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5.
J Foot Ankle Res ; 13(1): 63, 2020 Oct 15.
Article in English | MEDLINE | ID: covidwho-863227

ABSTRACT

BACKGROUND: The arrival of the novel coronavirus (SARS-CoV-2) has impacted the many aspects of modern life, especially, in the immediate term, the delivery of healthcare. CONTEXT: This commentary examines the profession of podiatry and how it has adapted and responded to the emerging crisis. It focusses on but is not exclusive to the position in the United Kingdom (UK) and the edicts and direction from the UK Government. PODIATRY ROLES DURING THE PANDEMIC: It describes the role of podiatry in the pandemic and highlights the deployment of podiatry resources to fight the pandemic beyond traditional podiatric practice. It also looks at the shift from conventional consultation to digital solutions for managing patients in an effort to achieve the goals of maintenance of foot health whilst reducing the spread of the virus. The commentary summarises the emerging data related to a possible foot related presentation of the coronavirus. CONCLUSION: The podiatry profession proved its flexibility and adaptability during the pandemic, to adjust rapidly to ensure that patients were able to access treatment to reduce risk of infection, ulceration and amputation. Dermatological presentations on the feet have been associated with Covid-19 in adolescents as is often the case in viral infections. CPD webinars to support clinicians and manage and prevent the spread of Covid-19 have been widely disseminated along with algorithms to ensure that patients that need treatment are being treated appropriately. Podiatrists have embraced remote technology to ensure that patients are correctly and safely triaged and, signposted and given appropriate self-care advice. MSK podiatrists have the ability to play an intrinsic role within the post discharge rehabilitation pathway.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Delivery of Health Care/statistics & numerical data , Pneumonia, Viral/epidemiology , Podiatry/organization & administration , Aged , Aged, 80 and over , Biomedical Technology/methods , Biomedical Technology/statistics & numerical data , Coronavirus Infections/prevention & control , Coronavirus Infections/virology , Delivery of Health Care/trends , Foot Diseases/prevention & control , Humans , Pandemics/prevention & control , Pliability , Pneumonia, Viral/prevention & control , Pneumonia, Viral/virology , Podiatry/statistics & numerical data , Risk Reduction Behavior , United Kingdom/epidemiology
6.
Bone Joint J ; 102-B(9): 1256-1260, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-844475

ABSTRACT

AIMS: The risk to patients and healthcare workers of resuming elective orthopaedic surgery following the peak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been difficult to quantify. This has prompted governing bodies to adopt a cautious approach that may be impractical and financially unsustainable. The lack of evidence has made it impossible for surgeons to give patients an informed perspective of the consequences of elective surgery in the presence of SARS-CoV-2. This study aims to determine, for the UK population, the probability of a patient being admitted with an undetected SARS-CoV-2 infection and their resulting risk of death; taking into consideration the current disease prevalence, reverse transcription-polymerase chain reaction (RT-PCR) testing, and preassessment pathway. METHODS: The probability of SARS-CoV-2 infection with a false negative test was calculated using a lower-end RT-PCR sensitivity of 71%, specificity of 95%, and the UK disease prevalence of 0.24% reported in May 2020. Subsequently, a case fatality rate of 20.5% was applied as a worst-case scenario. RESULTS: The probability of SARS-CoV-2 infection with a false negative preoperative test was 0.07% (around 1 in 1,400). The risk of a patient with an undetected infection being admitted for surgery and subsequently dying from the coronavirus disease 2019 (COVID-19) is estimated at approximately 1 in 7,000. However, if an estimate of the current global infection fatality rate (1.04%) is applied, the risk of death would be around 1 in 140,000, at most. This calculation does not take into account the risk of nosocomial infection. Conversely, it does not factor in that patients will also be clinically assessed and asked to self-isolate prior to surgery. CONCLUSION: Our estimation suggests that the risk of patients being inadvertently admitted with an undetected SARS-CoV-2 infection for elective orthopaedic surgery is relatively low. Accordingly, the risk of death following elective orthopaedic surgery is low, even when applying the worst-case fatality rate. Cite this article: Bone Joint J 2020;102-B(9):1256-1260.


Subject(s)
Asymptomatic Diseases , Cause of Death , Coronavirus Infections/epidemiology , Elective Surgical Procedures/adverse effects , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Postoperative Complications/mortality , Bayes Theorem , Clinical Laboratory Techniques , Cohort Studies , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Elective Surgical Procedures/mortality , False Negative Reactions , Female , Humans , Incidence , Male , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Postoperative Complications/physiopathology , Risk Assessment , Survival Rate , Treatment Outcome , United Kingdom
8.
J Med Internet Res ; 22(8): e20259, 2020 08 25.
Article in English | MEDLINE | ID: covidwho-836091

ABSTRACT

BACKGROUND: The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak is a public health emergency and the case fatality rate in the United Kingdom is significant. Although there appear to be several early predictors of outcome, there are no currently validated prognostic models or scoring systems applicable specifically to patients with confirmed SARS-CoV-2. OBJECTIVE: We aim to create a point-of-admission mortality risk scoring system using an artificial neural network (ANN). METHODS: We present an ANN that can provide a patient-specific, point-of-admission mortality risk prediction to inform clinical management decisions at the earliest opportunity. The ANN analyzes a set of patient features including demographics, comorbidities, smoking history, and presenting symptoms and predicts patient-specific mortality risk during the current hospital admission. The model was trained and validated on data extracted from 398 patients admitted to hospital with a positive real-time reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2. RESULTS: Patient-specific mortality was predicted with 86.25% accuracy, with a sensitivity of 87.50% (95% CI 61.65%-98.45%) and specificity of 85.94% (95% CI 74.98%-93.36%). The positive predictive value was 60.87% (95% CI 45.23%-74.56%), and the negative predictive value was 96.49% (95% CI 88.23%-99.02%). The area under the receiver operating characteristic curve was 90.12%. CONCLUSIONS: This analysis demonstrates an adaptive ANN trained on data at a single site, which demonstrates the early utility of deep learning approaches in a rapidly evolving pandemic with no established or validated prognostic scoring systems.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Aged , Aged, 80 and over , Artificial Intelligence , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Hospitalization , Humans , Male , Middle Aged , Neural Networks, Computer , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Prognosis , ROC Curve , United Kingdom
9.
BMC Pregnancy Childbirth ; 20(1): 600, 2020 Oct 07.
Article in English | MEDLINE | ID: covidwho-835822

ABSTRACT

BACKGROUND: The aim of this national survey was to explore pregnant women's perceptions of COVID-19 and their healthcare experiences. METHODS: Through patient and public involvement, a questionnaire was developed and advertised via the BBC website, Twitter and other online media during May 2020. The findings were analysed by qualitative thematic analysis. Women who are currently pregnant, or who have delivered during the COVID-19 pandemic were invited to partake in a national online survey. RESULTS: One thousand four hundred fifty-one participants replied to the online questionnaire. Participants provided significant insight into the perceived barriers to seeking healthcare during this pandemic. These include 'not wanting to bother anyone', 'lack of wider support from allied healthcare workers' and the influence of the media. Other concerns included the use of virtual clinics antenatally and their acceptability to patients, the presence of birthing partners, and the way in which information is communicated about rapidly changing and evolving services. The influence of the media has also had a significant impact on the way women perceive hospital care in light of COVID-19 and for some, this has shaped whether they would seek help. CONCLUSIONS: This is the first ever reported study in the United Kingdom to explore pregnant women's perceptions of COVID-19 and their subsequent healthcare experiences. It has also provided insight into perceived barriers into seeking care as well as maternal concerns antenatally, intrapartum and postpartum.


Subject(s)
Coronavirus Infections , Pandemics , Patient Acceptance of Health Care/statistics & numerical data , Pneumonia, Viral , Pregnancy Complications, Infectious , Pregnant Women/psychology , Social Perception , Adult , Attitude to Health , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/psychology , Female , Humans , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/psychology , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/prevention & control , Pregnancy Complications, Infectious/psychology , Qualitative Research , Surveys and Questionnaires , United Kingdom/epidemiology
10.
Science ; 367(6484): 1291, 2020 03 20.
Article in English | MEDLINE | ID: covidwho-831797
14.
MMW Fortschr Med ; 162(16): 32, 2020 09.
Article in German | MEDLINE | ID: covidwho-807335
16.
Fam Process ; 59(3): 1024-1033, 2020 09.
Article in English | MEDLINE | ID: covidwho-787775

ABSTRACT

Like a meteor hitting the earth's surface, 44, 131‡ unexpected deaths have shaken, disturbed, and saddened the core of our nation. This reflection considers the consequences of the coronavirus crisis in the UK with particular reference to the impact on families and on the practice of family therapists. The perspective presented can only be partial because of the fast-changing situation and the limited access to alternative perspectives that are available during this period of relational lockdown. The author provides a systemic understanding of what has happened and what is happening.


Subject(s)
Coronavirus Infections/psychology , Family Therapy , Pneumonia, Viral/psychology , Quarantine/psychology , Betacoronavirus , Coronavirus Infections/prevention & control , Humans , Interpersonal Relations , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , United Kingdom/epidemiology
19.
F1000Res ; 92020.
Article in English | MEDLINE | ID: covidwho-769916

ABSTRACT

The best way to ensure that preterm infants benefit from relevant neonatal expertise as soon as they are born is to transfer the mother and baby to an appropriately specialised neonatal facility before birth (" in utero"). This review explores the evidence surrounding the importance of being born in the right unit, the advantages of in utero transfers compared to ex utero transfers, and how to accurately assess which women are at most risk of delivering early and the challenges of in utero transfers. Accurate identification of the women most at risk of preterm birth is key to prioritising who to transfer antenatally, but the administrative burden and pathway variation of in utero transfer in the UK are likely to compromise optimal clinical care. Women reported the impact that in utero transfers have on them, including the emotional and financial burdens of being transferred and the anxiety surrounding domestic and logistical concerns related to being away from home. The final section of the review explores new approaches to reforming the in utero transfer process, including learning from outside the UK and changing policy and guidelines. Examples of collaborative regional guidance include the recent Pan-London guidance on in utero transfers. Reforming the transfer process can also be aided through technology, such as utilising the CotFinder app. In utero transfer is an unavoidable aspect of maternity and neonatal care, and the burden will increase if preterm birth rates continue to rise in association with increased rates of multiple pregnancy, advancing maternal age, assisted reproductive technologies, and obstetric interventions. As funding and capacity pressures on health services increase because of the COVID-19 pandemic, better prioritisation and sustained multi-disciplinary commitment are essential to maximise better outcomes for babies born too soon.


Subject(s)
Child Health Services , Infant, Premature , Maternal Health Services/organization & administration , Patient Transfer , Coronavirus Infections , Female , Humans , Infant , Infant, Newborn , Pandemics , Pneumonia, Viral , Pregnancy , Pregnancy, Multiple , United Kingdom
20.
JMIR Mhealth Uhealth ; 8(8): e19857, 2020 08 28.
Article in English | MEDLINE | ID: covidwho-769046

ABSTRACT

BACKGROUND: The COVID-19 pandemic is the greatest public health crisis of the last 100 years. Countries have responded with various levels of lockdown to save lives and stop health systems from being overwhelmed. At the same time, lockdowns entail large socioeconomic costs. One exit strategy under consideration is a mobile phone app that traces the close contacts of those infected with COVID-19. Recent research has demonstrated the theoretical effectiveness of this solution in different disease settings. However, concerns have been raised about such apps because of the potential privacy implications. This could limit the acceptability of app-based contact tracing in the general population. As the effectiveness of this approach increases strongly with app uptake, it is crucial to understand public support for this intervention. OBJECTIVE: The objective of this study is to investigate the user acceptability of a contact-tracing app in five countries hit by the pandemic. METHODS: We conducted a largescale, multicountry study (N=5995) to measure public support for the digital contact tracing of COVID-19 infections. We ran anonymous online surveys in France, Germany, Italy, the United Kingdom, and the United States. We measured intentions to use a contact-tracing app across different installation regimes (voluntary installation vs automatic installation by mobile phone providers) and studied how these intentions vary across individuals and countries. RESULTS: We found strong support for the app under both regimes, in all countries, across all subgroups of the population, and irrespective of regional-level COVID-19 mortality rates. We investigated the main factors that may hinder or facilitate uptake and found that concerns about cybersecurity and privacy, together with a lack of trust in the government, are the main barriers to adoption. CONCLUSIONS: Epidemiological evidence shows that app-based contact tracing can suppress the spread of COVID-19 if a high enough proportion of the population uses the app and that it can still reduce the number of infections if uptake is moderate. Our findings show that the willingness to install the app is very high. The available evidence suggests that app-based contact tracing may be a viable approach to control the diffusion of COVID-19.


Subject(s)
Contact Tracing/methods , Coronavirus Infections/prevention & control , Intention , Mobile Applications , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Adolescent , Adult , Aged , Coronavirus Infections/epidemiology , Cross-Cultural Comparison , Female , France/epidemiology , Germany/epidemiology , Humans , Italy/epidemiology , Male , Middle Aged , Pneumonia, Viral/epidemiology , Surveys and Questionnaires , United Kingdom/epidemiology , United States/epidemiology , Young Adult
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