Clinical frailty as a key characteristic of the patient population of the NHS Nightingale North West COVID-19 temporary emergency field hospital: cohort study April to June 2020.

OBJECTIVES: COVID-19 temporary emergency 'field' hospitals have been established in the UK to support the surge capacity of the National Health Service while protecting the community from onward infection. We described the population of one such hospital and investigated the impact of frailty on clinical outcomes. DESIGN: Cohort study. SETTING: NHS Nightingale Hospital North West, April-June 2020. PARTICIPANTS: All in-patients with COVID-19. MAIN OUTCOME MEASURES: Mortality and duration of admission. METHODS: We analysed factors associated with mortality using logistic regression and admission duration using Cox's regression, and described trends in frailty prevalence over time using linear regression. RESULTS: A total of 104 COVID-19 patients were admitted, 74% with moderate-to-severe frailty (clinical frailty score, CFS > 5). A total of 84 were discharged, 14 transferred to other hospitals, and six died on site. High C-reactive protein (CRP) > 50 mg/dL predicted 30-day mortality (adjusted odds ratio 11.9, 95%CI 3.2-51.5, p < 0.001). Patients with CFS > 5 had a 10-day median admission, versus 7-day for CFS ≤ 5 and half the likelihood of discharge on a given day (adjusted hazard ratio 0.51, 95%CI 0.29-0.92, p = 0.024). CRP > 50 mg/dL and hospital-associated COVID-19 also predicted admission duration. As more frail patients had a lower rate of discharge, prevalence of CFS > 5 increased from 64% initially to 90% in the final week (non-zero slope p < 0.001). Conclusions: The NNW population was characterized by high levels of frailty, which increased over the course of the hospital's operation, with subsequent operational implications. Identifying and responding to the needs of this population, and acknowledging the risks of this unusual clinical context, helped the hospital to keep patients safe.

Audit of the use of sugar dressings for the control of wound odour at Lilongwe Central Hospital, Malawi.

Seventy-one patients with malodorous, painful wounds were treated with sugar dressings in Lilongwe Hospital, Malawi, to assess the effects of such dressings on diminishing pain and odour. Pain and odour were assessed at the beginning of dressing application and then at frequent intervals. Mean patient odour scores reduced from 5.45 (out of 10) on application to 2.94 at 10 days, and mean patient discomfort scores reduced from 6.73 on application to 3.87 at 10 days. This very cheap treatment produced reproducible benefits as part of an appropriate protocol for use in developing world hospitals with limited resources and nursing care.

Results of manipulation of idiopathic clubfoot deformity in Malawi by orthopaedic clinical officers using the Ponseti method: a realistic alternative for the developing world?

This study looks at whether orthopaedic clinical officers, a cadre of clinicians who are not doctors, can effectively manipulate idiopathic clubfeet using the Ponseti technique. One hundred consecutive cases of uncomplicated idiopathic clubfeet in newborn babies were manipulated by orthopaedic clinical officers. Fifty-seven of these were fully corrected to a plantigrade position by Ponseti manipulation alone, and a further 41 were corrected by manipulation followed by a simple percutaneous tenotomy. Orthopaedic clinical officers therefore corrected 98 out of 100 feet; the remaining 2 feet were referred for surgical correction. This shows that the Ponseti method is suitable for use by nonmedical personnel in the developing world to achieve a plantigrade foot.

Managing the health effects of the explosive remnants of war.

Many civilian deaths and injuries across the globe are a consequence of 'explosive remnants of war' (ERW). These ERW include mines, unexploded ordnance (UXO) and cluster bombs. The numbers of deaths, injuries and resulting disabilities from ERW are expected to increase as armed conflicts proliferate. This will have a substantial effect on all aspects of health. This article first describes the mechanisms of these ERW and the nature of the injuries they can cause. It then briefly outlines the immediate medical management such injuries require; the long-term outcomes and sequelae, and what can be done to manage them. It highlights how research and medical interventions must take into account cultural, social and economic factors in addition to utilising safe and appropriate techniques and practices. The article concludes by noting that medical personnel are well placed not only to intervene and manage the direct health effects of ERW, but also indirectly by advocating on behalf of those affected by adding their voices to campaigns against their proliferation.

Potential health hazards of cluster bombing in the Shomali Valley, Afghanistan in October-November 2001.

A cluster bomb consists of a canister that opens in mid-air releasing a number of bomblets, which spread over a large area of ground and explode on impact. The exact proportion of bomblets that fail to explode on impact is a matter for debate between military and humanitarian agencies. After the recent bombing of Afghanistan, nine cluster bomb sites in the Shomali Valley were assessed. A total of 317 of 1,818 cluster bomblets had failed to explode (17.4%). Of these 317, 107 (33.7%) had become buried in the ground. Fifty-seven percent of the buried cluster bomblets were embedded deeper than 10 cm. To detect cluster bomblets buried at this depth, large loop metal detectors are needed.