Undergraduate pharmacy students' perceptions and experiences of a student-led clinic providing preventative services.

OBJECTIVES: Authentic work-based learning is crucial to facilitate the development and preparedness for training healthcare professionals. Such experiences are challenging to design and secure within the clinical environment. One School of Pharmacy established a student-led clinic to provide undergraduate pharmacy students the opportunity to practise physical assessment and communication skills with members of the public. The aim of this study was to explore students' thoughts and perspectives on this experience. METHODS: Undergraduate students were invited to participate in a semi-structured interview after their clinic experience. Transcriptions of the interviews were analysed by reflexive thematic analysis. RESULTS: Twelve students agreed to an interview that took place between October and December 2022. Three themes were identified from the qualitative data which related to external factors that influenced student experience of the clinic, for example, organizational issues and impact of the physical environment; interactions within the clinic environment; and internalized learning for example, professional growth and development, and the appreciating the learning opportunity. CONCLUSIONS: In the current climate, where securing valuable work-based learning opportunity is challenging, student-led clinics offer an environment that is well-received by students and appears to facilitate student professional development. Student clinics are receiving more attention and investment across undergraduate healthcare programmes around the world given advantages such as these. However, they need to be well integrated and structured into the existing training and education and students need appropriate induction to prepare them for the experience and manage expectations.

The impact and user experience of a student-led clinic providing preventative services.

OBJECTIVES: Preventative services are required to address the risk factors for chronic conditions such as cardiovascular disease. The National Health Service Health Checks in England were introduced to provide such services. One School of Pharmacy established a student-led clinic to provide this service to the local community. The clinic was provided by undergraduate pharmacy students and delivered free of charge within a central city locality. The aim was to explore the impact of the clinic on user thoughts and motivations around healthy living and investigate user experience. METHODS: A sequential explanatory mixed methods approach was used consisting of a survey that measured users' thoughts about their health and well-being and experience of the clinic. Qualitative interviews explored the user experience and barriers and facilitators to making healthier lifestyle choices. RESULTS: One hundred and fifty-four members of the public accessed the clinic over the evaluative period. Ninety-six (60%) completed the pre-post survey and 12 participated in follow-up interviews. Users reported statistically significant improvements in how informed, competent and motivated they felt towards making healthier lifestyle choices after the clinic consultation. Interview findings highlighted the positive user experience, reported appreciation for clinic accessibility, availability of healthy lifestyle education, and a desire for more preventative services being as readily available. CONCLUSIONS: The student-led clinic has demonstrated positive impacts on user experience, knowledge, competence, and motivation to make healthier lifestyle choices. The clinic provides proof-of-concept for pharmacy students to deliver preventative community services that aim to improve population health at a time when primary care is experiencing unprecedented challenges.

A qualitative exploration of the barriers and enablers to supporting informal and familial carers within community pharmacies.

OBJECTIVES: There are approximately 5.3 million informal carers in the United Kingdom, many of whom support family in their health despite being unpaid and often unsupported. Many visit pharmacies to collect medicines and look for advice. This work explores informal carer support within community pharmacies (CP). METHODS: Semi-structured video interviews exploring perspectives on the role of CP in supporting carers were conducted in autumn 2022. The study received institutional ethical approval. Interviews were audio-recorded, transcribed verbatim, and analysed using a reflexive thematic approach. KEY FINDINGS: In total 25 interviews were conducted with 13 carers and 12 pharmacy staff. Three themes were identified:-What support do carers need through CP?-medicines management, navigating services, and carers health and wellbeing.-Barriers to CP better supporting carers-relationships with CP, carer needs, identification as a 'carer'.-Enablers to CP better supporting carers-support is a team effort, and CP as a community 'hub'. CONCLUSIONS: There is a trusted relationships between carers and pharmacy staff which can contribute to establishing pharmacies as a safe space of support, this includes medicines-specific support and navigating services, but also carer health and wellbeing support. Pharmacy staff may need to reconsider approaches to identifying and supporting carers and not just treating them as an extension of supporting a patient. In making this support accessible, relationships with pharmacy staff are important, as well as embracing CP as a 'community hub', although pharmacy staff may need training and information to facilitate them in this role.

Pharmacy Students' Lived Experiences With Atopic Dermatitis Inform Perceptions of Learning in the Curriculum.

OBJECTIVE: To explore the impact of lived experiences of pharmacy students with atopic dermatitis (AD) on perceptions of learning in pharmacy curriculum. METHODS: An exploratory qualitative study was conducted with pharmacy students in the United Kingdom to understand how their lived experiences affect their perception of AD in pharmacy curriculum. Semistructured interviews were conducted, and a thematic analysis method was followed. Firstly, codes were created, and then relevant codes were combined to identify themes. RESULTS: Thirteen pharmacy students were interviewed. Study findings showed pharmacy students support teaching with a holistic approach to management and patient-centered care in AD in pharmacy curriculum. Although students had empathy and moral support for patients, they also described a need for teaching on the mental health effects of AD in pharmacy education. CONCLUSION: This brief report explores the role of lived experience of pharmacy students in considering the provision of holistic, patient-centered care in AD teaching in pharmacy education. Participants also suggest the need within the pharmacy curriculum for training to provide mental health advice to patients with AD.

How cultural competence is conceptualised, developed and delivered in pharmacy education: a systematic review.

BACKGROUND: It is important to have a pharmacy workforce that is culturally competent to recognise a patient's health beliefs to improve medication adherence and reduce poor treatment outcomes. AIM: This systematic review aimed to identify, critically appraise and summarise how cultural competency is conceptualised, developed and embedded in pre-qualification pharmacy education. METHOD: Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were searched for relevant papers published in English between January 2012 and December 2021, following PRISMA guidelines. Data from included papers were thematically analysed. Educational quality of papers was appraised using the GREET criteria. This systematic review was registered on PROSPERO, CRD42021295875. RESULTS: The review included 47 papers (46 studies) with 18 papers meeting ≥ 9 points on the GREET criteria thus considered of good educational quality. Forty papers focused on educational interventions implemented to pharmacy students only, the remaining included students from different health disciplines. Half of the educational interventions focused on cultural competence in general. Most educational interventions lasted over a week and 21 were compulsory. Cultural competence conceptualisation varied; a focus on knowledge about different cultures or on culturally competent behaviours or a continuum with knowledge at one end and behaviour at the other. CONCLUSION: There is variation in how cultural competence is embedded in pharmacy programmes, which could be a reflection of the differences in how educators conceptualised cultural competence. Further research is needed to develop a unified understanding of the meaning of cultural competence and how it can be embedded in pharmacy education.

The association between marital status and treatment initiation in lung cancer: A systematic review and meta-analysis of observational studies.

Lung cancer is associated with high mortality, and significant health burden. Marital status has been associated with lung cancer survival. This systematic review and meta-analysis set out to investigate the association between marital status and treatment receipt in lung cancer. The search was conducted across three databases: Medline (OVID), Embase and CINAHL, from inception to June 2022. Retrospective or prospective observational studies that quantified treatment receipt by marital status were eligible for inclusion. Study quality was assessed via a modified checklist for retrospective databased-based studies. Meta-analysis using a random effects model was undertaken by chemotherapy, radiotherapy, surgery, and any treatment relative to married or not married. Pooled unadjusted odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for each type of treatment. 837 papers were screened and 18 met the inclusion criteria with eight being eligible for inclusion in the meta-analysis. Studies were excluded from meta-analysis due to overlap in the data reported in papers; the mean quality score of the 18 included papers was 12/17. Being married was associated with increased odds of overall treatment OR 1.43 (95 % CI 1.14-1.79; I2 = 82 %; Tau2 = 0.07; six studies) and also increased receipt of: chemotherapy 1.40 (95 % CI 1.35-1.44; I2 = 82 %; Tau2 = 0.00); radiotherapy 1.29 (95 % CI 0.96-1.75; I2 = 100 %; Tau2= 0.09; four studies) and surgery (95 % CI 1.31-1.52; I2 = 86 %; Tau2 = 0.00; five studies). The results indicate that those who are married are more likely to receive treatment for lung cancer compared to those who are not married. This requires further investigation to better understand the explanations behind this finding and how we can work to combat this inequality.

Fetoplacental vascular effects of maternal adrenergic antihypertensive and cardioprotective medications in pregnancy.

Maternal cardiovascular diseases, including hypertension and cardiac conditions, are associated with poor fetal outcomes. A range of adrenergic antihypertensive and cardioprotective medications are often prescribed to pregnant women to reduce major maternal complications during pregnancy. Although these treatments are not considered teratogenic, they may have detrimental effects on fetal growth and development, as they cross the fetoplacental barrier, and may contribute to placental vascular dysregulation. Medication risk assessment sheets do not include specific advice to clinicians and women regarding the safety of these therapies for use in pregnancy and the potential off-target effects of adrenergic medications on fetal growth have not been rigorously conducted. Little is known of their effects on the fetoplacental vasculature. There is also a dearth of knowledge on adrenergic receptor activation and signalling within the endothelium and vascular smooth muscle cells of the human placenta, a vital organ in the maintenance of adequate blood flow to satisfy fetal growth and development. The fetoplacental circulation, absent of sympathetic innervation, and unique in its reliance on endocrine, paracrine and autocrine influence in the regulation of vascular tone, appears vulnerable to dysregulation by adrenergic antihypertensive and cardioprotective medications compared with the adult peripheral circulation. This semi-systematic review focuses on fetoplacental vascular expression of adrenergic receptors, associated cell signalling mechanisms and predictive consequences of receptor activation/deactivation by antihypertensive and cardioprotective medications.

Bladder-Sparing Treatment With Radical Dose Radiotherapy Is an Effective Alternative to Radical Cystectomy in Patients With Clinically Node-Positive Nonmetastatic Bladder Cancer.

PURPOSE: Bladder-sparing trimodal therapy (TMT) is an alternative to radical cystectomy (RC) according to international guidelines. However, there are limited data to guide management of nonmetastatic clinically node-positive bladder cancer (cN+ M0 BCa). We performed a multicenter retrospective analysis of survival outcomes in node-positive patients to inform practice. METHODS: Data from patients diagnosed with cN+ M0 BCa were collected from participating UK Oncology centers offering both TMT and RC. Overall survival (OS) and progression-free survival (PFS) outcomes were collected with details of treatment and clinical factors. RESULTS: A total of 287 patients with cN+ M0 BCa were included in the survival analysis. Median OS across all patients was 1.55 years (95% CI, 1.35 to 1.82 years). Receiving radical treatments was associated with improved OS (hazard ratio [HR], 0.32; 95% CI, 0.23 to 0.44; P < .001) compared with receiving palliative treatment. Radically treated patients (n = 163) received RC (n = 76) or radical dose radiotherapy (RT, n = 87); choice of radical treatment showed no association with OS (HR, 0.94; 95% CI, 0.63 to 1.41; P = .76) or PFS (HR, 0.74; 95% CI, 0.50 to 1.08; P = .12) on multivariable analysis. CONCLUSION: Patient cohorts with cN+ M0 BCa had equivalent survival outcomes whether treated with surgery or radical RT. Given the known morbidities of RC-in a patient group with poor survival-this study confirms that bladder-sparing TMT treatment should be a treatment option available to all patients with cN+ M0 BCa.

Intersectional Identities: Making Sense of Skill Development on Clinical Placements.

OBJECTIVE: Little is known about the influence of personal experiences on learners' trajectories toward mastery. Newell's theory of constraints articulates the relationship between environmental, individual, and task-related factors for skill development. This study explores how undergraduate pharmacy students experience skill development on placements and what the barriers and facilitators are within Newell's framework. METHODS: Year 3 undergraduate pharmacy students were invited to take part in focus groups exploring Newell's theory relative to skill development. Verbatim transcripts were analyzed using an interpretive phenomenological approach. RESULTS: Five focus groups were conducted with 16 students. The placement task provided structure through entrustable professional activities (EPAs). The resulting skill development varied but included EPA expected behaviors and also skills for mastery, eg, self-reflection. Students' personal identities acted as both barriers and facilitators. For example, expecting or experiencing racial microaggressions limited participation; having a local accent facilitated rapport with patients. Students worked toward integration into the community of practice (the ward), where the staff was critical to inclusion. Where students had barriers related to their identities, they found it more difficult to access the community of practice. CONCLUSION: Factors related to the community of practice (environment), students' identities (individual), and the EPA behaviors (task) can influence skill development during placement. For some students, these factors will be more prevalent, and elements of their identities may intersect and conflict, acting as both barriers and facilitators to skill development. Educators can consider the influence of intersectionality on student identity when designing and preparing new placements and assessing students.

Community pharmacies as a place for informal carer support in mental health and wellbeing.

There are 5.3 million informal carers in the United Kingdom who take on caring responsibilities for family and friends. Informal carers can be forgotten patients within health and care services, yet because of carer burden, they are at risk of deterioration in health and wellbeing. There are higher levels of anxiety, depression, burnout and low self-esteem amongst carers but, to our knowledge work to date has mainly focused on supporting carers to provide better care for their family member, and less on carers' health and wellbeing. There is increasing interest in social prescribing as a method of linking patients with community-based services to improve health and wellbeing. Initiatives have included social prescribing via community pharmacies which are already recognized to be accessible for support and signposting. The coming together of community pharmacy services and social prescribing could represent a framework to better support carers in their mental health and wellbeing.

Acute Respiratory Infection Hubs: A Service Model with Potential to Optimise Infection Management.

Patients with acute respiratory infections (ARI)-including those with upper and lower respiratory infections from both bacterial and viral pathogens-are one of the most common reasons for acute deterioration, with large numbers of potentially avoidable hospital admissions. The acute respiratory infection hubs model was developed to improve healthcare access and quality of care for these patients. This article outlines the implementation of this model and its potential impacts in a number of areas. Firstly, by improving healthcare access for patients with respiratory infections by increasing the capacity for assessment in community and non-emergency department settings and also by providing flexible response to surges in demand and reducing primary and secondary care demand. Secondly, by optimising infection management (including the use of point-of-care diagnostics and standardised best practise guidance to improve appropriate antimicrobial usage) and reducing nosocomial transmission by cohorting those with suspected ARI away from those with non-infective presentations. Thirdly, by addressing healthcare inequalities; in areas of greatest deprivation, acute respiratory infection is strongly linked with increased emergency department attendance. Fourthly, by reducing the National Health Service's (NHS) carbon footprint. Finally, by providing a wonderful opportunity to gather community infection management data to enable large-scale evaluation and research.

Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis.

BACKGROUND: Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual's socioeconomic status. METHODS: A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. RESULTS: Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. CONCLUSIONS: There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.

An orange will do: Suspending learner disbelief in simulations.

INTRODUCTION: Increasingly, educators are implementing simulation to supplement teaching. Where simulation is not already integral, difficulties have arisen with the utilization of simulation due to limited resources, training requirements, and educator uncertainty. PERSPECTIVE: A learner's ability to suspend disbelief in a simulation can impact the effectiveness of learning. In other words, they become so immersed in the simulation that they ignore obvious limitations and choose to believe the activity is realistic. When designing simulations, educators need to consider intended learning outcomes (ILOs), realism, and briefings/debriefings to help learners suspend disbelief. Realism encompasses physical realism (fidelity), conceptual realism, and emotional/experiential realism. The ILOs should drive the simulation design and type of realism required. These should be presented to learners in a briefing, explaining where and why they may need to suspend disbelief; this should be reiterated during a debriefing to centre a learner's focus on whether the ILOs were met. Without this, learners may not "buy into" the simulation and instead can get lost in detail not relevant to their learning. IMPLICATIONS: The use of cutting-edge equipment does not, on its own, ensure that learners get the most realistic learning experience. The goal of simulations should be to utilize resources in the most advantageous manner for attainment of ILOs. In a time when institutions may be pressured for time, staff, and resources, educators should remember that it is possible to facilitate effective learning in low-resource ways.

The Fragility Fracture Postoperative Mobilisation multicentre audit : the reality of weightbearing practices following operations for lower limb fragility fractures.

AIMS: The purpose of this study was to determine the weightbearing practice of operatively managed fragility fractures in the setting of publically funded health services in the UK and Ireland. METHODS: The Fragility Fracture Postoperative Mobilisation (FFPOM) multicentre audit included all patients aged 60 years and older undergoing surgery for a fragility fracture of the lower limb between 1 January 2019 and 30 June 2019, and 1 February 2021 and 14 March 2021. Fractures arising from high-energy transfer trauma, patients with multiple injuries, and those associated with metastatic deposits or infection were excluded. We analyzed this patient cohort to determine adherence to the British Orthopaedic Association Standard, "all surgery in the frail patient should be performed to allow full weight-bearing for activities required for daily living". RESULTS: A total of 19,557 patients (mean age 82 years (SD 9), 16,241 having a hip fracture) were included. Overall, 16,614 patients (85.0%) were instructed to perform weightbearing where required for daily living immediately postoperatively (15,543 (95.7%) hip fracture and 1,071 (32.3%) non-hip fracture patients). The median length of stay was 12.2 days (interquartile range (IQR) 7.9 to 20.0) (12.6 days (IQR 8.2 to 20.4) for hip fracture and 10.3 days (IQR 5.5 to 18.7) for non-hip fracture patients). CONCLUSION: Non-hip fracture patients experienced more postoperative weightbearing restrictions, although they had a shorter hospital stay. Patients sustaining fractures of the shaft and distal femur had a longer median length of stay than demographically similar patients who received hip fracture surgery. We have shown a significant disparity in weightbearing restrictions placed on patients with fragility fractures, despite the publication of a national guideline. Surgeons intentionally restrict postoperative weightbearing in the majority of non-hip fractures, yet are content with unrestricted weightbearing following operations for hip fractures. Cite this article: Bone Joint J 2022;104-B(8):972-979.

Identification and evaluation of medication-related issues relating to patient's own drugs by pharmacy students while on placement in a tertiary hospital.

Background Pharmacy students require knowledge of prescribing and supply of medicines; this is achievable through work-based learning. In UK hospitals, pharmacy technicians assess patient's own drugs (PODs) so medicines can be used as they would be at home. Student-led POD checks have not yet been considered as an opportunity for legitimate peripheral participation (LPP). Aim To evaluate an undergraduate pharmacy placement model using POD checking as a way of gaining LPP within a UK tertiary hospital. Method Students (n = 100) attended nine placements over academic year 2020-2021; they were supervised by a pharmacy technician to complete POD checks. Data were collected concerning student activities and resulting medication-related issues (MRIs); data were descriptively analysed. Results 1094 patients were seen by pharmacy students and 296 MRIs identified. Omitted (non-prescribed) medicines were the most common MRI (32.1%), followed by incorrect stock items (16.2%). Most MRIs were medium risk (65.5%). The most common actions/outcomes were handover to another ward member (41.6%) or medication removal (25.3%). Conclusion Clinically relevant MRIs relating to PODs can be identified by pharmacy students while experiencing LPP. These activities illustrate scalable work-based learning where pharmacy students can contribute to patient care in relation to the use and supply of medicines.

COVID-19 and delivery of difficult asthma services.

The COVID-19 pandemic necessitated an urgent reconfiguration of our difficult asthma (DA) service. We rapidly switched to virtual clinics and rolled out home spirometry based on clinical need. From March to August 2020, 110 patients with DA (68% virtually) were seen in clinic, compared with March-August 2019 when 88 patients were seen face-to-face. There was DA clinic cancellation/non-attendance (16% vs 43%; p<0.0003). In patients with home spirometers, acute hospital admissions (6 vs 26; p<0.01) from March to August 2020 were significantly lower compared with the same period in 2019. There was no difference in the number of courses of oral corticosteroids or antibiotics prescribed (47 vs 53; p=0.81). From April to August 2020, 50 patients with DA performed 253 home spirometry measurements, of which 39 demonstrated >20% decrease in forced expiratory volume in 1 s, resulting in new action plans in 87% of these episodes. In our DA cohort, we demonstrate better attendance rates at virtual multidisciplinary team consultations and reduced hospital admission rates when augmented with home spirometry monitoring.

Experiencing a virtual patient to practice patient counselling skills.

INTRODUCTION: Virtual patients (VPs) are a safe and standardised method of simulating clinical environments but few studies have explored health care professional's experiences of learning via a VP. This study explored how users experienced and used a VP that aimed to teach the user to deliver non-vitamin K oral anticoagulant patient education. METHODS: The study used semi-structured interviews with pharmacists and pre-registration trainees from a wider research study. Interview topics were based on key areas concerning VP use. Interviews were audio-recorded and transcribed verbatim before being analysed using the framework approach to thematic analysis. Ethical approval was granted by Keele University. RESULTS: There was variation in the type and nature of use of the VP and in the reported learning, which included reinforcement of knowledge, an opportunity to promote reflection, and acquisition and application of knowledge to clinical, patient-facing interactions. The VP was seen as an adjunct to other education and training. The majority of users indicated that they used the VP more than once. Some users seemed to have gamified their learning with a drive to achieve perfect feedback rather than true engagement with the learning, whereas for others the learning appeared to be deep with a reflective focus. CONCLUSIONS: The VP offered an educational use as experiential learning, although the users experienced the VP differently; commonly the VP facilitated learning via reinforcement of pre-existing knowledge. The users reported that the VP had value as an adjunct to other education and training resources.

Young@Heart clinic: a feasibility study of an undergraduate pharmacy student-led blood pressure and healthy lifestyle clinic.

OBJECTIVES: Student-led clinics offer a work-based learning (WBL) opportunity for undergraduate healthcare students to engage with professional activities in a real-life setting. Participation is posited to provide experiential learning and prepare students for clinical practice. This study aims to assess the feasibility of establishing and engaging undergraduate students in one such initiative through the collaboration between one School of Pharmacy and local authority. METHODS: The clinic was developed using a logic model and delivered in 2019-2020. A service specification and training were developed and provided to volunteering undergraduate pharmacy students. Anonymised service data were collected and process outcomes around student and public engagement were recorded to assess feasibility for longer-term embedding into the undergraduate programme. KEY FINDINGS: The clinic was operational for 20 days from November 2019 to February 2020. Student volunteers (n = 43, 36.7%) were trained and provided blood pressure screening and healthy living advice to 131 members of the public. Student drop-out occurred due to the voluntary nature of the initiative. CONCLUSIONS: Collaborative working with the local authority facilitated this WBL experience outside conventional clinical environments. The study demonstrated the potential for students to participate in service provision. This offers value to the local population through a health prevention service when a structured approach to the design and delivery of the educational experience is undertaken. The study provides insight into how the WBL can work, what it requires (e.g. resource, preparation), and learning to inform the wider implementation of this WBL into the undergraduate curriculum.

Exclusion of bacterial co-infection in COVID-19 using baseline inflammatory markers and their response to antibiotics.

BACKGROUND: COVID-19 is infrequently complicated by bacterial co-infection, but antibiotic prescriptions are common. We used community-acquired pneumonia (CAP) as a benchmark to define the processes that occur in bacterial pulmonary infections, testing the hypothesis that baseline inflammatory markers and their response to antibiotic therapy could distinguish bacterial co-infection from COVID-19. METHODS: Retrospective cohort study of CAP (lobar consolidation on chest radiograph) and COVID-19 (PCR detection of SARS-CoV-2) patients admitted to Royal Free Hospital (RFH) and Barnet Hospital (BH), serving as independent discovery and validation cohorts. All CAP and >90% COVID-19 patients received antibiotics on hospital admission. RESULTS: We identified 106 CAP and 619 COVID-19 patients at RFH. Compared with COVID-19, CAP was characterized by elevated baseline white cell count (WCC) [median 12.48 (IQR 8.2-15.3) versus 6.78 (IQR 5.2-9.5) ×106 cells/mL, P < 0.0001], C-reactive protein (CRP) [median 133.5 (IQR 65-221) versus 86.0 (IQR 42-160) mg/L, P < 0.0001], and greater reduction in CRP 48-72 h into admission [median ΔCRP -33 (IQR -112 to +3.5) versus +14 (IQR -15.5 to +70.5) mg/L, P < 0.0001]. These observations were recapitulated in the independent validation cohort at BH (169 CAP and 181 COVID-19 patients). A multivariate logistic regression model incorporating WCC and ΔCRP discriminated CAP from COVID-19 with AUC 0.88 (95% CI 0.83-0.94). Baseline WCC >8.2 × 106 cells/mL or falling CRP identified 94% of CAP cases, and excluded bacterial co-infection in 46% of COVID-19 patients. CONCLUSIONS: We propose that in COVID-19, absence of both elevated baseline WCC and antibiotic-related decrease in CRP can exclude bacterial co-infection and facilitate antibiotic stewardship efforts.