scholarly journals 1358 Does A COVID Protected Hospital Within A COVID Hospital Enable Elective Care and Training Opportunities?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Rashid ◽  
T Gala ◽  
Q Ain ◽  
H Ashraf ◽  
S Vesamia ◽  
...  
Keyword(s):  
Critical Care ◽  
Training Environment ◽  
Informatics System ◽  
Surgical Trainees ◽  
Business Informatics ◽  
The Uk ◽  
The Impact ◽  
Second Wave ◽  
Training Opportunities ◽  
And Training

Abstract Introduction Elective care in the UK came to a standstill with the advent of the COVID-19 pandemic. A restart could only be enabled with ‘green site’ separation and a ‘covid protected’ zone. A ‘hospital within the hospital’ concept was developed including 9 elective theatres, 28 ring fenced elective beds, a surgical enhanced care unit, a canteen, and a separated entrance. This model was underpinned with PPE, enhanced infection control and guidance for staff. The study documented the ability to recover elective activity and therefore provide a training environment for surgical trainees. Method Data was collected weekly (7/20 to 1/21) through the business informatics system with regard to theatres cases completed compared to the activity achieved in the 11-theatre elective estate pre COVID-19. Results Pre COVID-19, an average of 263 cases were completed per week. In the first week of operation, 31% of theatre capacity was achieved. By week 7, 106% of pre COVID was recorded and 130% by week 11. This was maintained until the impact of the second wave where activity has reduced to 50% but is not anticipated to reduce further as local anaesthetic and blocks maybe utilised. Conclusions This ‘hospital within the hospital’ has enabled elective care to return to above normal levels, with increased efficiencies. This has enabled a rapid return to a training environment for trainees disheartened with deployment to critical care in the first wave.

scholarly journals TP8.2.10 Impact of COVID-19 on General Surgery Training in a University Hospital with Ring Fenced Elective Centre

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Tanzeela Gala ◽  
Quratul Ain ◽  
Chekwas Obasi ◽  
Hajar Rashid ◽  
Sarkhell Radha ◽  
...  
Keyword(s):  
General Surgery ◽  
Normal Activity ◽  
University Hospital ◽  
Surgical Trainees ◽  
Higher Surgical Training ◽  
Theatre Utilisation ◽  
The Impact ◽  
Second Wave ◽  
Training Opportunities ◽  
General Surgery Training

Abstract Aim Higher Surgical training was decimated by the COVID-19 pandemic with cessation of elective care. Trainees raised concerns that the elective restart and need for higher theatre activity to clear backlogs would impact on training opportunities. This study evaluated the resumption of training associated with a ring-fenced elective centre (EC). Methods The EC was established in July 2020 and three time periods were determined: pre-COVID (10/19-2/20), 1st wave of COVID (3/20-7/20) and post EC go-live (8/20-12/20). Data was collated from the E-Logbooks of General Surgery Registrars. Results The normal all-speciality pre COVID theatre-activity averaged 1052 cases/month. During the first wave elective activity decreased to 254 cases/month (24% of normal activity). Within 5 weeks of establishment of the EC, theatre activity was near normal despite a reduced number of theatres (with higher theatre utilisation). Pre COVID, trainees accessed 22.9 cases per month which then dropped to 7.7 cases during the first wave of COVID. Post the go live of the EC, trainees were able to operate on 20 cases per month almost back to normal training levels. Prior to the impact of the second wave, each trainee had developed a deficit of 90 cases during the 5 months pause. Conclusion The ring-fenced elective centre has protected training opportunities for higher surgical trainees. However, the pause in training requires a targeted training recovery plan to overcome the deficit secondary to the first and subsequent waves of COVID to ensure that the JCST target of 1200 cases can be met for CCT.

scholarly journals The impact of the COVID-19 lockdown on orthopaedic emergency presentations in a remote and rural population

2020 ◽  
Vol 1 (10) ◽  
pp. 621-627
Author(s):  
Ahmed S. Elhalawany ◽  
James Beastall ◽  
Gerard Cousins
Keyword(s):  
Healthcare Providers ◽  
Local Area ◽  
Time Frame ◽  
Healthcare Provision ◽  
Proportional Increase ◽  
Minor Injuries ◽  
The Uk ◽  
A Minor ◽  
The Impact ◽  
Second Wave

Aims COVID-19 remains the major focus of healthcare provision. Managing orthopaedic emergencies effectively, while at the same time protecting patients and staff, remains a challenge. We explore how the UK lockdown affected the rate, distribution, and type of orthopaedic emergency department (ED) presentations, using the same period in 2019 as reference. This article discusses considerations for the ED and trauma wards to help to maintain the safety of patients and healthcare providers with an emphasis on more remote geography. Methods The study was conducted from 23 March 2020 to 5 May 2020 during the full lockdown period (2020 group) and compared to the same time frame in 2019 (2019 group). Included are all patients who attended the ED at Raigmore Hospital during this period from both the local area and tertiary referral from throughout the UK Highlands. Data was collected and analyzed through the ED Information System (EDIS) as well as ward and theatre records. Results A total of 1,978 patients presented to the ED during the lockdown period, compared to 4,777 patients in the same timeframe in 2019; a reduction of 58.6%. Orthopaedic presentations in 2020 and 2019 were 736 (37.2%) and 1,729 (36.2%) respectively, representing a 57.4% reduction. During the lockdown, 43.6% of operations were major procedures (n = 48) and 56.4% were minor procedures (n = 62), representing a significant proportional shift. Conclusion During the COVID- 19 lockdown period there was a significant reduction in ED attendances and orthopaedic presentations compared to 2019. We also observed that there was a proportional increase in fractures in elderly patients and in minor injuries requiring surgery. These represented the majority of the orthopaedic workload during the lockdown period of 2020. Given this shift towards smaller surgical procedures, we suggest that access to a minor operating theatre in or close to ED would be desirable in the event of a second wave or future crisis.

scholarly journals Vascular Access Support Team: A Multi-Disciplinary Response to Optimise Patients’ Care during COVID-19 Pandemic

2020 ◽  
Author(s):  
Manish Sinha ◽  
Prakash Saha ◽  
Melhem Nabil ◽  
Nicos Kessaris ◽  
Lukla Biasi ◽  
...  
Keyword(s):  
Critical Care ◽  
Clinical Outcomes ◽  
Vascular Access ◽  
Online Survey ◽  
High Rate ◽  
Minor Bleeding ◽  
Complication Rates ◽  
Support Team ◽  
The Uk ◽  
The Impact

Abstract Background: Vascular access support teams have been set up to help offload procedural tasks from critical care teams during the coronavirus disease 2019 (COVID-19) global pandemic. However, the impact of VAST on clinical outcomes and on workload has not been shown previously with no reports to date from the UK. Our aim was to evaluate clinical outcomes of a multidisciplinary vascular access support team (VAST) and the value of the service to critical care teams. Methods: Prospectively collected data on all patients requiring vascular access at St Thomas’ Hospital, London over a 5-week period during the first wave of the pandemic in the UK. At the end of study period, online anonymised questionnaire administered to critical care team members, including nursing and medical professionals, to evaluate their experience of the service. We report access-related complication until discharge from centre and description of results of online survey.Results: 122 patients aged 52.1 ± 13 years with high rate of pre-existing co-morbidities, underwent line insertion including 190 catheters (central venous n=182, arterial n=8). Median (range) number of 5 (0-17) lines were placed per day in patients of whom 90% tested positive for Severe Acute Respiratory Syndrome Coronavirus-type 2 pathogen (SARS-CoV-2). A single line (n=146) was inserted in 96 out of 122 patients (78.7%) and n=18 patients (14.7%) ‘double puncture’ technique used. 45 line insertions (24%) had complications with minor [bleeding (n=19), line infection (n=10)] and 2 lines (1%) with major complication. The survey respondents, n=54 professionals, highlighted ease of referral and timely access placement (>90% responses); with agreement that VAST service saved them precious time and allow them to focus on other jobs.Conclusions: We describe the successful deployment of a multidisciplinary vascular access team with low complication rates and high rates of satisfaction. We recommend similar models can be considered by health services to optimise patient care and ICU management.

scholarly journals The Manchester advanced course in liaison psychiatry

1996 ◽  
Vol 20 (12) ◽  
pp. 736-737
Author(s):  
Alison Puffett ◽  
Bill Williams
Keyword(s):  
Training Programme ◽  
Management Skills ◽  
Case Discussion ◽  
Liaison Psychiatry ◽  
Hospital Patients ◽  
Specialist Knowledge ◽  
The Uk ◽  
Supervision And Training ◽  
Training Opportunities ◽  
And Training

Liaison psychiatry is a relatively new and expanding speciality in the UK. A survey conducted in 1990 revealed widespread inadequacies in the training opportunities and resources in consultation liaison services (Mayou et al, 1990). In spite of a growing recognition of the need for more consultants with designated responsibility for general hospital patients, there is currently no formal training programme and many psychiatric schemes fail to provide satisfactory supervision and training opportunities in liaison psychiatry (House & Creed, 1993). The Manchester University liaison psychiatry course was developed in 1993 and is currently the only advanced liaison training course in the UK. Lasting five days, it provides an opportunity for senior psychiatric trainees to improve their specialist knowledge and to develop clinical, research and management skills in liaison psychiatry. The course does not give a comprehensive review of all aspects of liaison psychiatry but aims to generate ideas and discussion through skills based seminars, case discussion and workshop exercises.

scholarly journals Lessons for intensive care units in COVID-19 pandemic-moving towards sustainability

2020 ◽  
Vol 7 (3) ◽  
pp. 1
Author(s):  
Prashant Nasa ◽  
Ruchi Nasa ◽  
Aanchal Singh
Keyword(s):  
Critical Care ◽  
Supply Chain ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Standard Of Care ◽  
Infrastructure Development ◽  
Care Providers ◽  
Care Services ◽  
Second Wave ◽  
And Training

The Coronavirus disease-2019 (COVID-19) pandemic has inundated critical care services globally. The intensive care units (ICUs) and critical care providers have been forefront of this pandemic, evolving continuously from experiences and emerging evidence. In this review, we discuss the key lessons from the ongoing wave of COVID-19 pandemic and preparations for a future surge or second wave. The model of sustainable critical care services should be based on 1) infrastructure development, 2) preparation and training of manpower, 3) implementing standard of care and infection control, 4) sustained supply-chain and finally, and 5) surge planning. 

scholarly journals Predictions of COVID-19 dynamics in the UK: Short-term forecasting and analysis of potential exit strategies

2021 ◽  
Vol 17 (1) ◽  
pp. e1008619
Author(s):  
Matt J. Keeling ◽  
Edward M. Hill ◽  
Erin E. Gorsich ◽  
Bridget Penman ◽  
Glen Guyver-Fletcher ◽  
...  
Keyword(s):  
Critical Care ◽  
Health Service ◽  
Age Groups ◽  
Transmission Model ◽  
Bed Occupancy ◽  
Time Data ◽  
Social Distancing ◽  
Number Of Patients ◽  
The Uk ◽  
The Impact

Efforts to suppress transmission of SARS-CoV-2 in the UK have seen non-pharmaceutical interventions being invoked. The most severe measures to date include all restaurants, pubs and cafes being ordered to close on 20th March, followed by a “stay at home” order on the 23rd March and the closure of all non-essential retail outlets for an indefinite period. Government agencies are presently analysing how best to develop an exit strategy from these measures and to determine how the epidemic may progress once measures are lifted. Mathematical models are currently providing short and long term forecasts regarding the future course of the COVID-19 outbreak in the UK to support evidence-based policymaking. We present a deterministic, age-structured transmission model that uses real-time data on confirmed cases requiring hospital care and mortality to provide up-to-date predictions on epidemic spread in ten regions of the UK. The model captures a range of age-dependent heterogeneities, reduced transmission from asymptomatic infections and produces a good fit to the key epidemic features over time. We simulated a suite of scenarios to assess the impact of differing approaches to relaxing social distancing measures from 7th May 2020 on the estimated number of patients requiring inpatient and critical care treatment, and deaths. With regard to future epidemic outcomes, we investigated the impact of reducing compliance, ongoing shielding of elder age groups, reapplying stringent social distancing measures using region based triggers and the role of asymptomatic transmission. We find that significant relaxation of social distancing measures from 7th May onwards can lead to a rapid resurgence of COVID-19 disease and the health system being quickly overwhelmed by a sizeable, second epidemic wave. In all considered age-shielding based strategies, we projected serious demand on critical care resources during the course of the pandemic. The reintroduction and release of strict measures on a regional basis, based on ICU bed occupancy, results in a long epidemic tail, until the second half of 2021, but ensures that the health service is protected by reintroducing social distancing measures for all individuals in a region when required. Our work confirms the effectiveness of stringent non-pharmaceutical measures in March 2020 to suppress the epidemic. It also provides strong evidence to support the need for a cautious, measured approach to relaxation of lockdown measures, to protect the most vulnerable members of society and support the health service through subduing demand on hospital beds, in particular bed occupancy in intensive care units.

scholarly journals Influence of workshop attendance on management of pediatric fecal incontinence in Nigeria

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Taiwo Akeem Lawal
Keyword(s):  
Fecal Incontinence ◽  
Management Practices ◽  
Postgraduate Training ◽  
Surgical Care ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Past ◽  
The Impact ◽  
Training Opportunities ◽  
And Training

Abstract Background The care of children with fecal incontinence is suboptimal with inadequate support and training opportunities. The postgraduate training of pediatric surgeons on the management of fecal incontinence is inadequate since each training center is not likely to see enough number of cases yearly. Supplemental training through workshops on fecal incontinence may help to bridge the gap. The aim of this cross sectional study was to evaluate the impact of previous attendance of a workshop on fecal incontinence management practices among pediatric surgeons. Results A total of 41 respondents participated. Eleven (26.8%) respondents had attended a workshop in the past and seven (17.1%) had done a Malone antegrade continent enema (MACE) on patients. A higher proportion of respondents who had practiced for over 15 years had attended a workshop on fecal incontinence compared to those who had not attended one (90.9% vs. 33.3%, p = 0.001). The proportion of respondents who had attended a workshop on fecal incontinence and had performed a MACE (18.2%) was higher than the proportion of those who had not attended a workshop and had performed a similar procedure on patients (3.3%), p = 0.047. Conclusions One quarter of pediatric surgeons in the country surveyed had attended a workshop on fecal incontinence. Prior attendance of a workshop on fecal incontinence is significantly related to experience and significantly influenced the performance of a MACE procedure. Supplementation of the training of pediatric surgeons through workshops on fecal incontinence will help to improve capacity in pediatric colorectal surgical care.

The Impact of COVID-19 on dental education and training

Dental Update ◽  
2020 ◽  
Vol 47 (6) ◽  
pp. 527-528 ◽  
Author(s):  
Faye Doughty ◽  
Catherine Moshkun
Keyword(s):  
High Risk ◽  
Dental Care ◽  
Dental Education ◽  
Clinical Exposure ◽  
Close Proximity ◽  
Huge Impact ◽  
Training Programmes ◽  
The Uk ◽  
The Impact ◽  
And Training

COVID-19 has had a huge impact on dentistry. Dental care professionals work in close proximity with patients, they are therefore at high risk of contracting coronavirus. As of 25th March, all routine dentistry was postponed. The pandemic has led to clinic closures, university closures and postponement of exams and interviews. This has resulted in a deficit in clinical exposure for undergraduates and trainees. Changes in examination format have been implemented to prevent delays in course completions. The GDC have reassured that measures are being put in place to reduce the effect of COVID-19 on training. CPD/Clinical Relevance: This article aims to explore the impact of SARS-CoV-2 on dental education and dental training programmes in the UK.

Introduction

2021 ◽  
pp. 1-26
Author(s):  
Susan Nancarrow ◽  
Alan Borthwick
Keyword(s):  
British Empire ◽  
Allied Health ◽  
Industrial Revolution ◽  
Health Professions ◽  
Allied Health Professions ◽  
Meaningful Comparison ◽  
The Uk ◽  
The Impact ◽  
And Training ◽  
The Way

This chapter introduces how the book compares the allied health professions, both as a collective and as individual disciplines, in Australia and the UK. Australia and the UK were chosen as a basis for comparison because the allied health professions have emerged in each jurisdiction from similar philosophies, regulatory structures and training approaches, which allows meaningful comparison. The different funding and system contexts provide a comparative basis to understand the impact of different features on allied health professionalisation. It starts from the position of the similarities between the allied health contexts in both countries. Politically, neo-liberalism has been influential in driving the healthcare funding models and accountabilities in both nations, though different healthcare funding systems have facilitated varied flexibilities within the allied health workforces in each context. The modern allied health professions were heavily shaped by the formal organisation of labour that emerged within the colonies of the British Empire as a result of the Industrial Revolution. This book is largely focused on the way in which the allied health professions have emerged and developed within a Western context.

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