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3.
JMIR Mhealth Uhealth ; 8(12): e23157, 2020 12 09.
Article in English | MEDLINE | ID: covidwho-999986

ABSTRACT

BACKGROUND: The COVID-19 pandemic has impacted the lives of expectant parents and parents of young babies, with disruptions in health care provision and loss of social support. OBJECTIVE: This study investigated the impact of the COVID-19 pandemic and its associated lockdown on this population through the lens of users of the UK National Health Service-approved pregnancy and parenting smartphone app, Baby Buddy. The study aims were threefold: to gain insights into the attitudes and experiences of expectant and recent parents (with babies under 24 weeks of age) during the COVID-19 pandemic; to investigate whether Baby Buddy is meeting users' needs during this time; and to identify ways to revise the content of Baby Buddy to better support its users now and in future. METHODS: A mixed methods study design combining a web-based survey with semistructured telephone interviews among Baby Buddy users in the United Kingdom was applied. Data were collected from April 15 to mid-June 2020, corresponding to weeks 4-13 of the lockdown in the United Kingdom. RESULTS: A total of 436 expectant (n=244, 56.0%) and recent (n=192, 44.0%) parents responded to the web-based survey, of which 79.1% (n=345) were aged 25-39 years and 17.2% (n=75) spoke English as their second language. Of the 436 respondents, 88.5% (386/436) reported increased levels of anxiety around pregnancy, birth, and being a new parent, and 58.0% (253/436) were concerned about their emotional and mental health. Of the 244 pregnant respondents, 43.4% (n=106) were concerned about their physical health. Telephone interviews with 13 pregnant women and 19 recent parents revealed similarly increased levels of anxiety due to reduced health care provision and loss of support from friends and family. Although a minority of respondents identified some positive outcomes of lockdown, such as family bonding, many telephone interviewees reported feeling isolated, disregarded, and overwhelmed. Recent parents were particularly anxious about the impact of the lockdown on their baby's development and socialization. Many interviewees were also concerned about their physical health as a consequence of both limited access to face-to-face medical appointments and their own poorer dietary and physical activity behaviors. Across both samples, 97.0% (423/436) of respondents reported that Baby Buddy was currently helping them, with many commenting that its role was even more important given the lack of face-to-face support from health care and parenting organizations. Greater speed in updating digital content to reflect changes due to the pandemic was suggested. CONCLUSIONS: The COVID-19 pandemic has created heightened anxiety and stress among expectant parents and those with a young baby, and for many, lockdown has had an adverse impact on their physical and mental well-being. With reductions in health care and social support, expectant and new parents are increasingly relying on web-based resources. As a free, evidence-based app, Baby Buddy is well positioned to meet this need. The app could support its users even more by actively directing them to the wealth of existing content relevant to their concerns and by adding content to give users the knowledge and confidence to meet new challenges.


Subject(s)
Anxiety/epidemiology , /psychology , Parents/psychology , Adult , Female , Health Knowledge, Attitudes, Practice , Health Status , Humans , Male , Mental Health , Middle Aged , Pandemics , Parenting/psychology , Pregnancy , Social Support , Socioeconomic Factors , State Medicine , Stress, Psychological/epidemiology , United Kingdom/epidemiology , Young Adult
4.
BMJ Open Qual ; 9(4)2020 12.
Article in English | MEDLINE | ID: covidwho-999266

ABSTRACT

BACKGROUND: Preterm birth (PTB) occurs in 8% of births in the UK. At Imperial College Healthcare NHS Trust, our PTB prevention clinic manages the care of approximately 1000 women/year. Women referred to the clinic are seen from 12 weeks of pregnancy with subsequent appointments every 2-4 weeks to measure cervical length (CL) using transvaginal ultrasound (TVUS). Women with a history of cervical weakness or short cervix on TVUS are offered a cervical cerclage. LOCAL PROBLEM: During the COVID-19 outbreak, pregnant women were strongly advised to avoid social mixing and public transport. The National Health Service had to rapidly adopt remote consultation and redesign clinical pathways in order to reduce transmission, exposure and spread among women at high risk of PTB. METHODS: We focused on Specific, Measurable, Achievable, Realistic and Timebound aims and used a driver diagram to visualise our changes. We used a series of Plan Do Study Act cycles to evaluate and adapt change ideas through the UK's national lockdown during the COVID-19 pandemic between 23 March and 29 May 2020. RESULTS: We reduced the number of face-to-face appointments by 54%. This was achieved by increasing remote telephone consultations from 0% to 64%, and by reducing the intensity of surveillance. The rate of regional anaesthetic was increased from 53% to 95% for cerclage placement in order to minimise the number of aerosol-generating procedures. Patient and staff satisfaction responses to these changes were used to tailor practices. No women tested positive for COVID-19 during the study period. CONCLUSIONS: By using quality improvement methodology, we were able to safely and rapidly implement a new care pathway for women at high risk of PTB which was acceptable to patients and staff, and effective in reducing exposure of COVID-19.


Subject(s)
/epidemiology , Premature Birth/therapy , Quality Improvement/organization & administration , State Medicine/organization & administration , Female , Humans , Infant, Newborn , Pregnancy , United Kingdom/epidemiology
5.
Perspect Public Health ; 141(1): 9-10, 2021 01.
Article in English | MEDLINE | ID: covidwho-992341
6.
BMJ Open ; 10(12): e043949, 2020 12 16.
Article in English | MEDLINE | ID: covidwho-983653

ABSTRACT

OBJECTIVES: To gain insight into the experiences and concerns of front-line National Health Service (NHS) workers while caring for patients with COVID-19. DESIGN: Qualitative analysis of data collected through an anonymous website (www.covidconfidential) provided a repository of uncensored COVID-19 experiences of front-line NHS workers, accessed via a link advertised on the Twitter feed of two high profile medical tweeters and their retweets. SETTING: Community of NHS workers who accessed this social media. PARTICIPANTS: 54 healthcare workers, including doctors, nurses and physiotherapists, accessed the website and left a 'story'. RESULTS: Stories ranged from 1 word to 10 min in length. Thematic analysis identified common themes, with a central aspect being the experience and psychological consequence of trauma. Specific themes were: (1) the shock of the virus, (2) staff sacrifice and dedication, (3) collateral damage ranging from personal health concerns to the long-term impact on, and care of, discharged patients and (4) a hierarchy of power and inequality within the healthcare system. CONCLUSIONS: COVID-19 confidential gave an outlet for unprompted and uncensored stories of healthcare workers in the context of COVID-19. In addition to personal experiences of trauma, there were perceptions that many operational difficulties stemmed from inequalities of power between management and front-line workers. Learning from these experiences will reduce staff distress and improve patient care in the face of further waves of the pandemic.


Subject(s)
/therapy , Health Personnel/psychology , Occupational Stress/psychology , Psychological Trauma/psychology , Adult , Female , Health Personnel/organization & administration , Hospital Administration , Humans , Male , Mental Health , Middle Aged , Nurses/psychology , Physical Therapists/psychology , Physicians/psychology , Qualitative Research , Social Media , State Medicine/organization & administration , United Kingdom , Young Adult
7.
Nature ; 584(7821): 430-436, 2020 08.
Article in English | MEDLINE | ID: covidwho-981546

ABSTRACT

Coronavirus disease 2019 (COVID-19) has rapidly affected mortality worldwide1. There is unprecedented urgency to understand who is most at risk of severe outcomes, and this requires new approaches for the timely analysis of large datasets. Working on behalf of NHS England, we created OpenSAFELY-a secure health analytics platform that covers 40% of all patients in England and holds patient data within the existing data centre of a major vendor of primary care electronic health records. Here we used OpenSAFELY to examine factors associated with COVID-19-related death. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19-related deaths. COVID-19-related death was associated with: being male (hazard ratio (HR) 1.59 (95% confidence interval 1.53-1.65)); greater age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people of white ethnicity, Black and South Asian people were at higher risk, even after adjustment for other factors (HR 1.48 (1.29-1.69) and 1.45 (1.32-1.58), respectively). We have quantified a range of clinical factors associated with COVID-19-related death in one of the largest cohort studies on this topic so far. More patient records are rapidly being added to OpenSAFELY, we will update and extend our results regularly.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Adolescent , Adult , African Continental Ancestry Group/statistics & numerical data , Age Distribution , Age Factors , Aged , Aged, 80 and over , Aging , Asian Continental Ancestry Group/statistics & numerical data , Asthma/epidemiology , Cohort Studies , Coronavirus Infections/prevention & control , Coronavirus Infections/virology , Diabetes Mellitus/epidemiology , Female , Humans , Hypertension/epidemiology , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/virology , Proportional Hazards Models , Risk Assessment , Sex Characteristics , Smoking/epidemiology , State Medicine , Young Adult
11.
Clin Med (Lond) ; 20(4): e131, 2020 07.
Article in English | MEDLINE | ID: covidwho-977812
12.
Int J Risk Saf Med ; 31(4): 181-182, 2020.
Article in English | MEDLINE | ID: covidwho-972453

ABSTRACT

National Health Systems are facing a very serious health emergency related to COVID-19. In this phase of emergency, it is essential to ensure the care of all affected patients but also to ensure the economic stability of the National Health System. This stability is undermined by the potential exponential increase in claims caused by healthcare-associated infections related to COVID-19. That is why it will be essential to use all means necessary to prevent this economic crisis, which could overlap with the health crisis.


Subject(s)
/epidemiology , Cross Infection/epidemiology , Cross Infection/psychology , Cross Infection/prevention & control , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , State Medicine
14.
Klin Monbl Augenheilkd ; 237(12): 1400-1408, 2020 Dec.
Article in English, German | MEDLINE | ID: covidwho-962241

ABSTRACT

The customary doctor and patient interactions are currently undergoing significant changes through technological advances in imaging and data processing and the need for reducing person-to person contacts during the COVID-19 crisis. There is a trend away from face-to-face examinations to virtual assessments and decision making. Ophthalmology is particularly amenable to such changes, as a high proportion of clinical decisions are based on routine tests and imaging results, which can be assessed remotely. The uptake of digital ophthalmology varies significantly between countries. Due to financial constraints within the National Health Service, specialized ophthalmology units in the UK have been early adopters of digital technology. For more than a decade, patients have been managed remotely in the diabetic retinopathy screening service and virtual glaucoma clinics. We describe the day-to-day running of such services and the doctor and patient experiences with digital ophthalmology in daily practice.


Subject(s)
Diabetes Mellitus , Diabetic Retinopathy , Glaucoma , Ophthalmology , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/epidemiology , Diabetic Retinopathy/therapy , Glaucoma/diagnosis , Glaucoma/therapy , Humans , Mass Screening , Pandemics , State Medicine , United Kingdom
15.
Br J Community Nurs ; 25(12): 594-597, 2020 Dec 02.
Article in English | MEDLINE | ID: covidwho-961872

ABSTRACT

The COVID-19 pandemic will have long-term ramifications for many patients, including those who work in the NHS and have been victims of the disease. This short case study describes the journey of an emergency department (ED) charge nurse who contracted COVID-19 and was hospitalised in the intensive care unit (ICU). Post-discharge, he experienced a multitude of physical and mental health complications, which ultimately impacted on each other. Therefore, a bio-psycho-pharmaco-social approach to care is recommended from admission through ICU, discharge and beyond. From this and other narratives, it appears that COVID-19 patients are not adequately followed up after ICU discharge, something that must be considered going forward.


Subject(s)
/diagnosis , Emergency Medical Services/statistics & numerical data , Hospitalization/statistics & numerical data , Nursing Staff, Hospital/statistics & numerical data , Pandemics/statistics & numerical data , Survivors/psychology , Adult , /physiopathology , Humans , Male , Middle Aged , Patient Satisfaction/statistics & numerical data , State Medicine/statistics & numerical data , United Kingdom/epidemiology
16.
Eur J Hosp Pharm ; 28(1): 10-15, 2021 01.
Article in English | MEDLINE | ID: covidwho-961084

ABSTRACT

INTRODUCTION: Hospital admissions from COVID-19 initially increased rapidly within the UK. National Health Service (NHS) field hospitals are part of a capacity building response built at great scale and speed to respond to the anticipated increased demand the NHS faces during this time. NHS Nightingale Hospital Birmingham (NHB) is modelled to treat mild to moderate (non-critical care) COVID-19 disease, to provide step-down capacity for patients in recovery, or for palliating patients in the dying phase of their disease in the Midlands. Opportunities and challenges presented for optimal medicines management (MM) during the development of the NHB are investigated, and a framework developed to support future NHS field hospitals of this model. METHODS: A team, comprised of an associate medical director, trust chief pharmacist and senior pharmacists iteratively developed a framework to convert the large non-hospital setting into a functioning NHS field hospital with standardised MM processes adjusted appropriately to cope with operational constraints in the pandemic situation. NHB has, because of its repurposing, both challenges and advantages affecting MM that influence development of the framework. Throughout implementation, a 7-week period between announcement and opening, there was continuous evaluation, external stakeholder validation and peer review. RESULTS: The PESTLE model, a mechanism of analysis to identify elements of a project environment (Political, Environmental, Social, Technological, Legal and Economic), was applied to identify influencing factors and support detailed project planning. Compliance with medicines legislation was at the forefront of all MM process development for the NHB field hospital. Internal factors were identified by the core MM team, resulting in a workforce, education & training and clinical pharmacy MM plan. DISCUSSION: MM processes are extensive and integral to NHS field hospitals. The presented framework of influencing factors may support future NHS field hospital development. It is pertinent to have a broad team working approach to any large-scale project such as outlined here, and suggest the identified factors be used as a core framework for development of any future MM processes in NHS field hospitals.


Subject(s)
Hospital Administration/trends , Medication Therapy Management/organization & administration , Mobile Health Units/organization & administration , Pandemics , State Medicine/organization & administration , Health Facility Planning , Hospital Bed Capacity/statistics & numerical data , Humans , Medication Systems, Hospital , Medication Therapy Management/legislation & jurisprudence , Models, Organizational , Organizational Policy , Pharmacists , Pharmacy Service, Hospital , State Medicine/legislation & jurisprudence , United Kingdom , Workforce
17.
18.
Lancet Oncol ; 22(1): 66-73, 2021 01.
Article in English | MEDLINE | ID: covidwho-950829

ABSTRACT

BACKGROUND: Cancer services worldwide had to adapt in response to the COVID-19 pandemic to minimise risk to patients and staff. We aimed to assess the national impact of COVID-19 on the prescribing of systemic anticancer treatment in England, immediately after lockdown and after the introduction of new treatments to reduce patient risk. METHODS: We did a retrospective analysis using data from a central National Health Service England web database mandated for clinicians to register intention to start all new systemic anticancer treatments approved for use in England since 2016. We analysed the monthly number of treatment registrations in April, 2020, after the implementation of societal lockdown on March 23, 2020, and after implementation of treatment options to reduce patient risk such as oral or less immunosuppressive drugs, in May and June, 2020. We compared the number of registrations in April-June, 2020, with the mean number of registrations and SD during the previous 6 months of unaffected cancer care (September, 2019, to February, 2020). We calculated the percentage change and absolute difference in SD units for the number of registrations overall, by tumour type, and by type and line of therapy. FINDINGS: In April, 2020, 2969 registrations were recorded, representing 1417 fewer registrations than in the control period (monthly mean 4386; 32% reduction, absolute difference 4·2 SDs, p<0·0001). In May, 2020, total registrations increased to 3950, representing a 10% reduction compared with the control period (absolute difference 1·3 SDs, p<0·0001). In June, 2020, 5022 registrations were recorded, representing a 15% increase compared with the control period (absolute difference 1·9 SDs; p<0·0001]). INTERPRETATION: After the onset of the COVID-19 pandemic, there was a reduction in systemic anticancer treatment initiation in England. However, following introduction of treatment options to reduce patient risk, registrations began to increase in May, 2020, and reached higher numbers than the pre-pandemic mean in June, 2020, when other clinical and societal risk mitigation factors (such as telephone consultations, facemasks and physical distancing) are likely to have contributed. However, outcomes of providing less treatment or delaying treatment initiation, particularly for advanced cancers and neoadjuvant therapies, require continued assessment. FUNDING: None.


Subject(s)
Antineoplastic Agents/therapeutic use , Clinical Decision-Making , Neoplasms/drug therapy , Humans , Registries , Retrospective Studies , State Medicine , Time-to-Treatment
19.
Br J Nurs ; 29(21): 1299, 2020 Nov 26.
Article in English | MEDLINE | ID: covidwho-948246

ABSTRACT

Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on the need for regulators to take into account the care context, particularly with some trusts under more pressure than others from a second wave of COVID-19.


Subject(s)
/nursing , Nursing Care/statistics & numerical data , Nursing Care/standards , Practice Guidelines as Topic , State Medicine/statistics & numerical data , State Medicine/standards , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , United Kingdom
20.
BMJ ; 371: m4468, 2020 11 18.
Article in English | MEDLINE | ID: covidwho-934081
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