scholarly journals 1209 Effect Of COVID-19 On the Referral Base, Presentation, Treatment, And Immediate Outcome of Oral Cancer in An East Yorkshire Regional OMFS Head and Neck Unit. An Epidemiological Review Of 2019 vs 2020

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Gladwin ◽  
C O'Higgins ◽  
S Crank ◽  
K Mizen ◽  
J Philip
Keyword(s):  
Surgical Intervention ◽  
Tnm Staging ◽  
Initial Assessment ◽  
Adjunctive Treatment ◽  
Data Sets ◽  
Delayed Presentation ◽  
Healthcare Provision ◽  
Care Services ◽  
Primary Care Services ◽  
The Uk

Abstract Introduction The COVID-19 pandemic has drastically altered healthcare provision in primary and secondary care settings in the UK due to significant resources being prioritised for coronavirus care. Services have been affected at all levels of the referral ladder due to reductions and in some cases complete cancellation of face-to-face care. Throughout the pandemic the OMFS unit observed increasing numbers of patients with later stage oral malignant disease, therefore significantly more invasive surgical intervention, and reconstruction, associated with increased morbidity and mortality. Method This retrospective review collated data of all OMFS patients with oral squamous cell carcinomas requiring surgical intervention between the 23rd March and the 31st December 2019 compared with the same time period in 2020. Data collected included age, sex, time from referral to both 1st appointment and treatment, TNM staging, types of neck dissection and reconstruction, length of stay in hospital and any adjunctive treatment required. Results On comparison of the data sets, the 2020 cohort of patients had an overall later TNM staging result, with an increasing requirement for radical neck dissections and postoperative adjunctive treatment such as chemo/radiotherapy. The study found that on average, patients experienced a shorter waiting time from referral to initial assessment and commencement of treatment during the pandemic when compared to the previous year. Conclusions Overall, less patients were referred into hospital during period of the pandemic, however patients seen were diagnosed with significantly more advanced disease, this is likely attributed to reduced primary care services and delayed presentation.

scholarly journals 736. Delays in Malaria Recognition and Door to Anti-malarial Time in a South London Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S466-S466
Author(s):  
Nisha Patel ◽  
Tomasz Materski ◽  
Elisa Gonzalez ◽  
Solomon Russom ◽  
Gurjinder Sandhu
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Physician ◽  
African Countries ◽  
College Hospital ◽  
Travel History ◽  
Care Services ◽  
Primary Care Services ◽  
Sub Saharan ◽  
The Uk

Abstract Background The prompt recognition and treatment of Plasmodium falciparum is necessary to prevent death. We reviewed data from a cohort of patients presenting with malaria to Kings College Hospital NHS Trust, London. Methods Retrospective review of electronic records and drug charts of patients diagnosed with malaria from Jan 2019- March 2021. Results 109 cases of malaria were identified representing travellers from 11 Sub-Saharan African countries: Nigeria(38%), Sierra Leone(33%), Ivory Coast(10%). The age range varied from 4 to 76 years with a mean of 44, 66% of the cohort was male. 22 cases occurred during the COVID-19 Pandemic. The commonest symptoms were Fever (97%), Headache (92%) and malaise (72%). P. falciparum was present in 99% cases. A travel history was taken in 94% of cases. Malaria was considered by the first clinician in 82% of cases with the second highest differential being a viral illness. In 6 cases, it took 4 to 11 medical reviews before malaria was considered. 29 patients met the UK criteria for severe malaria. Door to antimalarial time varied from 1 to 128 hours, with a median of 7.4 hours. 46% of the cohort received intravenous Artesunate as their first antimalarial. Extreme delays occurred were clinicians did not consider malaria, patients had negative films or a patient did not declare a travel history when asked. 1 patient died of cerebral malaria with a door to needle time of 2hr 3min. Where a reason for delay is documented, drug availability represented the highest cause with mean delay from prescribing antimalarial to giving antimalarial of 2.7 hours. There was no difference in door to antimalarial administration during the COVID-19 Pandemic, but patients did have a delay in presentation to hospital from onset of symptoms, mean 6.2 days pre-pandemic, 10.5 days during pandemic, this was not statistically significant (P= 0.198). 3 patients presenting during the Pandemic had covid-19 swabs prior to admission and 10 had attended primary care services. Number of days between onset of malaria symptoms and presentation to the Emergency Department Box plot demonstrating that patients were waiting longer post symptom onset to access care in the Emergency Department. 3 patients had covid swabs in the community and 10 accessed care through their primary care physician. Conclusion Our data show that malaria is being considered early in the emergency department however there remain significant delays in administration of treatment. In 6 cases where malaria was not considered early there were delays in diagnosis of up to 5 days. An audit cycle will be completed with the aim of reducing door to antimalarial time. Disclosures All Authors: No reported disclosures

The impact of changes in service delivery in patients with colorectal cancer during the first peak of the COVID-19 pandemic.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 28-28
Author(s):  
Konstantinos Kamposioras ◽  
Kok Haw Jonathan Lim ◽  
Mark P. Saunders ◽  
Kalena Marti ◽  
Daniel Anderson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Service Delivery ◽  
Cancer Care ◽  
Well Being ◽  
Telephone Consultation ◽  
Care Services ◽  
The United Kingdom ◽  
Primary Care Services ◽  
The Uk ◽  
The Impact

28 Background: Increased levels of anxiety and distress in both patients and physicians have been reported in response to the significant impact COVID-19 has on cancer service delivery globally. We aimed to investigate how these changes have been perceived by patients diagnosed with colorectal cancer and identify determinants of increased anxiety. Methods: Survey (32-item) of consecutive patients diagnosed with colorectal cancer attending a large tertiary comprehensive cancer centre in the United Kingdom (18 May to 1 July 2020). Self-reported GAD-7 (both paper/electronic forms) was used as a screening tool for anxiety. Statistical analyses of associations:Chi-square, Fisher’s exact, and uni- and multi-variable analyses were performed using SPSS v19 and R. Results: A total of 143 patients (response rate 67%), 82% male, and median age of 61-70 years were included. Majority of patients had telephone consultation (78%), including 40% who had scan results discussed over the phone; with favourable feedback received with both respectively. Twenty-three patients (18%) were considered to have anxiety, with 7 (6%) scoring for moderate or severe anxiety. Three items asked patients if they had concerns about getting COVID-19, were worried that COVID-19 would have effect on mental health, and affect their experience of cancer care. Patients answering positively to any of these items were most likely to have anxiety; multivariate analysis – OR 2.361 (95% CI 1.187-4.694, p=0.014), 3.219 (95% CI 1.401-7.395, p=0.006) and 3.206 (95% CI 1.036-9.920, p=0.043), respectively. Majority of the patients did not feel that they needed support during the pandemic period and hence the available well-being services were not used. Patients felt that friends and family had been very supportive but less so the primary care services (p<0.05). However, they felt they were supported by the clinical team. Conclusions: At our centre, during the first-peak of COVID-19 pandemic in the UK, patients with colorectal cancer did not display increased rates of significant anxiety. The findings of this survey suggests that some service changes implemented, including increased telephone follow-up, may have already improved the overall experience of cancer care. Importantly, patients were much more concerned about their cancer treatment than COVID-19, emphasising the need to continue to provide comprehensive cancer care even if we get a “2nd wave” of COVID-19.

scholarly journals Mental health of regular and reserve military veterans

2009 ◽  
Vol 15 (2) ◽  
pp. 100-106 ◽  
Author(s):  
Amy C. Iversen ◽  
Neil Greenberg
Keyword(s):  
Mental Health ◽  
Treatment Options ◽  
Armed Forces ◽  
Health Issues ◽  
Post Traumatic Stress ◽  
Care Services ◽  
Primary Care Services ◽  
The Media ◽  
The Uk ◽  
Psychiatric Problems

SummaryThe psychiatric problems of combat returnees are a topical and important issue given the ongoing conflicts in Iraq and Afghanistan. Despite the media prominence afforded to post-traumatic stress disorder, the most common disorders in the UK armed forces post-deployment are depression, alcohol misuse and anxiety disorders. Although the majority of service personnel do well after leaving military life, a minority who leave with psychiatric problems appear to be at risk of social exclusion and ongoing ill health. Reserve veterans are at greater risk as they do not have access to the usual support networks of the regular military. Steps to improve the knowledge and expertise of primary care services about veterans' mental health issues and increasing the availability of treatment options are important and are underway.

scholarly journals Adapting primary care for new migrants: a formative assessment

BJGP Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. bjgpopen17X100701 ◽  
Author(s):  
Elizabeth Such ◽  
Elizabeth Walton ◽  
Brigitte Delaney ◽  
Janet Harris ◽  
Sarah Salway
Keyword(s):  
Primary Care ◽  
Case Studies ◽  
Online Survey ◽  
Resource Constraints ◽  
Sample Survey ◽  
Service Development ◽  
Care Provision ◽  
Care Services ◽  
Primary Care Services ◽  
The Uk

BackgroundImmigration rates have increased recently in the UK. Migrant patients may have particular needs that are inadequately met by existing primary care provision. In the absence of national guidance, local adaptations are emerging in response to these new demands.AimTo formatively assess the primary care services offered to new migrants and the ways in which practitioners and practices are adapting to meet need.Design & settingOnline survey and case studies of current practice across primary care in the UK. Case studies were selected from mainstream and specialist general practice as well as primary care provision in the third sector.MethodNon-probability sample survey of primary care practitioners (n = 70) with descriptive statistical analysis. Qualitative case studies (n = 8) selected purposively; in-depth exploration of organisational and practitioner adaptations to services. Analysis is structured around the principles of equitable care.ResultsSurvey results indicated that practitioners focused on working with communities and external agencies and adapting processes of, for example, screening, vaccination, and health checks. Lack of funding was cited most frequently as a barrier to service development (n = 51; 73%). Case studies highlighted the prominence partnership working and of an organisational and practitioner focus on equitable care. Adaptations centred on addressing wider social determinants, trauma, and violence, and additional individual needs; and on delivering culturally-competent care.ConclusionDespite significant resource constraints, some primary care services are adapting to the needs of new migrants. Many adapted approaches can be characterised as equity-oriented.

Sexually transmitted infections in primary care

2021 ◽  
Vol 14 (3) ◽  
pp. 168-174
Author(s):  
Harsha Dhokia
Keyword(s):  
Primary Care ◽  
Sexually Transmitted Infections ◽  
Sexually Transmitted ◽  
Care Services ◽  
Primary Care Services ◽  
Genitourinary Medicine ◽  
The Uk

Sexually transmitted infections (STIs) have often been managed in genitourinary medicine clinics. However, with increasing rates of STIs, more patients are now presenting to primary care services. It can be a sensitive subject for patients, who may be embarrassed to attend. A non-judgemental approach and knowledge about STIs are important in easing patients’ anxieties. This article provides an overview of the most common STIs in the UK, including presenting features and primary care investigation and management.

scholarly journals P108 Service Evaluation - the impact and lessons learnt from the COVID-19 pandemic on a UK burns centre

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Georgina Phillips ◽  
Cyrus Talwar ◽  
Stanislau Makaranka ◽  
Declan Collins ◽  
Stanislau Makaranka
Keyword(s):  
Public Awareness ◽  
Service Evaluation ◽  
Medical Attention ◽  
Delayed Presentation ◽  
Healthcare Provision ◽  
Burn Care ◽  
Lessons Learnt ◽  
Referral Criteria ◽  
The Uk ◽  
The Impact

Abstract The COVID-19 pandemic has dramaticallyimpacted healthcare provision in the UK and burns services have had to adapt to ensure the continuityof a safe care. As we return to " normalit y" we reflect on lessons learnt from our response to this pandemic. A service evaluation was performed from patient notes between March 23rd and May8th 2020 and an anonymoussurveygiven to patients attending outpatient appointments. 258 patients were referred to our burns service and 148 patients completed the survey. Eleven burns were caused bytreatment or prevention of COVID-19. Patients delayed seeking medical attention due to concern of catching COVID-19 (36% adults, 8% children). There was a delayin referral of 17 patients despite them fulfilling the referral criteria. Infection rates were higher following delayed presentation (21% vs 6%). The majorityof burns were managed conservatively (237/258). Dressing changes were performed at home by32% of patients. The outreach team treated 22 patients. During the pandemic telemedicine has improved the efficiencyof outpatient burn care and outreach nurses have enabled treatment of vulnerable patients. More must be done to raise public awareness of preventable causes of burn injuryand to reassure them to seek help when burns occur.

Sign in / Sign up

Export Citation Format

Share Document