scholarly journals A seven week observational analysis of clinical activities in a North Italian orthopaedic hospital during the second wave of SARS-CoV-2 pandemic: far from usual volumes, but different from the first wave

2021 ◽  
Author(s):  
Luigi Zagra ◽  
Martina Faraldi ◽  
Mauro Andreata ◽  
Immacolata Ottaiano ◽  
Giuseppe Basile ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Health Service ◽  
Elective Surgery ◽  
Activity Levels ◽  
Hospital Budget ◽  
Observational Analysis ◽  
Orthopaedic Hospital ◽  
Second Wave ◽  
Acute Admissions

Abstract Purpose We previously described the radical changes occurred in an orthopaedic hospital in Milan (Italy) during the first SARS-CoV-2 pandemic outbreak. Currently, during the second wave, the situation is still far from normality. Here we describe the changes that took place, and are still ongoing, in the clinical practice. Methods Number and type of admissions, outpatients activity, ER and urgent procedures in SARS-CoV-2 negative and positive patients have been analyzed over seven weeks (October 26th–December 13th, 2020) and compared with the correspondent period in 2019 and the same timeframe during the first wave (February 24th–April 10th). Results 2019 vs. 2020: Overall admissions decreased by 39.8%; however, while admissions for elective surgery dropped by 42.0%, urgent surgeries increased by 117.0%. Rehabilitation admissions declined by 85.2%. White and green priority ER consultations declined by 41.6% and 52.0%, respectively; yellow and red increased by 766.7% and 400.0%, respectively. Second vs. first wave: Overall admissions increased by 58.6% with a smoother decrement in weekly admissions than during the first wave. Disparity of acute admissions vs. rehabilitation expanded: Acute cases increased by 63.6% while rehabilitation cases decreased by 8.7%. Admissions to triage procedures increased by 72.3%. Conclusions Activity levels are far from normality during the second COVID-19 wave. Elective surgery and outpatients-related activities are still strongly limited compared to 2019 while the number of urgent cases treated increased consistently. SARS-CoV-2 positive emergencies are slightly higher than during the first wave. These important changes are expected to impact on health service and hospital budget for long.

scholarly journals Impact of COVID-19 lockdowns on hospital presentations and admissions in the context of low community transmission: evidence from time series analysis in Melbourne, Australia

2021 ◽  
pp. jech-2021-217010
Author(s):  
Taya A Collyer ◽  
George Athanasopoulos ◽  
Velandai Srikanth ◽  
Ravindranath Tiruvoipati ◽  
Chris Matthews ◽  
...  
Keyword(s):  
Health Service ◽  
Catchment Area ◽  
Historical Data ◽  
Forecasting Methods ◽  
Triage Category ◽  
Life Threatening ◽  
Community Transmission ◽  
The Impact ◽  
Second Wave ◽  
Acute Admissions

BackgroundMelbourne, Australia, successfully halted exponential transmission of COVID-19 via two strict lockdowns during 2020. The impact of such restrictions on healthcare-seeking behaviour is not comprehensively understood, but is of global importance. We explore the impact of the COVID-19 pandemic on acute, subacute and emergency department (ED) presentations/admissions within a tertiary, metropolitan health service in Melbourne, Australia, over two waves of community transmission (1 March to 20 September 2020).MethodsWe used 4 years of historical data and novel forecasting methods to predict counterfactual hospital activity for 2020, assuming absence of COVID-19. Observed activity was compared with forecasts overall, by age, triage category and for myocardial infarction and stroke. Data were analysed for all patients residing in the health service catchment area presenting between 4 January 2016 and 20 September 2020.ResultsED presentations (n=401 805), acute admissions (n=371 723) and subacute admissions (n=15 676) were analysed. Substantial departures from forecasted presentation levels were observed during both waves in the ED and acute settings, and during the second wave in subacute. Reductions were most marked among those aged >80 and <18 years. Presentations persisted at expected levels for urgent conditions, and ED triage categories 1 and 5, with clear reductions in categories 2–4.ConclusionsOur analyses suggest citizens were willing and able to present with life-threatening conditions during Melbourne’s lockdowns, and that switching to telemedicine did not cause widespread spill-over from primary care into ED. During a pandemic, lockdowns may not inhibit appropriate hospital attendance where rates of infectious disease are low.

scholarly journals The myth of pre-operative isolation during the COVID-19 pandemic

2021 ◽  
Vol 104 (3) ◽  
pp. 003685042110261
Author(s):  
Filip Mijovic ◽  
Stuart James ◽  
Bindhiya Thomas ◽  
Mohit Bhatia ◽  
Guillaume Lafaurie ◽  
...  
Keyword(s):  
Mental Health ◽  
Adverse Effect ◽  
Patient Satisfaction ◽  
National Health Service ◽  
Patient Adherence ◽  
Elective Surgery ◽  
University Hospital ◽  
Evidence Based ◽  
Retrospective Data ◽  
Second Wave

The SARS-CoV-2 (COVID-19) pandemic called for the restructuring of National Health Service (NHS) surgical departments across the country. Initial guidance advised that patients undergoing elective surgery isolate for 14 days prior to their operation. As we learnt more about COVID-19 and its incubation period, at the Princess Royal University Hospital this guidance has been decreased to 72 h. We collected retrospective data for two patient cohorts that underwent elective surgery in June and September 2020, isolating for 14 days and 72 h, respectively. We followed-up these patients with several questions allowing us to categorise the cohorts into three groups based on their compliance with isolation measures and also to assess their satisfaction with the isolation process. Our data shows that only 16% of the June cohort and 53% of the September cohort isolated in accordance with the guidelines whilst patient satisfaction was 16% and 64% respectively. These results highlight a suboptimal compliance to pre-operative guidelines as well as an adverse effect on patient mental health and raise the issue of both patient and NHS staff safety. With the possibility of a COVID-19 second wave and for future pandemics, a clear evidence-based plan for pre-operative isolation is vital. Furthermore, consideration of patient adherence and satisfaction is key in deciding which guideline will be most effective.

scholarly journals Changing radiotherapy review practice in response to COVID-19 in a radiotherapy satellite centre

2020 ◽  
Vol 19 (4) ◽  
pp. 312-314
Author(s):  
Tracy Mason ◽  
Rachael Bennett ◽  
Alison White ◽  
Agata Rembielak
Keyword(s):  
Clinical Practice ◽  
Infection Risk ◽  
Risk Of Infection ◽  
Optimal Care ◽  
Delivery Of Care ◽  
Safe Delivery ◽  
Satellite Centre ◽  
The World ◽  
Second Wave ◽  
Insight Into

AbstractBackground:The COVID-19 pandemic has required a rapid and evolving response in order to enable the continued delivery of radiotherapy, whilst effectively managing the risk of infection to patients and staff. In early March 2020, we were presented with the challenge of achieving safe delivery of care in clinical practice for a group of patients that are already at higher risk of morbidity from COVID-19 with only limited guidance.Purpose:This article outlines the adjustments made at The Christie at Oldham satellite centre in order to promote optimal care to our patients receiving radiotherapy, and to mitigate infection risk at the department for both patients and staff.Materials and Methods:We share insight into some of the evolving processes that our team have developed since March 2020 in promoting optimal care to patients receiving radiotherapy at The Christie at Oldham satellite centre. These include changes to the department floor, paper flow, supportive care and staffing.Results and Conclusions:As we continue to progress through this pandemic, we accept that there will be an ongoing journey of learning with adjustments to practice and evolving ‘new norm’, thereby ensuring we keep our patients and team safe and well. We also hoped that our experience would support radiotherapy-related practices in surges of the pandemic in other parts of the world or in case of the second wave.

scholarly journals COVID ‐19 Risk in Elective Surgery during a Second Wave: a Prospective Cohort Study

2020 ◽  
Author(s):  
Paul S Myles ◽  
Sophie Wallace ◽  
David A Story ◽  
Wendy Brown ◽  
Allen C Cheng ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Elective Surgery ◽  
Second Wave

scholarly journals Recommendations for 24-Hour Movement Behaviours in Adults with Asthma: A Review of Current Guidelines

2020 ◽  
Vol 17 (5) ◽  
pp. 1789
Author(s):  
Shilpa Dogra ◽  
Ilana Patlan ◽  
Carley O’Neill ◽  
Hayley Lewthwaite
Keyword(s):  
Physical Activity ◽  
Clinical Practice ◽  
General Population ◽  
Sedentary Behaviour ◽  
Healthcare Professionals ◽  
Activity Levels ◽  
Movement Behaviour ◽  
Asthma Care ◽  
Future Work ◽  
Current Guidelines

Background: Many countries have clinical practice guidelines (CPG) for asthma that serve as an important resource for healthcare professionals and inform the development of policies and practices relevant to asthma care. The purpose of this scoping review was to search for CPGs related to asthma to determine what recommendations related to the 24-h movement behaviours are provided. Methods: We searched for the most recent CPGs published by a national authoritative body from 195 countries. Guidelines were reviewed for all movement behaviours; that is, physical activity, sedentary behaviour, and sleep. Results: In total, 82 documents were searched for eligibility and 19 were included in our review. Of these, only 10 CPGs provided information on physical activity; none provided recommendations consistent with the FITT principle, while seven recommended activity levels similar to the general population. None of the guidelines included information on sedentary behaviour. Nine guidelines included information on sleep: recommendations mostly focused on changes to medication to reduce disruptions in sleep. Conclusions: It is recommended that future work be conducted to create comprehensive movement behaviour guidelines accompanied with relevant precautions and strategies to ensure that adults with asthma are able to safely and effectively engage in movement behaviours throughout the day.

Validation of the Security Needs Assessment Profile (SNAP) by a national survey of secure units in England

2012 ◽  
Vol 36 (10) ◽  
pp. 366-371 ◽  
Author(s):  
Steffan Davies ◽  
Mick Collins ◽  
Chris Ashwell
Keyword(s):  
Clinical Practice ◽  
National Health Service ◽  
Health Service ◽  
Needs Assessment ◽  
National Health ◽  
National Survey ◽  
Content Validity ◽  
Security Requirements ◽  
Clinical Implications

Aims and methodThe Security Needs Assessment Profile (SNAP) was developed to provide a detailed description of individual patient's security requirements in the then Trent Region of England. A national survey of secure units was undertaken to examine the content validity of the item structure of SNAP and revise the item definitions to reflect more broadly based clinical practice. A follow-up survey sought views on the usefulness of SNAP in clinical practice.ResultsThirty-five secure units from National Health Service and independent sector providers participated. No new security items were generated. All the item definitions were reviewed, many amended, and a small number revised extensively. Units' security profiles were rated on the original and revised instruments.Clinical implicationsThe revised SNAP has been shown to be generalisable across secure services in England; 92% of respondents agreed or strongly agreed that SNAP would be useful in providing a structured security needs assessment.

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