informing the development of a support package to help parents change their home smoking behaviours. METHODS AND ANALYSIS: This qualitative study will be theoretically underpinned by the Capability, Opportunity and Motivation Behaviour (COM-B) model of behavioural change. It will involve semistructured interviews and/or discussion groups with up to 20 parents who smoke and up to 25 HCPs. Stakeholders will be recruited from a single National Health Service children's hospital in England. Interviews and/or discussion groups will be audio recorded, transcribed and anonymised. The transcripts and any field notes will be analysed using the framework method. Initially, we will apply COM-B to the data deductively and will then code inductively within each domain. ETHICS AND DISSEMINATION: The protocol for this study received a favourable outcome from the East Midlands Leicester Central Research Ethics Committee (19/EM/0171). Results will be written up as part of a PhD thesis, submitted for publication in peer-reviewed journals and presentation at conferences. TRIAL REGISTRATION NUMBER: ISRCTN40084089.


Subject(s)
Tobacco Smoke Pollution , Child , Hospitals , Humans , Qualitative Research , Secondary Care , State Medicine
6.
Surgery ; 171(2): 437-446, 2022 02.
Article in English | MEDLINE | ID: covidwho-1500272

ABSTRACT

BACKGROUND: In March 2020, in response to the COVID-19 pandemic, the New Zealand government instituted a 4-level alert system, which resulted in the rapid dissolution of nonurgent surgical services to minimize occupational exposure to both patients and staff, with the primary health sector bearing most of the diverted caseload. Consequently, the study authors sought to collate information around the establishment of a supportive nonacute surgical liaison role in a public hospital surgical department, with an interest in establishing this role in New Zealand. METHODS: The narrative review conducted systematically in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases searched included Pubmed, MEDLINE, Embase, and Cochrane Controlled Register of Trials. A deductive analysis was applied using a demand management model developed by the Institute for Innovation and Improvement at Waitemata District Health Board. All included studies were rated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence tool. RESULTS: Collation of 19 studies resulted in 3 key findings: first, that a surgical liaison could be utilized at the primary care to specialist interface to improve communication and workflow between services. Second, a liaison could be utilized directly communicating with patients as a means of increasing engagement and self-management. Finally, this service can be offered through multiple modalities including a noncontact telehealth service. CONCLUSION: Evidence of nonacute surgical liaisons both internationally and specifically within New Zealand has been collated to provide evidence for its application.


Subject(s)
COVID-19/prevention & control , Elective Surgical Procedures , Nurse's Role , Physician's Role , Primary Health Care/organization & administration , Referral and Consultation/organization & administration , Secondary Care/organization & administration , Delivery of Health Care/organization & administration , Global Health , Humans , Nurse Practitioners/organization & administration , Surgeons/organization & administration , Workflow
7.
Rev. baiana enferm ; 35: e43433, 2021. tab
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-1368080

ABSTRACT

Objetivo: descrever vivências de enfermeiros e médicos de Unidades de Pronto Atendimento no enfrentamento da pandemia da Covid-19. Método: estudo descritivo-exploratório de abordagem qualitativa, realizado com sete médicos e sete enfermeiros atuantes em duas Unidades de Pronto Atendimento, referência para Covid-19. As entrevistas ocorreram entre setembro e novembro de 2020 e foram guiadas por questionário semiestruturado. Os depoimentos foram gravados, transcritos e submetidos a Análise de Conteúdo. Resultados: surgiram duas categorias de análise: "A gente se sente esgotado": a vivência de enfermeiros e médicos e Estratégias para enfrentar os percalços no contexto da pandemia. Considerações finais: os profissionais vivenciaram diversos desafios, como falta de protocolo institucional, falta de estrutura física, material, recursos humanos e capacitação, dificuldade para sensibilizar a população e preocupação de contaminar-se e contaminar a família. Entretanto, apoiaram-se em diferentes estratégias, como autoisolamento preventivo, apoio familiar, troca de experiências com outros profissionais e manter-se atualizado sobre a doença.


Objetivo: describir las experiencias de enfermeros y médicos de Unidades de Urgencias en el enfrentamiento de la pandemia de Covid-19. Método: estudio descriptivo-exploratorio con abordaje cualitativo, realizado con siete médicos y siete enfermeros que trabajan en dos Unidades de Urgencias, referencia para Covid-19. Las entrevistas tuvieron lugar entre septiembre y noviembre de 2020 y se guiaron por un cuestionario semiestructurado. Las declaraciones fueron grabadas, transcritas y sometidas a Análisis de Contenido. Resultados: surgieron dos categorías de análisis: "Nos sentimos agotados": la experiencia de enfermeros y médicos y Estrategias para enfrentar los percances en el contexto de la pandemia. Consideraciones finales: los profesionales experimentaron varios desafíos, como la falta de protocolo institucional, la falta de estructura física, material, recursos humanos y capacitación, la dificultad para sensibilizar a la población y la preocupación por contaminar a sí mismo y a la familia. Sin embargo, se apoyaron en diferentes estrategias, como el autoaislamiento preventivo, el apoyo familiar, el intercambio de experiencias con otros profesionales y mantenerse al día sobre la enfermedad.


Objective: to describe experiences of nurses and doctors of Emergency Care Units in coping with the Covid-19 pandemic. Method: descriptive-exploratory study with a qualitative approach, conducted with seven doctors and seven nurses working in two Emergency Care Units, reference for Covid-19. The interviews took place between September and November 2020 and were guided by a semi-structured questionnaire. The statements were recorded, transcribed and submitted to Content Analysis. Results: two categories of analysis emerged: "We feel exhausted": the experience of nurses and doctors and Strategies to face the mishaps in the pandemic context. Final considerations: the professionals experienced several challenges, such as lack of institutional protocol, lack of physical structure, material, human resources and training, difficulty in sensitizing the population and concern to contaminate oneself and the family. However, they relied on different strategies, such as preventive self-isolation, family support, exchange of experiences with other professionals and keeping up to date on the disease.


Subject(s)
Social Perception , Working Conditions , Secondary Care , Health Personnel , Pandemics , Physicians , Nurses
8.
Int J Geriatr Psychiatry ; 36(12): 1899-1907, 2021 12.
Article in English | MEDLINE | ID: covidwho-1353448

ABSTRACT

OBJECTIVE: To investigate factors contributing to excess deaths of older patients during the initial 2020 lockdown beyond those attributable to confirmed COVID-19. METHODS: Retrospective cohort study comparing patients treated between 23 March 2020 and 14 June 2020, deemed exposed to the pandemic/lockdown, to patients treated between 18 December 2019 and 10 March 2020, deemed to be unexposed. Data came from electronic clinical records from secondary care mental health services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (catchment area population ∼0.86 million). Eligible patients were aged 65 years or over at baseline with at least 14 days' follow-up, excluding patients diagnosed with confirmed or suspected SARS-CoV-2 infection. The primary outcome was all-cause mortality. FINDINGS: In the two cohorts, 3,073 subjects were exposed to lockdown and 4,372 subjects were unexposed; the cohorts were followed up for an average of 74 and 78 days, respectively. After controlling for confounding by sociodemographic factors, smoking status, mental comorbidities, and physical comorbidities, patients with dementia suffered an additional 53% risk of death (HR = 1.53, 95% CI = 1.02-2.31), and patients with severe mental illness suffered an additional 123% risk of death (HR = 2.23, 95% CI = 1.42-3.49). No significant additional mortality risks were identified from physical comorbidities, potentially due to low statistical power in that respect. CONCLUSION: During lockdown people with dementia or severe mental illness had a higher risk of death without confirmed COVID-19. These data could inform future health service responses and policymaking to help prevent avoidable excess death during future outbreaks of this or a similar infectious disease.


Subject(s)
COVID-19 , Mental Health Services , Communicable Disease Control , Humans , Retrospective Studies , Risk Factors , SARS-CoV-2 , Secondary Care
9.
Euro Surveill ; 26(30)2021 07.
Article in English | MEDLINE | ID: covidwho-1334901

ABSTRACT

An outbreak caused by the SARS-CoV-2 Delta variant (B.1.617.2) spread from one inpatient in a secondary care hospital to three primary care facilities, resulting in 58 infections including 18 deaths in patients and 45 infections in healthcare workers (HCW). Only one of the deceased cases was fully vaccinated. Transmission occurred despite the use of personal protective equipment by the HCW, as advised in national guidelines, and a high two-dose COVID-19 vaccination coverage among permanent staff members in the COVID-19 cohort ward.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19 Vaccines , Disease Outbreaks , Finland/epidemiology , Health Personnel , Hospitals , Humans , Secondary Care
10.
J Orthod ; 49(1): 24-31, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1325288

ABSTRACT

OBJECTIVE: To evaluate the impact of the coronavirus pandemic on patients in active orthodontic treatment. DESIGN: Digital online survey. SETTING: Two secondary care orthodontic departments in the United Kingdom. PARTICIPANTS: A prospective convenience sample of 103 patients in active orthodontic treatment. METHODS: A 12-item questionnaire developed using the platform SurveyMonkey was used to assess the following: (1) patient's feelings towards attending their orthodontic appointments; (2) their desire to continue with their treatment; (3) how many patients encountered problems with their appliance during the lockdown; (4) how patients sought help during the first national lockdown period; and (5) any other concerns regarding impact on their orthodontic treatment. RESULTS: A total of 103 participants responses were collected over a four-week period across two departments. Of them, 45% required a face-to-face appointment to solve a problem with their appliance; 45% of patients who had problems with their orthodontic appliance were able to resolve the issue through digital means either via telephone/email advice from their provider or from accessing help via the Internet; and 99% of patients wanted to continue with their orthodontic treatment. CONCLUSION: Our study has shown that a significantly higher percentage of patients are more concerned regarding attending face-to-face appointments after the first national lockdown due to the coronavirus pandemic. Providers of orthodontic care should ensure they support their patients by providing digital support and adopt virtual means of managing emergency cases patients in the event of any further imposed national or local lockdowns. Furthermore, access and availability of emergency face-to-face orthodontic care is necessary for many patients in active orthodontic treatment.


Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Humans , Prospective Studies , SARS-CoV-2 , Secondary Care
11.
J Orthod ; 49(1): 39-47, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1304378

ABSTRACT

OBJECTIVE: To assess the impact of the temporary cessation of orthodontic services on patients undergoing treatment during the COVID-19 pandemic. DESIGN: Two-phase multicentre service evaluation. SETTING: Secondary care orthodontic departments in the South West of England. MATERIALS AND METHODS: Phase 1 - Patient-Reported Experience Measure questionnaire (PREM). The questionnaire was distributed to patients who had undergone orthodontic treatment during the COVID-19 pandemic once services had resumed. Phase 2 - assessment of treatment outcomes, specifically with the Peer Assessment Rating (PAR) Index. A total of 280 PAR scores were obtained from a cohort of patients treated before and during the pandemic. RESULTS: A total of 711 PREM questionnaires were completed. Participants generally felt relaxed when visiting secondary care settings, orthodontic departments and whilst wearing orthodontic appliances during the pandemic. Nearly 40% of participants were concerned that the pandemic would impact on their treatment, particularly treatment length. Treatment outcomes revealed that patients treated before and during the pandemic experienced percentage PAR score reductions of 83.9% and 80.6%, respectively. Patients receiving treatment during the pandemic experienced longer treatment durations of 126 days. CONCLUSION: During the pandemic, low levels of anxiety were reported with respect to receiving orthodontic treatment in secondary care settings. Irrespective of the pandemic, a high standard of orthodontic treatment was provided. However, patient concerns regarding treatment length were justified.


Subject(s)
COVID-19 , Pandemics , England/epidemiology , Humans , Patient Reported Outcome Measures , SARS-CoV-2 , Secondary Care , Treatment Outcome
12.
BMC Infect Dis ; 21(1): 556, 2021 Jun 11.
Article in English | MEDLINE | ID: covidwho-1266473

ABSTRACT

BACKGROUND: We investigated for change in blood stream infections (BSI) with Enterobacterales, coagulase negative staphylococci (CoNS), Streptococcus pneumoniae, and Staphylococcus aureus during the first UK wave of SARS-CoV-2 across five London hospitals. METHODS: A retrospective multicentre ecological analysis was undertaken evaluating all blood cultures taken from adults from 01 April 2017 to 30 April 2020 across five acute hospitals in London. Linear trend analysis and ARIMA models allowing for seasonality were used to look for significant variation. RESULTS: One hundred nineteen thousand five hundred eighty-four blood cultures were included. At the height of the UK SARS-CoV-2 first wave in April 2020, Enterobacterales bacteraemias were at an historic low across two London trusts (63/3814, 1.65%), whilst all CoNS BSI were at an historic high (173/3814, 4.25%). This differed significantly for both Enterobacterales (p = 0.013), CoNS central line associated BSIs (CLABSI) (p < 0.01) and CoNS non-CLABSI (p < 0.01), when compared with prior periods, even allowing for seasonal variation. S. pneumoniae (p = 0.631) and S. aureus (p = 0.617) BSI did not vary significant throughout the study period. CONCLUSIONS: Significantly fewer than expected Enterobacterales BSI occurred during the UK peak of the COVID-19 pandemic; identifying potential causes, including potential unintended consequences of national self-isolation public health messaging, is essential. High rates of CoNS BSI, with evidence of increased CLABSI, but also likely contamination associated with increased use of personal protective equipment, may result in inappropriate antimicrobial use and indicates a clear area for intervention during further waves.


Subject(s)
Bacteremia , Bacteria , COVID-19 , Adult , Bacteremia/epidemiology , Bacteremia/microbiology , Bacteria/classification , Bacteria/isolation & purification , Humans , Pandemics , Retrospective Studies , Secondary Care , United Kingdom
13.
Clin Exp Optom ; 104(6): 711-716, 2021 08.
Article in English | MEDLINE | ID: covidwho-1238095

ABSTRACT

CLINICAL RELEVANCE: Following the COVID-19 lockdown, uptake of slitlamp-enabled live teleophthalmology increased. Its use contributed to a reduction of referrals escalated to secondary care during-lockdown (avoided: 64% pre-lockdown vs 86% during-lockdown). BACKGROUND: Live teleophthalmology using video conferencing allows real-time, three-way consultation between secondary care, community providers and patients, improving interpretation of slit lamp findings and potentially reducing referrals to secondary care. NHS Forth Valley implemented live teleophthalmology in March 2019. In March 2020, the COVID-19 pandemic created urgency to deliver ophthalmic care while minimising the risk of contracting or spreading the disease. We aim to compare the uptake and two outcomes (number of avoided secondary care referrals; pattern of presenting conditions) of live teleophthalmology consultations in NHS Forth Valley before and during the COVID-19 national lockdown. METHODS: An NHS secure video conferencing platform connected the video slit lamps of optometrists, or an iPad mounted on a slit lamp and viewing through the eyepieces, to a secondary care ophthalmologist via a virtual live clinic/waiting area. Data about avoiding a secondary care referral were extracted from a post-consultation ophthalmologist survey for 14 months of data. Pre- and during-lockdown intervals were before/after 23 March 2020, when routine eyecare appointments were suspended. Numbers of avoided referrals to secondary care and patterns of presenting conditions were compared for pre- and during-lockdown periods. RESULTS: The COVID-19 pandemic markedly increased use of live teleophthalmology in NHS Forth Valley. Surveys were completed for 164 of 250 (66%) teleophthalmology consultations over the study period. Data from 154 surveys were analysed, 78 and 76 for the pre- and during-lockdown periods, respectively. Significantly more during-lockdown (86%) than pre-lockdown (64%; difference 21%, 95% CI 8-34%, p = 0.001) surveys indicated that referrals to secondary care were avoided. CONCLUSION: Survey data from ophthalmologists suggest significantly fewer escalations to secondary care due to teleophthalmology use.


Subject(s)
COVID-19/epidemiology , Eye Diseases/epidemiology , Ophthalmology/methods , Quarantine , Referral and Consultation/trends , Secondary Care/standards , Telemedicine/methods , Communicable Disease Control/methods , Eye Diseases/therapy , Humans , Pandemics , SARS-CoV-2
14.
Influenza Other Respir Viruses ; 15(5): 577-588, 2021 09.
Article in English | MEDLINE | ID: covidwho-1214796

ABSTRACT

BACKGROUND: It is important that population cohorts at increased risk of hospitalisation and death following a COVID-19 infection are identified and protected. OBJECTIVES: We identified risk factors associated with increased risk of hospitalisation, intensive care unit (ICU) admission and mortality in inner North East London (NEL) during the first UK COVID-19 wave. METHODS: Multivariate logistic regression analysis on linked primary and secondary care data from people aged 16 or older with confirmed COVID-19 infection between 01/02/2020 and 30/06/2020 determined odds ratios (OR), 95% confidence intervals (CI) and P-values for the association between demographic, deprivation and clinical factors with COVID-19 hospitalisation, ICU admission and mortality. RESULTS: Over the study period, 1781 people were diagnosed with COVID-19, of whom 1195 (67%) were hospitalised, 152 (9%) admitted to ICU and 400 (23%) died. Results confirm previously identified risk factors: being male, or of Black or Asian ethnicity, or aged over 50. Obesity, type 2 diabetes and chronic kidney disease (CKD) increased the risk of hospitalisation. Obesity increased the risk of being admitted to ICU. Underlying CKD, stroke and dementia increased the risk of death. Having learning disabilities was strongly associated with increased risk of death (OR = 4.75, 95% CI = [1.91, 11.84], P = .001). Having three or four co-morbidities increased the risk of hospitalisation (OR = 2.34, 95% CI = [1.55, 3.54], P < .001; OR = 2.40, 95% CI = [1.55, 3.73], P < .001 respectively) and death (OR = 2.61, 95% CI = [1.59, 4.28], P < .001; OR = 4.07, 95% CI = [2.48, 6.69], P < .001 respectively). CONCLUSIONS: We confirm that age, sex, ethnicity, obesity, CKD and diabetes are important determinants of risk of COVID-19 hospitalisation or death. For the first time, we also identify people with learning disabilities and multi-morbidity as additional patient cohorts that need to be actively protected during COVID-19 waves.


Subject(s)
COVID-19 , Critical Care , Hospitalization , Adolescent , Adult , Aged , COVID-19/complications , Dementia/complications , Diabetes Mellitus, Type 2/complications , Female , Humans , Male , Middle Aged , Obesity/complications , Renal Insufficiency, Chronic/complications , Secondary Care , Stroke/complications , Young Adult
15.
J Glob Health ; 10(2): 020509, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1106356

ABSTRACT

BACKGROUND: The COVID-19 pandemic has overwhelmed hospitals in several areas in high-income countries. An effective response to this pandemic requires health care workers (HCWs) to be present at work, particularly in low- and middle-income countries (LMICs) where they are already in critically low supply. To inform whether and to what degree policymakers in Bangladesh, and LMICs more broadly, should expect a drop in HCW attendance as COVID-19 continues to spread, this study aims to determine how HCW attendance has changed during the early stages of the COVID-19 pandemic in Bangladesh. METHODS: This study analyzed daily fingerprint-verified attendance data from all 527 public-sector secondary and tertiary care facilities in Bangladesh to describe HCW attendance from January 26, 2019 to March 22, 2020, by cadre, hospital type, and geographic division. We then regressed HCW attendance onto fixed effects for day-of-week, month, and hospital, as well as indicators for each of three pandemic periods: a China-focused period (January 11, 2020 (first confirmed COVID-19 death in China) until January 29, 2020), international-spread period (January 30, 2020 (World Health Organization's declaration of a global emergency) until March 6, 2020), and local-spread period (March 7, 2020 (first confirmed COVID-19 case in Bangladesh) until the end of the study period). FINDINGS: On average between January 26, 2019 and March 22, 2020, 34.1% of doctors, 64.6% of nurses, and 70.6% of other health care staff were present for their scheduled shift. HCWs' attendance rate increased with time in 2019 among all cadres. Nurses' attendance level dropped by 2.5% points (95% confidence interval (CI) = -3.2% to -1.8%) and 3.5% points (95% CI = -4.5% to -2.5%) during the international-spread and the local-spread periods of the COVID-19 pandemic, relative to the China-focused period. Similarly, the attendance level of other health care staff declined by 0.3% points (95% CI = -0.8% to 0.2%) and 2.3% points (95% CI = -3.0% to -1.6%) during the international-spread and local-spread periods, respectively. Among doctors, however, the international-spread and local-spread periods were associated with a statistically significant increase in attendance by 3.7% points (95% CI = 2.5% to 4.8%) and 4.9% points (95% CI = 3.5% to 6.4%), respectively. The reduction in attendance levels across all HCWs during the local-spread period was much greater at large hospitals, where the majority of COVID-19 testing and treatment took place, than that at small hospitals. CONCLUSIONS: After a year of significant improvements, HCWs' attendance levels among nurses and other health care staff (who form the majority of Bangladesh's health care workforce) have declined during the early stages of the COVID-19 pandemic. This finding may portend an even greater decrease in attendance if COVID-19 continues to spread in Bangladesh. Policymakers in Bangladesh and similar LMICs should undertake major efforts to achieve high attendance levels among HCWs, particularly nurses, such as by providing sufficient personal protective equipment as well as monetary and non-monetary incentives.


Subject(s)
Coronavirus Infections , Health Workforce/statistics & numerical data , Hospitals, Public/statistics & numerical data , Pandemics , Pneumonia, Viral , Secondary Care/statistics & numerical data , Tertiary Healthcare/statistics & numerical data , Adult , Bangladesh/epidemiology , Betacoronavirus , COVID-19 , Female , Humans , Longitudinal Studies , Male , Middle Aged , SARS-CoV-2 , Secondary Care/organization & administration , Tertiary Healthcare/organization & administration
16.
BMJ Open Qual ; 10(1)2021 02.
Article in English | MEDLINE | ID: covidwho-1084233

ABSTRACT

Effective communication between members of the multidisciplinary team is imperative for patient safety. Within the Medicine for the Elderly wards at Royal Victoria Hospital (RVH) in Dundee, we identified an inefficient process of information-sharing between the orthopaedics outpatient department (OPD) at the main teaching hospital and our hospital's rehabilitation teams, and sought to improve this by introducing several changes to the work system. Our aim was for all patients who attended the OPD clinic to have a plan communicated to the RVH team within 24 hours.Before our intervention, clinic letters containing important instructions for ongoing rehabilitation were dictated by the OPD team, transcribed and uploaded to an electronic system before the RVH team could access them. We analysed clinic attendances over a 4-week period and found that it took 15 days on average for letters to be shared with the RVH teams. We worked with both teams to develop a clinical communication tool and new processes, aiming to expedite the sharing of key information. Patients attended the OPD with this form, the clinician completed it at the time of their appointment and the form returned with the patient to RVH on the same day.We completed multiple Plan-Do-Study-Act cycles; before our project was curtailed by the COVID-19 pandemic. During our study period, seven patients attended the OPD with a form, with all seven returning to RVH with a completed treatment plan documented by the OPD clinician. This allowed rehabilitation teams to have access to clinic instructions generated by orthopaedic surgeons almost immediately after a patient attended the clinic, essentially eliminating the delay in information-sharing.The introduction of a simple communication tool and processes to ensure reliable transfer of information can expedite information-sharing between secondary care teams and can potentially reduce delays in rehabilitation.


Subject(s)
COVID-19/rehabilitation , Health Services for the Aged/standards , Patient Care Team/standards , Quality Improvement , Secondary Care/standards , Aged , Aged, 80 and over , Communication , Female , Humans , Interprofessional Relations , Male , SARS-CoV-2 , Secondary Care/methods
17.
Int J Infect Dis ; 102: 136-143, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1060129

ABSTRACT

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the pulmonary disease coronavirus disease 2019 (COVID-19, which has challenged health care facilities worldwide. The sustainability of health care systems is largely reliant on the health status of their health care workers (HCW). This study aimed to detect the SARS-CoV-2 virus and specific antibodies among HCWs in a German hospital as a model system for the potential spread of the pandemic. METHODS: Between March and June 2020, we used a combination of RT-PCR testing to detect SARS-CoV-2 RNA and an enzyme-linked immunosorbent assay to detect the presence of anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies among HCWs in a German hospital based on repetitive oropharyngeal swabs (OPSs) and blood samples. RESULTS: In total, 871/1081 employees participated in this prospective longitudinal study. During the study period of 9 weeks, 5329 OPSs and 2136 blood samples were analyzed. SARS-CoV-2 RNA was detected in three participants (0.34%). Anti-SARS-CoV-2 IgG antibodies were detected in 38 (4.36%) participants. CONCLUSION: Our study determined a low prevalence of COVID-19 in HCW, which may reflect the effectiveness of hygiene protocols. However, it could also indicate a low prevalence of SARS CoV-2 in hospital employees. Our study protocol may serve as an instructive example for future pandemic containment protocols in hospitals.


Subject(s)
Antibodies, Viral/blood , COVID-19/epidemiology , Personnel, Hospital , SARS-CoV-2/immunology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/prevention & control , Female , Germany/epidemiology , Humans , Longitudinal Studies , Male , Middle Aged , Prospective Studies , Secondary Care , Seroepidemiologic Studies , Young Adult
19.
JAMA Netw Open ; 3(12): e2031640, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-995811

ABSTRACT

Importance: The coronavirus disease 2019 (COVID-19) pandemic has required a shift in health care delivery platforms, necessitating a new reliance on telemedicine. Objective: To evaluate whether inequities are present in telemedicine use and video visit use for telemedicine visits during the COVID-19 pandemic. Design, Setting, and Participants: In this cohort study, a retrospective medical record review was conducted from March 16 to May 11, 2020, of all patients scheduled for telemedicine visits in primary care and specialty ambulatory clinics at a large academic health system. Age, race/ethnicity, sex, language, median household income, and insurance type were all identified from the electronic medical record. Main Outcomes and Measures: A successfully completed telemedicine visit and video (vs telephone) visit for a telemedicine encounter. Multivariable models were used to assess the association between sociodemographic factors, including sex, race/ethnicity, socioeconomic status, and language, and the use of telemedicine visits, as well as video use specifically. Results: A total of 148 402 unique patients (86 055 women [58.0%]; mean [SD] age, 56.5 [17.7] years) had scheduled telemedicine visits during the study period; 80 780 patients (54.4%) completed visits. Of 78 539 patients with completed visits in which visit modality was specified, 35 824 (45.6%) were conducted via video, whereas 24 025 (56.9%) had a telephone visit. In multivariable models, older age (adjusted odds ratio [aOR], 0.85 [95% CI, 0.83-0.88] for those aged 55-64 years; aOR, 0.75 [95% CI, 0.72-0.78] for those aged 65-74 years; aOR, 0.67 [95% CI, 0.64-0.70] for those aged ≥75 years), Asian race (aOR, 0.69 [95% CI, 0.66-0.73]), non-English language as the patient's preferred language (aOR, 0.84 [95% CI, 0.78-0.90]), and Medicaid insurance (aOR, 0.93 [95% CI, 0.89-0.97]) were independently associated with fewer completed telemedicine visits. Older age (aOR, 0.79 [95% CI, 0.76-0.82] for those aged 55-64 years; aOR, 0.78 [95% CI, 0.74-0.83] for those aged 65-74 years; aOR, 0.49 [95% CI, 0.46-0.53] for those aged ≥75 years), female sex (aOR, 0.92 [95% CI, 0.90-0.95]), Black race (aOR, 0.65 [95% CI, 0.62-0.68]), Latinx ethnicity (aOR, 0.90 [95% CI, 0.83-0.97]), and lower household income (aOR, 0.57 [95% CI, 0.54-0.60] for income <$50 000; aOR, 0.89 [95% CI, 0.85-0.92], for $50 000-$100 000) were associated with less video use for telemedicine visits. These results were similar across medical specialties. Conclusions and Relevance: In this cohort study of patients scheduled for primary care and medical specialty ambulatory telemedicine visits at a large academic health system during the early phase of the COVID-19 pandemic, older patients, Asian patients, and non-English-speaking patients had lower rates of telemedicine use, while older patients, female patients, Black, Latinx, and poorer patients had less video use. Inequities in accessing telemedicine care are present, which warrant further attention.


Subject(s)
Ambulatory Care/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Telemedicine/statistics & numerical data , Telephone/statistics & numerical data , Videoconferencing/statistics & numerical data , Adult , African Americans , Age Factors , Aged , Asian Americans , COVID-19 , Female , Health Services Accessibility , Healthcare Disparities/ethnology , Humans , Income , Language , Male , Medicaid , Medicare , Middle Aged , Primary Health Care , SARS-CoV-2 , Secondary Care , Sex Factors , Tertiary Healthcare , United States
20.
Diabetes Res Clin Pract ; 166: 108291, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-912133

ABSTRACT

We aim to describe the prevalence of diabetic ketoacidosis (DKA) in individuals admitted to a single centre with COVID-19. We identified 218 individuals hospitalised with COVID-19, of these four fulfilled criteria for DKA (4/218, 1.8%). We conclude DKA is common and severe in individuals hospitalised with COVID-19.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Diabetic Ketoacidosis/epidemiology , Pneumonia, Viral/complications , Secondary Care/statistics & numerical data , Adult , Aged, 80 and over , COVID-19 , Coronavirus Infections/transmission , Coronavirus Infections/virology , Cross-Sectional Studies , Diabetic Ketoacidosis/virology , Hospitalization , Humans , Middle Aged , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Prevalence , Retrospective Studies , SARS-CoV-2 , United Kingdom/epidemiology
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