An evaluation of a pilot of daily testing of SARS-CoV-2 contacts in acute hospital and ambulance trusts in England.

OBJECTIVES: Healthcare worker (HCW) SARS-CoV-2 contacts in England have been required to quarantine, creating staff shortages. We piloted daily contact testing (DCT) to assess its feasibility as an alternative. STUDY DESIGN: Observational service evaluation. METHODS: We conducted an observational service evaluation of 7-day DCT using antigen lateral flow devices (LFDs) at four acute hospital trusts and one ambulance trust in England. Mixed methods were used, using aggregate and individual-level test monitoring data, semi-structured interviews, and a survey of eligible contacts. RESULTS: In total, 138 HCWs were identified as contacts of a confirmed SARS-CoV-2 case. Of these, 111 (80%) consented to daily LFD testing, of whom 82 (74%) completed the required programme without interruption and 12 (11%) completed with interruption. Fifty-eight participants (52%) and two non-participants (7.4%) completed the survey. In total, 28 interviews were conducted with participants, site and infection control leads, and union representatives. One participant tested positive on LFD and polymerase chain reaction (PCR) test. Three participants tested positive on PCR but not LFD. DCT was well-accepted by trusts and staff. Participants reported no relaxation of their infection prevention and control behaviours. No incidents of transmission were detected. An estimated 729 potential days of work absence were averted. CONCLUSIONS: DCT can be acceptably operated in a healthcare setting, averting quarantine-related work absences in HCW SARS-CoV-2 contacts.

Psychological outcomes following missed abortions and provision of follow-up care.

This cross-sectional study of 204 women who had experienced a missed abortion, diagnosed at 10-14 weeks of pregnancy, examined the availability and desirability of routine follow-up care, and whether such care is associated with reduced psychological morbidity in the aftermath of miscarriage. Clinically elevated anxiety and depression were observed in 45% and 15% of women, respectively, and the mean score of grief was 2.52 which is similar to that observed in people who suffer death of a close relative. A follow-up appointment after the miscarriage was thought to have been desirable by 92% of women but was offered to only 30%. No significant association between such care and reduced psychological morbidity was identified. However, there were significantly more women with clinically elevated levels of anxiety among those who felt that they were not provided with an opportunity to discuss their feelings during the follow-up, suggesting that such a follow-up either had a deleterious effect on women's psychological state or the distress itself led to such a perception of care. One-third of women in our sample would have liked psychological counselling to help them deal with the emotional aspects of their loss.

PIP: The 10-14 week ultrasound scan has been introduced to routine prenatal care for early diagnosis of major defects and screening for chromosomal abnormalities. In about 3% of such scans, the diagnosis of missed abortion is made. Despite evidence of substantial emotional stress associated with early pregnancy loss, follow-up care is not routinely provided. The present study investigated the availability and effectiveness of such follow-up care in 204 women (median age, 36 years) from London, England, who received a diagnosis of missed abortion or anembryonic pregnancy at 10-14 weeks of gestation in 1995-96. At the time of the survey, 19-400 days after the ultrasound, clinically elevated anxiety and depression were observed in 45% and 15% of women, respectively. The mean grief score was 2.52, which exceeded that reported in another study of persons who suffered the death of a close relative (2.23). 187 women (92%) expressed the belief a follow-up appointment after diagnosis would have been desirable; 73 (36%) thought they would have benefited from emotional counseling. However, a follow-up appointment was offered to only 61 women (30%). Even among women offered a follow-up visit, 22 (42%) indicated they were not provided an opportunity to discuss their feelings about the miscarriage. Women who attended the follow-up but felt they were not given an opportunity to express feelings had significantly higher mean anxiety and depression scores than women who did not have follow-up care or those who attended the follow-up and discussed their feelings. Overall, these findings indicate that miscarriage and the evacuation of retained products of conception are traumatic experiences that are too often dismissed as routine by medical staff.

Investigation of the cause of miscarriage and its influence on women's psychological distress.

OBJECTIVE: To determine whether knowledge of the possible cause of miscarriage reduces women's long term psychological distress. DESIGN: Prospective longitudinal study. SETTING: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London. METHODS: In 143 women where a routine ultrasound scan at 10-14 weeks of gestation showed an anembryonic pregnancy or fetal death, investigations were carried out to help ascertain the cause of the pregnancy loss. The participants were divided into two groups according to whether the cause was identified or not, and the psychological conditions of the two groups were compared at four weeks and four months after the diagnosis of fetal loss. MAIN OUTCOME MEASURES: Anxiety, depression, grief, self-blame, worry. RESULTS: The scores for all outcome variables were significantly lower at the four-month compared with the four-week post-miscarriage assessment. A fetal chromosomal abnormality was the most commonly identified cause of miscarriage, and this group reported significantly less self-blame than women in whom no cause was identified. There were no significant differences between the groups on any other outcome variables. CONCLUSIONS: In women with a missed miscarriage, identification of the cause of fetal loss reduces the feelings of self-blame.