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1.
Lancet Gastroenterol Hepatol ; 6(5): 381-390, 2021 05.
Article in English | MEDLINE | ID: covidwho-1202043

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to a substantial reduction in gastrointestinal endoscopies, creating a backlog of procedures. We aimed to quantify this backlog nationally for England and assess how various interventions might mitigate the backlog. METHODS: We did a national analysis of data for colonoscopies, flexible sigmoidoscopies, and gastroscopies from National Health Service (NHS) trusts in NHS England's Monthly Diagnostic Waiting Times and Activity dataset. Trusts were excluded if monthly data were incomplete. To estimate the potential backlog, we used linear logistic regression to project the cumulative deficit between actual procedures performed and expected procedures, based on historical pre-pandemic trends. We then made further estimations of the change to the backlog under three scenarios: recovery to a set level of capacity, ranging from 90% to 130%; further disruption to activity (eg, second pandemic wave); or introduction of faecal immunochemical testing (FIT) triaging. FINDINGS: We included data from Jan 1, 2018, to Oct 31, 2020, from 125 NHS trusts. 10 476 endoscopy procedures were done in April, 2020, representing 9·5% of those done in April, 2019 (n=110 584), before recovering to 105 716 by October, 2020 (84·5% of those done in October, 2019 [n=125 072]). Recovering to 100% capacity on the current trajectory would lead to a projected backlog of 162 735 (95% CI 143 775-181 695) colonoscopies, 119 025 (107 398-130 651) flexible sigmoidoscopies, and 194 087 (172 564-215 611) gastroscopies in January, 2021, attributable to the pandemic. Increasing capacity to 130% would still take up to June, 2022, to eliminate the backlog. A further 2-month interruption would add an extra 15·4%, a 4-month interruption would add an extra 43·8%, and a 6-month interruption would add an extra 82·5% to the potential backlog. FIT triaging of cases that are found to have greater than 10 µg haemoglobin per g would reduce colonoscopy referrals to around 75% of usual levels, with the backlog cleared in early 2022. INTERPRETATION: Our work highlights the impact of the pandemic on endoscopy services nationally. Even with mitigation measures, it could take much longer than a year to eliminate the pandemic-related backlog. Urgent action is required by key stakeholders (ie, individual NHS trusts, Clinical Commissioning Groups, British Society of Gastroenterology, and NHS England) to tackle the backlog and prevent delays to patient management. FUNDING: Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) at University College London, National Institute for Health Research University College London Hospitals Biomedical Research Centre, and DATA-CAN, Health Data Research UK.


Subject(s)
COVID-19 , Capacity Building , Endoscopy, Digestive System , Gastrointestinal Diseases , Procedures and Techniques Utilization , Triage , COVID-19/epidemiology , COVID-19/prevention & control , Capacity Building/methods , Capacity Building/organization & administration , Change Management , Endoscopy, Digestive System/methods , Endoscopy, Digestive System/statistics & numerical data , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/therapy , Humans , Immunochemistry , Infection Control , Outcome and Process Assessment, Health Care , Procedures and Techniques Utilization/statistics & numerical data , Procedures and Techniques Utilization/trends , SARS-CoV-2 , State Medicine/organization & administration , State Medicine/trends , Triage/methods , Triage/statistics & numerical data , United Kingdom/epidemiology , Waiting Lists
2.
Seizure ; 86: 8-15, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1045115

ABSTRACT

INTRODUCTION: The yield of epileptiform EEG abnormalities is lower in unselected Paediatric populations than in prospective studies of incident seizures or prevalent epilepsy studies. At a time of limited capacity, it is important to match available EEG resources to children who are most likely to benefit. In this study we evaluated a prospective triage tool for estimating the likelihood of epileptiform abnormality in children's first out-patient EEG. METHODS: We prospectively triaged 1865 out-patient referrals to the largest Paediatric EEG laboratory in Ireland. Based on a structured algorithm, we dichotomized first EEG referrals into priority and non-priority groups and assigned one of 5 sub-levels based on anticipated EEG yield. EEGs were reported by a single Consultant in Clinical Neurophysiology. RESULTS: Triage designated 757 (41 %) EEG referrals as non-priority. Priority exceeded non-priority referrals for all age groups except children between 18 months and 3.5 years. EEGs showed a two-fold higher incidence of interictal epileptiform abnormalities for priority referrals (36 % vs 18 %, p < 0.001). Rates of interictal epileptiform abnormality correlated with the 5 sub-levels of triage (p < 0.01). Epileptiform yield was highest (39 %) for children over 5 years vs 17 % for those under 5 years (p < 0.00001); these rates increased to 49 % and 20 % respectively for priority referrals. CONCLUSION: Structured pre-test triage of EEG referrals can identify children who have the greatest likelihood of epileptiform abnormality. In a mixed population of Paediatric referrals, the epileptiform yield of first time EEG is 49 % for children over 5 years who are referred with an appropriate EEG indication. This is subject to much variability with epileptiform yields as low as 13 % in younger children with non-priority referrals. The use of a structured triage algorithm can help to optimise utility of EEG in situations of limited laboratory capacity.


Subject(s)
Outpatients , Triage , Child, Preschool , Electroencephalography , Humans , Infant , Ireland , Pandemics , Probability , Prospective Studies , Retrospective Studies
3.
JMIR Res Protoc ; 10(3): e23492, 2021 Mar 05.
Article in English | MEDLINE | ID: covidwho-1167217

ABSTRACT

BACKGROUND: By 2025, 5 million Canadians will be diagnosed with diabetes, and women from lower socioeconomic groups will likely account for most new diagnoses. Diabetic retinopathy is a primary vision complication of diabetes and a leading cause of blindness among adults, with 26% prevalence among women. Tele-retina is a branch of telemedicine that delivers eye care remotely. Screening for diabetic retinopathy has great potential to reduce the incidence of blindness, yet there is an adverse association among screening, income, and gender. OBJECTIVE: We aim to explore gender disparity in the provision of tele-retina program services for diabetic retinopathy screening in a cohort of women of low socioeconomic status (SES) receiving services in South Riverdale Community Health Centre (SRCHC) between 2014 and 2019. METHODS: Using a convergent mixed methods design, we want to understand patients', providers', administrators', and decision makers' perceptions of the facilitators and barriers associated with the implementation and adoption of tele-retina. Multivariate logistic regression will be utilized to assess the association among client characteristics, referral source, and diabetic retinopathy screening. Guided by a grounded theory approach, systematic coding of data and thematic analysis will be utilized to identify key facilitators and barriers to the implementation and adoption of tele-retina. RESULTS: For the quantitative component, we anticipate a cohort of 2500 patients, and we expect to collect data on the overall patterns of tele-retina program use, including descriptions of program utilization rates (such as data on received and completed diabetic retinopathy screening referrals) along the landscape of patient populations receiving these services. For the qualitative component, we plan to interview up to 21 patients and 14 providers, administrators, and decision makers, and to conduct up to 14 hours of observations alongside review of relevant documents. The interview guide is being developed in collaboration with our patient partners. Through the use of mixed methods research, the inquiry will be approached from different perspectives. Mixed methods will guide us in combining the rich subjective insights on complex realities from qualitative inquiry with the standard generalizable data that will be generated through quantitative research. The study is under review by the University Health Network Research Ethics Board (19-5628). We expect to begin recruitment in winter 2021. CONCLUSIONS: In Ontario, the screening rate for diabetic retinopathy among low income groups remains below 65%. Understanding the facilitators and barriers to diabetic retinopathy screening may be a prerequisite in the development of a successful screening program. This study is the first Ontario study to focus on diabetic retinopathy screening practices in women of low SES, with the aim to improve their health outcomes and revolutionize access to quality care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/23492.

4.
Front Oncol ; 11: 629207, 2021.
Article in English | MEDLINE | ID: covidwho-1156136

ABSTRACT

BACKGROUND: Experimental data highlight the potential benefits and health system cost savings related to surgical prehabilitation; however, adequately powered randomized controlled trial (RCT) data remain nascent. Emerging prehabilitation services may be informed by early RCT data but can be limited in informing real-world program development. Pragmatic trials emphasize external validity and generalizability to understand and advise intervention development and implementation in clinical settings. This paper presents the methodology of a pragmatic prehabilitation trial to complement emerging phase III clinical trials and inform implementation strategies. METHODS: This is a pilot pragmatic clinical trial conducted in a large academic hospital in Toronto, Ontario, Canada to assess feasibility of clinical implementation and derive estimates of effectiveness. Feasibility data include program referral rates, enrolment and attrition, intervention adherence and safety, participant satisfaction, and barriers and facilitators to programming. The study aims to receive 150 eligible referrals for adult, English-speaking, preoperative oncology patients with an identified indication for prehabilitation (e.g., frailty, deconditioning, malnutrition, psychological distress). Study participants undergo a baseline assessment and shared-decision making regarding the intervention setting: either facility-based prehabilitation or home-based prehabilitation. In both scenarios, participants receive an individualized exercise prescription, stress-reduction psychological support, nutrition counseling, and protein supplementation, and if appropriate, smoking cessation program referrals. Secondary objectives include estimating intervention effects at the week prior to surgery and 30 and 90 days postoperatively. Outcomes include surgical complications, postoperative length of stay, mortality, hospital readmissions, physical fitness, psychological well-being, and quality of life. Data from participants who decline the intervention but consent for research-related access to health records will serve as comparators. The COVID-19 pandemic required the introduction of a 'virtual program' using only telephone or internet-based communication for screening, assessments, or intervention was introduced. CONCLUSION: This pragmatic trial will provide evidence on the feasibility and viability of prehabilitation services delivered under usual clinical conditions. Study amendments due to the COVID-19 pandemic are presented as strategies to maintain prehabilitation research and services to potentially mitigate the consequences of extended surgery wait times.

5.
J Addict Med ; 16(1): e40-e43, 2022.
Article in English | MEDLINE | ID: covidwho-1072432

ABSTRACT

OBJECTIVES: The purpose of this study was to assess the feasibility and clinical impact of telemedicine-based opioid treatment with buprenorphine-naloxone following the Coronavirus disease 2019 pandemic. METHODS: Participants included in this retrospective analysis consisted of adult New York City residents with opioid use disorder eligible for enrollment in the NYC Health+Hospitals Virtual Buprenorphine Clinic between March and May 2020 (n = 78). Follow-up data were comprised of rates of retention in treatment at 2 months, referrals to community treatment, and induction-related events. RESULTS: During the initial 9 weeks of clinic operations, the clinic inducted 78 patients on to buprenorphine-naloxone and completed 252 visits. Patient referrals included non-NYC Health + Hospitals (n = 22, 28.2%) and NYC Health + Hospitals healthcare providers (n = 17, 21.8%), homeless shelter staff (n = 13, 16.7%), and the NYC Health + Hospitals jail reentry program in Rikers Island (n = 11, 14.1%). At 8 weeks, 42 patients remained in care (53.8%), 21 were referred to a community treatment program (26.9%), and 15 were lost to follow-up (19.2%). No patients were terminated from care due to disruptive behavior or suspicions of diversion or misuse of Buprenorphine. Adverse clinical outcomes were uncommon and included persistent withdrawal symptoms (n = 8, 4.3%) and one nonfatal opioid overdose (0.5%). CONCLUSIONS: Telemedicine-based opioid treatment and unobserved home induction on buprenorphine-naloxone offers a safe and feasible approach to expand the reach of opioid use disorder treatment, primary care, and behavioral health for a highly vulnerable urban population during an unprecedented natural disaster.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Telemedicine , Adult , Buprenorphine/therapeutic use , Hospitals, Public , Humans , Narcotic Antagonists/therapeutic use , New York City/epidemiology , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2
6.
Scand J Gastroenterol ; 55(8): 976-978, 2020 08.
Article in English | MEDLINE | ID: covidwho-639122

ABSTRACT

BACKGROUND: Radical changes to clinical and endoscopy practice have been rapidly introduced following the spread of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Urgent endoscopies are, however, intended to proceed as normal with additional personal protective procedures. A perceived reduction in hospital attendances may suggest a number of urgently indicated endoscopic retrograde cholangio-pancreatographies (ERCPs) are being missed. Objectives and Methods: A review of all ERCPs carried out in a large tertiary referral endoscopy unit under healthcare restrictions was compared to the same time period in previous years. The intention was to determine if ERCPs are proceeding as normal or if there is a difference in referral characteristics. RESULTS: Under service restrictions (13 March to the end of April 2020), 55 ERCPs were performed compared with 87 ERCPs in 2019. Similar numbers to 2019 were also recorded in the preceding years. One case of coronavirus disease 2019 (COVID-19) was reported in a patient in the days following ERCP, with no cases notified among staff related to endoscopy. CONCLUSIONS: A reduction in ERCP referrals raises concern that a cohort of patients with significant biliary disease remain undetected. Whether this results in later, and more severe, presentation remains to be seen but a potential surge in such cases could significantly burden all future endoscopy planning services.


Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/statistics & numerical data , Coronavirus Infections/epidemiology , Cross Infection/prevention & control , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Referral and Consultation/statistics & numerical data , Age Factors , Aged , Aged, 80 and over , COVID-19 , Cholangiopancreatography, Endoscopic Retrograde/methods , Cohort Studies , Coronavirus Infections/prevention & control , Cross Infection/epidemiology , Databases, Factual , Female , Humans , Incidence , Infection Control/organization & administration , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Reference Values , Retrospective Studies , Risk Assessment , Sex Factors
7.
Head Neck ; 42(7): 1674-1680, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-291714

ABSTRACT

BACKGROUND: Outpatient telemedicine consultations are being adopted to triage patients for head and neck cancer. However, there is currently no established structure to frame this consultation. METHODS: For suspected referrals with cancer, we adapted the Head and Neck Cancer Risk Calculator (HaNC-RC)-V.2, generated from 10 244 referrals with the following diagnostic efficacy metrics: 85% sensitivity, 98.6% negative predictive value, and area under the curve of 0.89. For follow-up patients, a symptom inventory generated from 5123 follow-up consultations was used. A customized Excel Data Tool was created, trialed across professional groups and made freely available for download at www.entintegrate.co.uk/entuk2wwtt, alongside a user guide, protocol, and registration link for the project. Stakeholder support was obtained from national bodies. RESULTS: No remote consultations were refused by patients. Preliminary data from 511 triaging episodes at 13 centers show that 77.1% of patients were discharged directly or have had their appointments deferred. DISCUSSION: Significant reduction in footfall can be achieved using a structured triaging system. Further refinement of HaNC-RC-V.2 is feasible and the authors welcome international collaboration.


Subject(s)
Continuity of Patient Care , Coronavirus Infections/epidemiology , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/epidemiology , Pneumonia, Viral/epidemiology , Referral and Consultation , Risk Assessment/methods , Triage/organization & administration , Betacoronavirus , COVID-19 , Clinical Decision-Making , Evidence-Based Practice , Humans , Medical Oncology/methods , Pandemics , Predictive Value of Tests , Remote Consultation , SARS-CoV-2 , Symptom Assessment , United Kingdom/epidemiology
8.
Res Social Adm Pharm ; 17(1): 1819-1824, 2021 01.
Article in English | MEDLINE | ID: covidwho-15549

ABSTRACT

BACKGROUND: The novel coronavirus pneumonia (COVID-19), which was first detected in Wuhan City, has now became a pandemic that affecting patients around the world. Particularly, the community patient population are at high risk of infection and are facing potential failure of proper medication use during the pandemic. OBJECTIVE: To discuss community pharmacists' role and the content of pharmaceutical care (PC) during the novel coronavirus pandemic to promote effective prevention and control and safe drug use of the community patient population. METHOD: Collect and summarize the experience Chinese community pharmacies gained from providing pharmacy services during the COVID-19 outbreak, and taking patients' PC needs into consideration, analyze and discuss the methods and strategies that community pharmacies and pharmacists shall use to provide PC during the pandemic. RESULTS: Community pharmacy management teams shall support PC services by providing adequate supply of COVID-19 related medications and preventative products, following environment regulations, and providing sufficient staff trainings. Pharmacists shall use various approaches to provide PC services in drug dispensing, consulting and referrals, chronic disease management, safe use of infusions, patient education, home care guidance and psychological support to promote the COVID-19 pandemic control and ensure safe medication use of community patients during the pandemic. CONCLUSION: PC services in communities during the COVID-19 shall possess different properties due to disease characteristics and related change in patients' need. Community pharmacies shall work as a strong supporter of patient's medication and protective equipment supply. Community pharmacists shall be prepared to provide skilled and effective PC services for community patient population to ensure medication safety and promote the overall COVID-19 pandemic control.


Subject(s)
COVID-19/prevention & control , Community Pharmacy Services/organization & administration , Pharmacists/organization & administration , COVID-19/epidemiology , China , Health Services Needs and Demand , Humans , Personal Protective Equipment/supply & distribution , Professional Role
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