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Objectives: The COVID pandemic has imposed significant direct medical cost and resource use burden on healthcare systems. This study described the patient demographic and clinical characteristics, healthcare resource utilization and costs associated with acute COVID in adults in England. Method(s): This population-based retrospective study used linked primary care (Clinical Practice Research Datalink, CPRD, Aurum) and secondary care (Hospital Episode Statistics) data to identify: 1) hospitalized (admitted within 12 weeks of a positive COVID-19 PCR test between August 2020 and March 2021) and 2) non-hospitalized patients (positive test between August 2020 and January 2022 and managed in the community). Hospitalization and primary care costs, 12 weeks after COVID diagnosis, were calculated using 2021 UK healthcare reference costs. Result(s): We identified 1,706,368 adult COVID cases. For hospitalized (n=13,105) and non-hospitalized (n=1,693,263) cohorts, 84% and 41% considered high risk for severe COVID using PANORAMIC criteria and 41% and 13% using the UKHSA's Green Book for prioritized immunization groups, respectively. Among hospitalized cases, median (IQR) length of stay was 5 (2-7), 6 (4-10), 8 (5-14) days for 18-49 years, 50-64 years and >= 65 years, respectively;6% required mechanical ventilation support, and median (IQR) healthcare costs (critical care cost excluded) per-finished consultant episode due to COVID increased with age (18-49 years: 4364 (1362-4471), 50-64 years: 4379 (4364-5800), 65-74 years: 4395 (4364-5800), 75-84 years: 4473 (4364-5800) and 85+ years: 5800 (4370-5807). Among non-hospitalized cases, older adults were more likely to seek GP consultations (13% of persons age 85+, 9% age 75-84, 7% age 65-74, 5% age 50-64, 3% age 18-49). Of those with at least 1 GP visit, the median primary care consultation total cost in the non-hospitalized cohort was 16 (IQR 16-31). Conclusion(s): Our results quantify the substantial economic burden required to manage adult patients in the acute phase of COVID in England.Copyright © 2023
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At a Health and Social Care Select Committee evidence session on 14 May the King's Fund, the Nuffield Trust, and the Health Foundation warned that it would take many more months before core health and care services were able to fully restart. Limited capacity Jennifer Dixon, chief executive officer at the Health Foundation, told the committee that capacity within hospitals would be severely limited because of the need for social distancing, separating out covid and non-covid patients, and more time for deep cleaning of equipment and facilities. Chris Hopson, chief executive officer at NHS Providers, told the committee that NHS staff had worked incredibly hard in the past few months, with leave cancelled, and were very tired as a result.
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Aim: People with type 1 or type 2 diabetes have a higher hospital admission rate following Covid-19 infection. This study aims to determine the degree to which the results of a previous study in Greater Manchester (GM) could be replicated in national-level data for England. Method(s): We focussed on the univariable regression analysis, which shows the association between admission and Covid-19 infection in people with diabetes. Modelling was conducted using logistic regression on data from the Covid-IMPACT database. Odds ratios were compared descriptively with the previous study. Result(s): In people with type 2 diabetes, factors associated with an increased risk of hospitalisation similar to the previous study were: older age, male sex, higher social deprivation, higher body mass index (BMI), higher cholesterol, lower eGFR, taking an ACE-inhibitor/ ARB, not taking metformin, and having asthma or hypertension. Patients with COPD, and those taking aspirin or clopidogrel also had increased risk, but the national data showed a greater risk (GM COPD odds ratio 1.89 [1.63-2.19] vs national 2.34 [2.28-2.40] / aspirin 1.49 [1.34-1.66] vs 1.66 [1.63-1.70] / clopidogrel 1.71 [1.47-1.98] vs 1.99 [1.94-2.04]). Similar results were observed in patients with type 1 diabetes. However, due to the increase in sample size, many factors which were previously not statistically significant have become significant, such as in type 2 diabetes BMI, low HDL-cholesterol. Conclusion(s): We have successfully replicated the methods, results and conclusions of our previous study in relation to factors associated with increased risk of hospital admission in diabetes individuals. Regional databases are suitable for large cohort studies, and in this instance produced similar results to a national database, validating our previous findings.
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BackgroundPsoriasis (PsO) and psoriatic arthritis (PsA) can greatly impact quality of life and result in substantial personal and societal costs. Complete and up to date data on the prevalence and incidence of these conditions and whether these change over time and vary by age is important for healthcare service planning so that specialist care and funding can be appropriately allocated.ObjectivesTo determine the prevalence and incidence of PsO and PsA in males and females from 2009-2019 across all age groups in England.MethodsWe used Clinical Practice Research Datalink AURUM, a primary care electronic health record database, including 20% of the English population. The codes used to identify patients with PsO and PsA were selected by rheumatologists and dermatologists and cross-checked with published code lists from other studies to ensure inclusion of all relevant codes. All included patients must have data for at least 1 year before their diagnosis. The annual incidence and point prevalence were calculated from 2009-2019 and stratified by age/sex. The study period ended in 2019 to avoid COVID-19 pandemic affecting results.ResultsThe prevalence of PsO and PsA in males and females increased annually, peaking in 2019 (PsO males 2.41% [95% confidence interval (CI) 2.40, 2.42];PsO females 2.60% [95% CI 2.59-2.61];PsA males 0.20% [95% CI 0.20-0.20];PsA females 0.21% [95% CI 0.21- 0.22]), as illustrated in Table 1. In 2019, the prevalence of PsO and PsA was highest in the over 65 years age group;PsO 4.25% [95% CI 4.22-4.28] and PsA 0.38% [95% CI 0.37-0.38]. The annual incidence (per 100,000 person years) of PsO has gradually decreased in males (from 168 (164-171) in 2009 to 148 (145-151) in 2019) but in females it has been stable with a slight annual decrease (from 180 (177-184) in 2009 to 173 (170-176) in 2019). The annual incidence for PsA has increased in both males and females (13 (12-14) in 2009 and 15 (14-16) in 2019 for males and 12 (11-13) in 2009 and 18 (17-19) in 2019 for females).ConclusionThe increasing prevalence of PsO and PsA highlights the importance of organising healthcare services to meet this need, particularly in the elderly population.ReferencesNIL.Table 1.Prevalence of PsO and PsA from 2009-2019 in EnglandYear20092010201120122013201420152016201720182019Population (n)1073383110910802110318501118036711343299112249341137842211657996119336261223432512420998PsO (n)216841229106239819250667259988268032276804286499295712304568311104PsO prevalence (%, 95%CI)-Male1.98 (1.96-1.99)2.06 (2.05- 2.07)2.13 (2.12-2.14)2.19 (2.18-2.20)2.24 (2.23- 2.25)2.33 (2.32- 2.34)2.37 (2.36- 2.38)2.39 (2.38- 2.40)2.40 (2.39- 2.41)2.40 (2.39- 2.42)2.41 (2.40- 2.42)-Female2.07 (2.05- 2.08)2.14 (2.13- 2.16)2.22 (2.21- 2.23)2.29 (2.28- 2.31)2.35 (2.33- 2.36)2.45 (2.43- 2.46)2.50 (2.49- 2.51)2.53 (2.52- 2.54)2.56 (2.54- 2.57)2.58 (2.56- 2.59)2.60 (2.59- 2.61)PsO incidence (100,000 person years)-Male168 (164-171)158 (155- 162)161 (158-165)153 (150-157)161 (157- 164)156 (153- 159)155 (152- 159)154 (151- 157)153 (150-156)150 (147-153)148 (145-151)-Female180 (177-184)176 (172-179)181 (177-184)171 (167-174)175 (171-178)176 (172-180)179 (176-183)178 (174-181)177 (174-181)174 (170-177)173 (170-176)PsA (n)1444515443164681752218545196182072021994232572451425683PsA prevalence (%, 95%CI)-Male0.14 (0.14- 0.14)0.15 (0.14- 0.15)0.15 (0.15- 0.16)0.16 (0.16- 0.16)0.17 (0.16- 0.17)0.18 (0.17- 0.18)0.18 (0.18- 0.19)0.19 (0.18- 0.19)0.19 (0.19- 0.20)0.20 (0.19- 0.20)0.20 (0.20- 0.20)-Female0.13 (0.13- 0.13)0.14 (0.13- 0.14)0.15 (0.14- 0.15)0.15 (0.15- 0.16)0.16 (0.16- 0.16)0.17 (0.17- 0.18)0.18 (0.18- 0.18)0.19 (0.19- 0.19)0.20 (0.19- 0.20)0.20 (0.20- 0.21)0.21 (0.21- 0.22)PsA incidence (100,000 person years)-Male13 (12- 14)12 (11- 13)13 (12- 14)12 (11- 13)13 (12-14)14 (13- 15)14 (13- 15)14 (13-15)1514-16)14(13- 15)15 (14-16)-Female12 (11- 13)13 (12- 14)13 (12- 14)14 (13-15)14 (13-15)15 (14-16)17 (16- 18)16 (15- 17)17 (16- 18)18 (17-19)18 (17-19)Acknowledgements:NIL.Disclosure of InterestsArani Vivekanantham: None declared, Edward Burn: None dec ared, Marta Pineda-Moncusí: None declared, Sara Khalid Grant/research support from: SK has received research grant funding from the UKRI and Alan Turing Institute outside this work. SK's research group has received grant support from Amgen and UCB Biopharma., Daniel Prieto-Alhambra Grant/research support from: DPA's department has received grant/s from Amgen, Chiesi-Taylor, Lilly, Janssen, Novartis, and UCB Biopharma. His research group has received consultancy fees from Astra Zeneca and UCB Biopharma. Amgen, Astellas, Janssen, Synapse Management Partners and UCB Biopharma have funded or supported training programmes organised by DPA's department., Laura Coates Speakers bureau: LC has been paid as a speaker for AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Medac, Novartis, Pfizer and UCB., Consultant of: LC has worked as a paid consultant for AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Novartis, Pfizer and UCB., Grant/research support from: LC has received grants/research support from AbbVie, Amgen, Celgene, Eli Lilly, Novartis and Pfizer.
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Objectives: During the COVID-19 pandemic, the NHS delivered a community-based remote home monitoring service for COVID-19 patients. The service came in two models characterised based on the referral method: home-based care to ensure the right people were admitted at hospital at the right time (named COVID Oximetry @ home (CO@h)) and facilitation of patients' transition when discharged home (named Covid-19 Virtual Ward (CVW)). Patients were provided with pulse oximeters and asked to regularly record and submit oxygen levels and other symptoms to a team of administrators and clinicians via digital means (tech-enable and analogue mode) and/or over the phone (analogue). Our aim was to evaluate the costs of implementing these services in England during wave 2 of the pandemic (October 2020-April 2021). Method(s): We used a top-down approach to describe the costs of setting-up and running the service. 26 sites reported the number of patients and staff members involved in the service, and other used resources. Descriptive statistics and multivariate regression analysis were used appropriately. Result(s): The mean cost per patient monitored was lower in the CO@h service compared to the CVW (527.5 vs. 599.1). The corresponding cost was lower for sites using tech-enabled and analogue data submission mode compared to sites using analogue-only mode for both CO@h (515 vs. 561) and CVW (584 vs. 612) services. The number of patients enrolled in the service and the service type significantly affected the mean cost per patient (b=0.62, p= 0.001;b=-457.99, p=0.05 correspondingly). Conclusion(s): Our analysis offers a model for future research since it covers sites of various sizes and raises questions about different practices within the overall remote monitoring services.Copyright © 2023
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Aims/objectives: To develop an app to support virtual diabetes clinics to help people with diabetes to check themselves for lipos and to discuss what they found during the virtual consultation. Method(s): Collaborative project between clinical teams and medical illustrators in Swansea Bay University Health Board, academics in Swansea University and Eli Lilly under a Collaborative Working Agreement. The teams worked together to develop the content, animations, and a learning technologist developed progressive web app (PWA). The app was tested by diabetes patient groups in Wales, as well as HCP groups, Welsh Academy for Nurses in Diabetes (WAND) and Diabetes Specialist Nurses (DSN) forum prior to launch in June 2021. Result(s): Between 28th June 2021 and 11th November 2022 the app had 827 unique users and 124 returning users. Users came from 15 different countries including UK, Australia, USA, Germany, Brazil and Saudi Arabia. The proportion of UK users were 480 (60%) England, 265 (34%) Wales, and 19 (2%) Scotland. A total of 41 users completed the feedback form;of those 11 (27%) did not know about lipos prior to using the app, 11 (27%) found a lipo using the app, 14 (34%) said they made changes to injection technique after using the app and 37 (90%) said their knowledge of lipos increased following using the app. Conclusion(s): A PWA can help to aid virtual clinics an provide education for people with diabetes. The diabetesclinic@ home app improved knowledge and detection of lipos and improved injection technique.
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Aims: At our Trust, all severe inpatient hypoglycaemic episodes in individuals with diabetes (defined as a hypoglycaemic episode requiring injectable treatment) are reported to NaDIA-Harms (National Diabetes Inpatient Audit). We conducted a detailed review of the care of all these events to improve patient safety. In this study, we assessed the risk of 12-month mortality following an episode of severe inpatient hypoglycaemia. Method(s): Reportable NaDIA harms of patients admitted during the period 2018-2022 were recorded into a dataset. Applicable patient records were reviewed at 12 months following the event to see how many patients were deceased and details of comorbidities at the time of the severe hypoglycaemic episode were collected. Result(s): To date, of 107 inpatients who experienced a severe hypoglycaemic episode 55% were deceased within 12 months. In patients admitted during the peak of the Covid-19 pandemic recorded as year April 2020/March 2021, 80% of patients who had a NaDIA hypoglycaemic event died within 12 months. Conclusion(s): Mortality rate following an episode of inpatient hypoglycaemia appears to be several-fold higher than previous reported rates of 4.45%-22.1% for community-dwelling individuals who experience a severe hypoglycaemic event. This maybe partially explained by the increased frailty, polypharmacy and multimorbidity among this cohort, but there is evidence linking hypoglycaemia with cardiovascular mortality. Although no causality between severe inpatient hypoglycaemia and death can be inferred from this study because of the observational nature, it does highlight the importance preventing inpatient episodes of hypoglycaemia through effective monitoring and proactive treatment modification.
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Background: People living with cancer are reported to be at increased risk of hospitalization and death following infection with acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This is proposed to be dependent on a combination of intrinsic patient and cancer factors such as cancer subtype, and emerging SARS-CoV-2 variants with differing pathogenicity. However, COVID-19 phenotype evolution across the pandemic from 2020 has not yet been systematically evaluated in cancer patients. Method(s): This study is a population-scale real-world evaluation of Coronavirus outcomes in the United Kingdom for cancer patients from 1st November 2020-31st August 2022. The cancer cohort comprises individuals from Public Health England's national cancer dataset, excluding individuals less than 18 years old. Case-outcome rates, including hospitalization, intensive care and casefatality rates were used to assess the evolution in disease phenotype of COVID-19 in cancer patients. Multivariable logistic regression models were fitted to compare risk of Coronavirus outcomes in the cancer cohort relative to the non-cancer population during the Omicron wave in 2022. Result(s): The cancer cohort comprised of 198,819 positive SARS-CoV-2 tests from 127,322 individual infections. Coronavirus case-outcome rates were evaluated by reference to 18,188,573 positive tests from 15,801,004 individual infections in the non-cancer population. From 2020 to 2022, the SARS-CoV-2 disease phenotype became less severe in both patients with cancer and the non-cancer population, though cancer patients remain at higher risk. In 2022, the relative risk of Coronavirus hospital admission, inpatient hospitalization, intensive care admission and mortality in cancer patients was 3.02x, 2.10x, 2.53x and 2.54x compared to the non-cancer population following multivariable adjustment, respectively. Higher risk of hospital admission and inpatient hospitalization were associated with receipt of B/T cell antibody and/or targeted therapy which also corresponded with an increased risk of Coronavirus mortality. Conclusion(s): The disease phenotype of SARS-CoV-2 in cancer patients in 2022 has evolved significantly from the disease phenotype in 2020. Direct effects of the virus in terms of SARS-CoV-2 hospitalization, intensive care and case fatality rates have fallen significantly over time. However, relative to the general population, people living with cancer and hematological malignancies remain at elevated risk. In order to mitigate the indirect effects of the SARS-CoV-2 pandemic in terms of disruption to cancer care, there should be increased focus on preventative measures. Used in conjunction with vaccination and early treatment programs, this will maximize quality of life for those with cancer during the ongoing pandemic and ensure the best cancer outcomes.
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Too little, too late, too flawed
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In 2016, an innovative project of three ultrasound trainers evolved to support multi-professional trainees in Obstetric and Gynaecology ultrasound across the Wessex region. The aim of the project was to deliver a high-quality ultrasound training programme. One of the project's successes resulted in establishing the Sonographer Training Network Forum which allowed ultrasound leads from seven Trusts to meet and share ideas, which ultimately led to the development of regional ultrasound guidelines. From 2016 to early 2020, we have supported 75 trainees in O&G ultrasound. The vision was to create a dedicated ultrasound training centre to support trainees in a safe environment. Late 2019, with the support and funding from Health Education England South-East, the plans were set in motion to create the first Ultrasound Training Academy in the South- East Region. A briefing paper was submitted to the Trust Investment Group for approval. Approval from TIG acknowledged the Trust's support in the project as well as supporting the sonography workforce. This began the search for space that would accommodate the academy. Frustratingly, COVID stopped all activities, however, with reflection, COVID gave us the time to plan accordingly for the Ultrasound Training Academy. Without the normal pressure of a time frame, it was an opportunity to find an ideal location as well as purchasing the required equipment befitting the academy. The Ultrasound Training Academy - HEE (South-East) is based in the Princess Anne Hospital (University Hospital Southampton NHS FT). The advantages based within a hospital setting allowed the academy to follow the Trust's governance as well as absorbing some of the capacity from the ultrasound department. We have two ultrasound rooms and a dedicated space for simulation training. We have plans to create a third ultrasound room.
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PurposeThis paper is a commentary on COVID-19's impact on Domestic Homicide Reviews (DHRs), the system in England and Wales that enables learning from domestic abuse-related deaths.Design/methodology/approachDrawing on a practitioner–researcher perspective, this paper reflects on how COVID-19 affected the delivery and experience of DHRs, the place of victims at the heart of this process and what the pandemic's impact might mean moving forward.FindingsThis paper explicates some of the challenges of undertaking DHRs in a pandemic. Critically, however, it argues that these challenges illuminate broader questions about the practice of DHR.Originality/valueThis paper's originality comes from the author's practitioner–researcher perspective and its use of COVID-19 as a lens to consider DHRs.
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In March 2020, stringent social distancing measures were introduced across England and Wales to reduce the spread of Covid-19. These measures have presented significant challenges for the family justice system. This article sets out the findings of interviews conducted with professionals in the North East of England who have represented or otherwise supported litigants in private and public children proceedings since social distancing measures were introduced. The findings reveal that whilst practitioners are broadly positive about their experiences of shorter non-contested hearings, they nonetheless have concerns about the effectiveness of remote/hybrid hearings in ensuring a fair and just process in lengthy and complex cases. In particular, the findings indicate that the move to remote hearings has exacerbated pre-existing barriers to justice for unrepresented and vulnerable litigants. The aims of this article are not to ‘name and shame' any particular court but to highlight evidence of good practice in the North East of England and provide scope for improving practitioners' and litigants' experiences within current restrictions.
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Aims: A proof-of- concept pilot investigating the profile of person who engaged with remote testing for their annual diabetes review, and service user (SU) and primary care practice acceptability for completing annual diabetes review tests remotely (blood pressure, finger-stick blood test and urine test). Method(s): A mixed methods evaluation based on SU surveys sent to all 144 pilot participants, semi-structured SU and staff interviews, and demographic and clinical data extraction from primary care electronic patient record system. Result(s): Profile: The pathway was considered suitable for people who were working, digitally capable, younger, had household support to complete the tests, had non-complex diabetes, or a combination of these attributes. It was deemed less suitable for the very elderly, the less digitally capable, those with complex health needs or socially isolated. SU Acceptability: Interviewees and survey respondents overall deemed the remote tests acceptable for use. Convenience and reduced exposure to Covid-19 were motivating factors for participation. Preference for face-to- face care or concerns around using digital technologies were key reasons for decline. Staff Acceptability: The pathway was deemed acceptable and was successfully implemented at both practices. Support from a designated pathway co-ordinator and project manager were key factors linked to acceptability and success. The remote pathway was seen as an opportunity to reduce primary care pressures on in-person care. Conclusion(s): It is possible to successfully conduct annual diabetes reviews remotely. Although not appropriate nor desirable to everyone, remote testing provides a viable alternative to in-person testing for certain individuals.
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Introduction: There is a distinct unmet need in structured, curriculum based, unbiased education in neuromodulation. Current teaching is through sporadic industry workshops, cadaver courses and peer proctorship. The COVID pandemic has created a unique opportunity where online platforms have enabled education to be delivered remotely in both synchronous and asynchronously. The William Harvey Research Institute, Queen Mary University, London, UK have initiated University based accreditation- Post Graduate Certificate in neuromodulation (PGCert) that provides candidate a qualification in one academic year through part-time study. Method(s): The program underwent rigorous staged university approval process (figure 1). To ensure market feasibility, two short proof of concept CPD programs "Executive Education in Neuromodulation (EEPIN)" were delivered in 2021. These courses attracted 87 candidates across Australia, Singapore, India, Germany, Poland, Czech Republic, Ireland, and UK. The faculty includes key opinion leaders that will deliver the program ensuring the candidates gain academic background and specialist skills to understand safe practice of neuromodulation. The PGCert advisory board has been established to ensure strict governance in terms of content and unbiased delivery confirming ACCME guidance. In order to obtain PGCert, candidates are required to complete 4 x 15 credit modules (60 credits). The four modules include Anatomy & Neurophysiology;Patient care and Procedurals skills;Devices and available technology;Intrathecal drug delivery for cancer and non-cancer pain. The modular nature of the program is designed to provide cumulative knowledge, from basic science to clinical application in line with the best available evidence. The modules comprise nine lectures, spreading over three consecutive days, followed by a written assignment with 40 direct contact hours in each module. The webpage can be accessed at Results: The anonymous data from EEPIN reported on Likert scale 1-5: Objectives defined 30.6% - 4 and 69.4% -5;Relevance of topics 10.2%- 4 and 89.8% -5;Content of presentations 22.4%- 4 and 77.6% -5;Organization 24.5% -4 and 69.4% -5;Candidate faculty interaction 14.3% -4 and 81.6% -5. 97% of the EEPIN candidates recommended the program to others whilst 81.8% expressed their strong interest to enroll for university-based post graduate qualification if offered. Conclusion(s): This PGcert Neuromodulation is a unique, university accredited program that provides qualification in neuromodulation with access to a flexible online e-learning platform to discuss and exchange ideas, share knowledge in candidate's own time. This will support the ongoing need for formal curriculum-based education in neuromodulation. Disclosure: Kavita Poply, PHD: None, Phillippe Rigoard: None, Jan Kallewaard, MD/PhD: None, FRANK J.P.M. HUYGEN, MD PhD: ABBOTT: Speakers Bureau:, Saluda: Consulting Fee:, Boston Scientific: Consulting Fee:, Grunenthal: Speakers Bureau:, Pfizer: Speakers Bureau:, Ashish Gulve, FRCA, FFPMRCA, FFPMCAI, DPMed, FCARCSI, MD, MBBS: None, Ganesan Baranidharan, FRCA: None, Sam ELDABE, MD, FRCA, FFPMRCA: Medtronic: Consulting Fee:, Medtronic: Contracted Research:, Mainstay Medical: Consulting Fee:, Saluda Medical: Consulting Fee:, Boston Scientific: Contracted Research:, Saluda Medical: Contracted Research:, James Fitzgerald, MA,PhD: St Jude Medical: Consultant: Self, Medtronic: Consulting Fee:, UCB: Contracted Research:, Merck: Contracted Research:, Serge Nikolic, MD: None, Stana Bojanic, BSc MBBS FRCS (SN): Abbott: Contracted Research:, Habib Ellamushi: None, Paresh Doshi, MS MCh: None, Preeti Doshi, MBBS, MD, FRCA: None, Babita Ghai, MBBS, MD, DNB: None, Marc Russo, MD: Presidio Medical: Ownership Interest:, Saluda Medical: Ownership Interest:, Boston Scientific: Contracted Research: Self, Mainstay Medical: Contracted Research: Self, Medtronic: Contracted Research: Self, Nevro: Contracted Research: Self, Saluda Medical: Contracted Research: Self, Presidio Medical: Contracted Research: Self, Freedom Ne ro: Ownership Interest - Own Stocks: Self, Lungpacer: Ownership Interest - Own Stocks: Self, SPR Therapeutics: Ownership Interest - Own Stocks: Self, Lawrence Poree, MD,MPH,PHD: Medtronic: Consulting Fee: Self, Saluda Medical: Contracted Research: Family, Nalu Medical: Contracted Research: Family, Gimer Medical: Consulting Fee: Self, Nalu Medical: Consulting Fee: Self, Saluda Medical: Consulting Fee: Self, Nalu: Ownership Interest:, Saluda Inc: Ownership Interest:, Alia Ahmad: None, Alaa Abd Sayed, MD: Medtronic, Abbott, SPR and StimWave: Consulting Fee:, Salim Hayek, MD,PhD: None, CHRISTOPHER GILLIGAN, MD MBA: Persica: Consulting Fee: Self, Saluda: Consulting Fee: Self, Mainstay Medical: Contracted Research: Self, Sollis Therapeutics: Contracted Research: Self, Iliad Lifesciences, LLC: Owner: individuals with legal ownership in a company:, Vivek Mehta: NoneCopyright © 2023
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Given that cyber security underwrites public trust in digital services and technologies, the new cyber strategy sets out a vision for reducing the cyber security risk to health and social care organizations across the Department of Health and Social Care (DHSC), National Health Service (NHS) organizations, local authorities, independent social care providers, and suppliers-which includes pharmaceutical manufacturers. [...]attacks can cause a complete loss of access to clinical and administrative information technology (IT) systems, resulting in significant disruption in day-to-day operations. According to the NCSC, ransomware attacks are increasingly seen to include data theft and extortion with a threat of data leaks (3). According to the UK government's recently published policy paper outlining the new cyber security strategy, "all these threats pose risk not just to patient and staff safety, but also to public trust in a health and social care system that can and must safeguard people's data" (2).
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The most common non-Hodgkin's lymphoma (NHL) is diffuse large B-cell lymphoma (DLBCL), an aggressive lymphoma that can be cured with standard frontline chemo-immunotherapy in 60%-70% of patients but with historically poor outcomes for relapsed/refractory disease. Patients with relapsed DLBCL after autologous stem cell transplant (ASCT) or with chemotherapy-refractory disease have a particularly dismal prognosis, with a median overall survival (OS) of only 6 months. Chimeric antigen receptor (CAR) T-cell therapy has significantly improved outcomes for patients with relapsed/refractory large B-cell lymphoma, mantle cell lymphoma and follicular lymphoma, with multiple FDA approved CAR T products now commercially available in many developed world including European countries. Ongoing studies seek to move CAR T cells to earlier lines of therapy and to characterise the efficacy and safety of CAR T-cell approaches in additional lymphoma histologies including relapsed/refractory follicular lymphoma and chronic lymphocytic leukaemias. Other areas of active research address CAR T in combination with other lymphoma-directed therapies, and mechanisms of CAR T resistance. We conducted a retrospective observational study assessing the outcomes of patients referred to our tertiary centre, University College London hospital NHS foundation Trust (UCLH) from January 2018 to December 2022, over a 48-month period. We collected data including patients' demographics, types of lymphomas, prior lines of therapies including stem cell transplantation, bridging therapies as appropriate, complications and overall response rate. We also analysed the communication between teams during the challenging period of the COVID-19 pandemic.
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As the COVID-19 pandemic swept across the United States, the media began reporting stories of people leaving cities for rural destinations, setting off frenzied real estate activity in receiving communities. This article builds a case study of New England using nonconventional data collected from mobile devices as a proxy for population to explore the temporal and spatial patterns of movement down the urban hierarchy since the onset of the COVID-19 pandemic. Two research questions guide the analysis: (1) How have urban–rural migration systems in New England shifted since the onset of the COVID-19 pandemic? (2) In what ways have real estate markets been affected by these apparent migration shifts? The analysis reveals shifts of population away from metropolitan core areas of the region and into micropolitan and noncore counties. These population shifts were most pronounced in late summer and fall 2020 with loosening travel restrictions. By the end of 2020, migration systems in New England once more resembled prepandemic patterns. Further, these places down the urban hierarchy consistently showed more substantial increases in real estate activity as reflected in rising prices, reduced inventories, and increased sales volume. These real estate dynamics suggest urban to rural migration during the COVID-19 pandemic might be initiating new waves of rural gentrification. (English) [ FROM AUTHOR] A medida que la pandemia del COVID-19 afectó por todo lado los Estados Unidos, los medios empezaron a informar sobre historias de gente que dejaban atrás las ciudades por destinos rurales, desencadenando una frenética actividad inmobiliaria en las comunidades receptoras. Este artículo construye un estudio de caso de Nueva Inglaterra, usando datos no convencionales recogidos de dispositivos móviles, como un proxy por la población para explorar los patrones temporales y espaciales del movimiento descendente desde la jerarquía urbana a partir de la aparición de la pandemia del COVID-19. El análisis se guía por dos preguntas de investigación: (1) ¿Cómo han cambiado los sistemas de migración ciudad–campo en Nueva Inglaterra desde el comienzo de la pandemia del COVID-19? (2) ¿De qué manera se han visto afectados los mercados inmobiliarios por estos cambios aparentes de migración? El análisis revela desplazamientos de población fuera de las áreas del núcleo metropolitano de la región hacia condados micropolitanos y no nucleados. (Spanish) [ FROM AUTHOR] 随着COVID-19流行病席卷美国, 媒体开始报道人们离开城市前往农村、在农村引发疯狂的房地产活动。本文构建了美国新英格兰地区（New England）案例, 使用来自移动设备的非常规数据替代人口数据, 探索了COVID-19流行病发生以来由城市迁移到农村的时空模式。研究分析了两个问题：（1）自COVID-19发生以来, 新英格兰地区的城乡迁移体系如何变化？（2）这些显著的迁移变化, 对房地产市场产生了哪些影响？分析表明, 人口从新英格兰大都市核心区域迁移到小城镇和非核心县。随着旅行限制的放松, 人口迁移在2020年夏末和秋季最为显著。到2020年底, 新英格兰地区的迁移体系, 再次呈现出类似于COVID-19之前的模式。处于城市等级体系底层的地区, 房地产活动持续大幅增长, 这反映在价格上涨、库存减少和销售量增加。房地产变化表明, 在COVID-19流行病期间, 城市到农村迁移可能会引发新一轮的农村中产阶级化。 (Chinese) [ FROM AUTHOR] Copyright of Professional Geographer is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
The coronavirus pandemic is a global health emergency which has had widespread unforeseen mental health consequences. Those with borderline personality disorder are predisposed to poor coping strategies to manage such stress and require intense psychological input which was not widely available during the peak of the pandemic. It is likely that the coronavirus outbreak has had a significant impact on the mental stability of such patients aggravating deliberate self-harm behaviours. A 20-year old psychiatric in-patient with borderline personality disorder, held under Section III of the mental health act, presented to the adult plastic surgery team in Bristol with localised infection of her right forearm. Foreign bodies were easily palpable and imaging revealed linear metal objects. The patient reported that she had removed metal strips from her collection of face masks and inserted them into her forearm as an act of deliberate self-harm. The patient was taken to operating theatre for removal of these foreign bodies under general anaesthetic. After twenty-four hours of antibiotics she was discharged safely back to the psychiatric ward. Despite the epilogue of the COVID-19 pandemic facemasks are still mandatory within the hospital setting. Clinicians need to be aware of these unusual circumstances where a form of protective equipment was deconstructed to cause actual bodily harm. The purpose of this report is to promote awareness of this type of injury especially in those suffering from mental illness. The authors would suggest an alternative mask without any form of metal.
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Objectives: 1) What is the SARS-CoV-2 virus?2) How has the COVID-19 pandemic affected cardiac surgery globally?3) How did a leading cardiac surgery centre in England cope and endure the pandemic?4) What suggestions have been looked into for future planning and service protection? Methods: In this report, the tangible effect withstood by this cardiac surgery service was assessed by analysing data collected in the fashion of an audit from four different time points: Pre-COVID, England's 1st Peak, England's 2nd Peak and the Present Day. Parameters included: total surgeries conducted, cancellations, cancellations due to a shortage of cardiothoracic critical care unit (CTCCU) beds and weekly averages for the aforementioned. Result(s): Results showed a significant drop in surgical output during the first peak (79.6% decreased output from Pre-COVID) and a large increase in cancellations both generally (from 25.1% to 28.2%) and due to CTCCU bed shortage (from 36.2% to 45.5%). However, a strong comeback was seen during the second peak (47.8% decreased output from Pre- COVID and 2.4% fewer cancellations), and an almost complete optimisation of service was observed in the Present day (45.1% increased output from Pre-COVID and 8.9% fewer cancellations). Conclusion(s): This trust's cardiac surgery service has adapted immensely;this audit has reported the list of measures taken to achieve this and the recommendations to achieve future surgical optimisation. The Trust managed to optimise its service and outperformed itself both from Pre- COVID and internationally. With further refining using PLECS and Canadian Society of Cardiac Surgeons guidance, full optimisation is feasible.
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NHS England Genomics introduced whole genome sequencing (WGS) with standard-of- care (SoC) genetic testing for haemato-oncology patients who meet eligibility criteria, including patients with acute leukaemia across all ages, and exhausted SoC testing. Alongside, the role of germline mutations in haematological cancers is becoming increasingly recognised. DNA samples are required from the malignant cells (somatic sample) via a bone marrow aspirate, and from non-malignant cells (germline sample) for comparator analysis. Skin biopsy is considered the gold-standard tissue to provide a source of fibroblast DNA for germline analysis. Performing skin punch biopsies is not within the traditional skillset for haematology teams and upskilling is necessary to deliver WGS/germline testing safely, independently and sustainably. A teaching programme was designed and piloted by the dermatology and haematology teams in Sheffield and delivered throughout the NHS trusts in North East & Yorkshire Genomic Laboratory Hub. The training programme consisted of a 90-min session, slides, video and practical biopsy on pork belly or synthetic skin, designed to teach up to six students at one time. To disseminate best practice, the standard operating procedure and patient information used routinely in Sheffield were shared, to be adapted for local service delivery. From January 2021 to December 2022, 136 haematology staff from 11 hospitals, including 34 consultants, 41 registrars, 34 nurses and 8 physician associates, across the NEY GLH region completed the skin biopsy training programme. Feedback from the course was outstanding, with consistently high scores in all categories. Practical components of the course were especially valued;98.6% (71/72) trainees scored the practical element of the programme a top score of 5 out of 5, highlighting that despite the challenges of delivering face-to- face teaching due to COVID-19, teaching of practical skills was highly valued;training in this way could not have been replicated virtually. Costs of the programme have been approximately 16 000, including consultant input and teaching/educational materials. Recent support has been provided by a separately funded Genomic Nurse Practitioner (GNP), with succession planning for the GNP to take over leadership from the consultant dermatologist. Plans are in place to use the remaining budget to disseminate the programme nationally. Our training programme has shown that skin biopsy can be formally embedded into training for haematology consultants, trainees, nursing team, and physician associates. Delivery of training can be effective and affordable across regional GLHs with appropriate leadership and inter-speciality coordination, and ultimately sustainable with specialist nursing staff, including GNPs.