scholarly journals P059 Wellbeing and shielding of patients with rheumatic disease on biologic therapy during the early COVID-19 pandemic: a single centre experience

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Lucy M Carter ◽  
Hannah Irvine ◽  
Adnan D’Cunha Kamath ◽  
Ankita Sahni ◽  
Patrick Hanna ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Biologic Therapy ◽  
Initial Period ◽  
Medical Officer ◽  
Mental Wellbeing ◽  
British Society ◽  
Risk Category ◽  
Autoimmune Rheumatic Disease ◽  
The Uk ◽  
The Impact

Abstract Background/Aims  Individuals on immunosuppressive therapies were among those identified by the UK Department of Health and Chief Medical Officer as clinically extremely vulnerable to COVID-19. Advice on shielding from infection was disseminated by NHS England, primary care and NHS hospital trusts to those identified at highest risk. The British Society for Rheumatology (BSR) developed further risk stratification guidance specifically focused on autoimmune rheumatic disease. As the UK entered a period of nationwide lockdown on 23rd March 2020, the clinically highly vulnerable group were asked to shield from infection by staying at home and avoiding any face-to-face contact for an initial period of 12 weeks. The implications of social isolation, disruption to planned medical care and economic consequences became increasingly recognised. This work aimed to understand the experience and wellbeing of this patient group during week 5 -6 of UK Lockdown, as a guide to how we might best adapt services and address the needs of this group. Methods  Short semi-structured telephone interviews were conducted with 141 patients during week five and six of UK lockdown, between 20th April and 1st May 2020. Participants were sampled systematically from the departmental biologic therapy database at Wexham Park Hospital, a general hospital providing services to a diverse population of approximately 450,000 people in Berkshire and South Buckinghamshire. Results  Telephone interview was conducted with 141 patients prescribed biologic therapy. Written advice on risk and shielding was received by over 90%. Sixty four percent of respondents were female with a median age of 56 years. Thirty-nine percent of those interviewed fell within highest BSR risk category for whom full shielding was highly recommended, yet at the time of interview 51.1% of respondents reported they had committed to full shielding. Four percent of respondents self-identified as key workers and had continued their usual commitments. Amongst those interviewed, 35% reported significant adverse impact on their emotional and mental wellbeing within the first six weeks of UK lockdown. Isolation, uncertainty, limited physical exercise and cancellations to planned appointments were common themes. Twenty-eight percent of respondents felt their disease control had significantly deteriorated during the ongoing pandemic. Due to prevailing anxiety about the impact of immunosuppression on COVID-19 risk, 5% of patients had adjusted their prescribed therapies without the direct supervision or clinical advice. Conclusion  This study gives initial insights into the behaviours and concerns of patients with autoimmune and inflammatory disease on biologic therapy during the first wave of COVID-19 in the UK. Wellbeing and disease management have considerably suffered for many individuals. Further understanding patient experience may help guide restructuring of rheumatology services in next phase of the UK pandemic. Disclosure  L.M. Carter: None. H. Irvine: None. A. D’Cunha Kamath: None. A. Sahni: None. P. Hanna: None. N. Rahimi: None. K. Bhamra: None.

scholarly journals Emotional and Mental Wellbeing Following COVID-19 Public Health Measures on People Living With Dementia and Carers

2021 ◽  
pp. 089198872199681
Author(s):  
Kerry Hanna ◽  
Clarissa Giebel ◽  
Hilary Tetlow ◽  
Kym Ward ◽  
Justine Shenton ◽  
...  
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Social Support ◽  
Support Services ◽  
Mental Wellbeing ◽  
Daily Lives ◽  
Health Measures ◽  
Social Support Services ◽  
The Uk ◽  
The Impact

Background: To date, there appears to be no evidence on the longer-term impacts caused by COVID-19 and its related public health restrictions on some of the most vulnerable in our societies. The aim of this research was to explore the change in impact of COVID-19 public health measures on the mental wellbeing of people living with dementia (PLWD) and unpaid carers. Method: Semi-structured, follow-up telephone interviews were conducted with PLWD and unpaid carers between June and July 2020. Participants were asked about their experiences of accessing social support services during the pandemic, and the impact of restrictions on their daily lives. Results: 20 interviews were conducted and thematically analyzed, which produced 3 primary themes concerning emotional responses and impact to mental health and wellbeing during the course of the pandemic: 1) Impact on mental health during lockdown, 2) Changes to mental health following easing of public health, and 3) The long-term effect of public health measures. Conclusions: The findings from this research shed light on the longer-term psychological impacts of the UK Government’s public health measures on PLWD and their carers. The loss of social support services was key in impacting this cohort mentally and emotionally, displaying a need for better psychological support, for both carers and PLWD.

scholarly journals New Labour, New Policies: Constructing a Discourse of Citizenship

1998 ◽  
Vol 3 (2) ◽  
pp. 101-114
Author(s):  
Keith Crawford
Keyword(s):  
Citizenship Education ◽  
New Labour ◽  
Political Context ◽  
British Society ◽  
Contemporary Society ◽  
Legitimation Crisis ◽  
New Policies ◽  
The Uk ◽  
The Impact

The purpose of this paper is examine the development of citizenship education as a curriculum priority within the UK. Employing Habermas' theory of legitimation crisis, the paper places the contemporary enthusiasm for citizenship education within a socioeconomic, cultural and political context. The paper argues that current preoccupations with citizenship education contained in Education for Citizenship and the Teaching of Democracy in Schools (Dfee, 1999), stem from the impact of Neo-Liberal concerns with individualism, economic and technological globalisation and the potential fragmentation of contemporary society. The paper explores the principles of education for citizenship and the teaching of democracy in schools and suggests that, as part of New Labour's developing conception of British society, citizenship education asks some fundamental questions of that society.

scholarly journals Study protocol for COvid-19 Vascular sERvice (COVER) study: The impact of the COVID-19 pandemic on the provision, practice and outcomes of vascular surgery

2020 ◽  
Author(s):  
Ruth A Benson
Keyword(s):  
Vascular Surgery ◽  
Service Provision ◽  
British Society ◽  
Tier 2 ◽  
Patient Level ◽  
Tier 1 ◽  
Ethical Approval ◽  
The Uk ◽  
Tier 3 ◽  
The Impact

ABSTRACTBackgroundThe novel Coronavirus Disease 2019 (COVID-19) pandemic is having a profound impact on global healthcare. Shortages in staff, operating theatre space and intensive care beds has led to a significant reduction in the provision of surgical care. Even vascular surgery, often insulated from resource scarcity due to its status as an urgent specialty, has limited capacity due to the pandemic. Furthermore, many vascular surgical patients are elderly with multiple comorbidities putting them at increased risk of COVID-19 and its complications. There is an urgent need to investigate the impact on patients presenting to vascular surgeons during the COVID-19 pandemic.Methods and AnalysisThe COvid-19 Vascular sERvice (COVER) study has been designed to investigate the worldwide impact of the COVID-19 pandemic on vascular surgery, at both service provision and individual patient level. COVER is running as a collaborative study through the Vascular and Endovascular Research Network (VERN) with the support of numerous national (Vascular Society of Great Britain and Ireland, British Society of Endovascular Therapy, British Society of Interventional Radiology, Rouleaux Club) and an evolving number of international organisations (Vascupedia, SingVasc, Audible Bleeding (USA), Australian and New Zealand Vascular Trials Network (ANZVTN)). The study has 3 ‘Tiers’: Tier 1 is a survey of vascular surgeons to capture longitudinal changes to the provision of vascular services within their hospital; Tier 2 captures data on vascular and endovascular procedures performed during the pandemic; and Tier 3 will capture any deviations to patient management strategies from prepandemic best practice. Data submission and collection will be electronic using online survey tools (Tier 1: SurveyMonkey® for service provision data) and encrypted data capture forms (Tiers 2 and 3: REDCap® for patient level data). Tier 1 data will undergo real-time serial analysis to determine longitudinal changes in practice, with country-specific analyses also performed. The analysis of Tier 2 and Tier 3 data will occur on completion of the study as per the prespecified statistical analysis plan.Ethical ApprovalEthical approval from the UK Health Research Authority has been obtained for Tiers 2 and 3 (20/NW/0196 Liverpool Central). Participating centres in the UK will be required to seek local research and development approval. Non-UK centres will need to obtain a research ethics committee or institutional review board approvals in accordance with national and/or local requirements.ISRCTN: 80453162 (https://doi.org/10.1186/ISRCTN80453162)Ethical Approval: 20/NW/0196 Liverpool Central, IRAS: 282224

Polypharmacy is associated with treatment response and serious adverse events: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Rheumatology ◽  
2019 ◽  
Vol 58 (10) ◽  
pp. 1767-1776 ◽  
Author(s):  
Katie Bechman ◽  
Benjamin D Clarke ◽  
Andrew I Rutherford ◽  
Mark Yates ◽  
Elena Nikiphorou ◽  
...  
Keyword(s):  
Adverse Events ◽  
Rheumatic Disease ◽  
Treatment Response ◽  
Biologic Therapy ◽  
British Society ◽  
Receiver Operator Characteristic ◽  
Serious Adverse Events ◽  
Comorbidity Index ◽  
Adjusted Model ◽  
Biologics Register

Abstract Objective To evaluate whether polypharmacy is associated with treatment response and serious adverse events (SAEs) in patients with RA using data from the British Society for Rheumatology Biologics Register (BSRBR-RA). Methods The BSRBR-RA is a prospective observational cohort study of biologic therapy starters and a DMARD comparator arm. A logistic regression model was used to calculate the odds of a EULAR ‘good response’ after 12 months of biologic therapy by medication count. Cox proportional hazards models were used to identify risk of SAEs. The utility of the models were compared with the Rheumatic Disease Comorbidity Index using Receiver Operator Characteristic and Harrell’s C statistic. Results The analysis included 22 005 patients, of which 83% were initiated on biologics. Each additional medication reduced the odds of a EULAR good response by 8% [odds ratios 0.92 (95% CI 0.91, 0.93) P < 0.001] and 3% in the adjusted model [adjusted odds ratios 0.97 (95% CI 0.95, 0.98) P < 0.001]. The Receiver Operator Characteristic demonstrated significantly greater areas under the curve with the polypharmacy model than the Rheumatic Disease Comorbidity Index. There were 12 547 SAEs reported in 7286 patients. Each additional medication equated to a 13% increased risk of an SAE [hazard ratio 1.13 (95% CI 1.12, 1.13) P < 0.001] and 6% in the adjusted model [adjusted hazard ratio 1.06 (95% CI 1.05, 1.07) P < 0.001]. Predictive values for SAEs were comparable between the polypharmacy and Rheumatic Disease Comorbidity Index model. Conclusion Polypharmacy is a simple but valuable predictor of clinical outcomes in patients with RA. This study supports medication count as a valid measure for use in epidemiologic analyses.

scholarly journals The Impact of the European Working Time Regulations on Orthopaedic Trainee Operative Experience

2012 ◽  
Vol 94 (5) ◽  
pp. 156-158 ◽  
Author(s):  
PJ Wraighte ◽  
DP Forward ◽  
P Manning
Keyword(s):  
Medical Officer ◽  
Surgical Experience ◽  
Surgical Specialty ◽  
European Working ◽  
Hands On ◽  
Apprenticeship Model ◽  
Set Up ◽  
The Uk ◽  
The Impact ◽  
Orthopaedic Trainee

Trauma and orthopaedic surgery (T&O) has the largest number of trainees of any individual surgical specialty in the UK. It is a craft-based specialty, with 'hands-on' training, based on an apprenticeship model involving operative and procedural skills. In 1992 Kenneth Calman, then Chief Medical Officer, set up a working group to reform the specialist curriculum, placing more emphasis on structured teaching, supervised learning and surgical experience.

scholarly journals O22 Evaluating the impact of COVID-19 on patient access to rheumatology services, medication and future care: a nationwide study of more than 2,000 patients

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Chris Wincup ◽  
Raj Amarnani ◽  
Ian Giles
Keyword(s):  
Drug Monitoring ◽  
Online Survey ◽  
British Society ◽  
National Study ◽  
Telephone Consultation ◽  
Patient Reported ◽  
Future Care ◽  
The Uk ◽  
The Impact

Abstract Background/Aims  COVID-19 has had significant impacts upon the delivery of rheumatology care in the UK. To date, there is little data specifically addressing how care has been disrupted and the impact upon patient attitudes and beliefs. Herein, we describe the results of a national study investigating how COVID-19 has; (1) reduced access to services; (2) altered treatment and drug monitoring; (3) impacted on clinic follow-up; (4) changed patient beliefs regarding ongoing/future care. Methods  We conducted an online survey of patients attending rheumatology clinics in the UK. Questions were developed by clinicians with input from patient charities and four expert patients. The survey was hosted online between 8 September and 8 October 2020. Results  In total, 2,054 patients completed the survey and the average number of rheumatic conditions each patient reported was 1.98±1.38 with the most common being; rheumatoid arthritis (48%), lupus (20%), Sjogren’s syndrome (19%), fibromyalgia (15%) and vasculitis (8%). More than half (57%) were told to shield, whilst 10% decided to shield of their own accord. Compared with before the pandemic, 57% felt it was difficult/very difficult to contact their rheumatologist. Regarding treatment, 15% reported difficulty obtaining their usual medication. Less than half (45%) of patients continued medication as previously and had no problem accessing it, although 21% said their usual drug monitoring had been discontinued. Overall, 3% stopped their treatment of their own accord. In all, 26% said their appointments in rheumatology clinics had been cancelled and they did not know when they would be seen again (4% reported no change in their outpatient follow-up). Prior to the pandemic, 13% of patients had received a telephone consultation, however, since the pandemic 60% had received one. Just 19% felt it was easy to be honest with their clinician via telephone. Only 33% were satisfied with the current level of care, 43% reported their rheumatology care was worse than pre-pandemic and 38% of patients felt they needed to see their rheumatologist but could not get an appointment. Over half (57%) of patients expressed worries about their future care. If offered an appointment in the next few months 66% said they would prefer it be face-to-face. Conclusion  To our knowledge, this study is the largest survey of patient experiences of the COVID-19 pandemic under rheumatological care anywhere in the world. We found more than half of patients were told to shield and one-in-ten decided to shield without being directly told to do so. Less than half of patients maintained relatively good access to their usual medication without necessary monitoring in many cases. In particular, patients express high levels of concern about their future care. These high levels of disruption indicate the importance of maintaining routine rheumatology services during the ongoing pandemic. Disclosure  C. Wincup: Grants/research support; CW has received research funding from Versus Arthritis, LUPUS UK and the British Society for Rheumatology. R. Amarnani: None. I. Giles: None.

scholarly journals Impact of COVID-19 pandemic on key performance indicators in pancreatobiliary endoscopy: prioritise, minimise risk, keep scoping and training

2020 ◽  
pp. flgastro-2020-101701
Author(s):  
Shiran Esmaily ◽  
Chia Chuin Yau ◽  
Deepak Dwarakanath ◽  
John Hancock ◽  
Vikramjit Mitra
Keyword(s):  
Performance Indicators ◽  
Key Performance Indicators ◽  
Needle Aspiration ◽  
British Society ◽  
Advisory Group ◽  
National Guidelines ◽  
Retrospective Audit ◽  
The Uk ◽  
The Impact ◽  
Related Mortality

BackgroundThe COVID-19 pandemic has profoundly affected endoscopy services including pancreatobiliary (PB) endoscopy across the UK. The British Society of Gastroenterology and Joint Advisory Group have issued guidance for managing endoscopy services safely throughout this period. There have been perceived concerns among the PB endoscopists that wearing full personal protective equipment might have an adverse impact on key performance indicators (KPIs) in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) procedures leading to non-compliance with the national guidelines. The aim of the study was to assess the impact of COVID-19 pandemic on KPIs in ERCP and EUS and ascertain the risk of procedure-related complications.MethodsA retrospective audit of a prospectively maintained endoscopy database was carried out between 18 March and 31 July 2020.Results146 ERCP procedures (common bile duct (CBD) cannulation rate of naïve papilla 89.2%, complete CBD stone extraction rate at first ERCP 88.2%, biliary stricture decompression rate 91%) and 87 EUS procedures (diagnostic accuracy of EUS-fine needle aspiration 92%) were carried out during this period. ERCP-related complications included pancreatitis (4.8%), bleeding (0.68%) and cholangitis (0.68%). 30-day ERCP procedure-related mortality was 0.68%. There were no complications or procedure-related mortality in the EUS group.ConclusionThis is the first study looking at the impact of COVID-19 on KPIs and procedure-related complications in ERCP and EUS in the literature. Our study confirms that a high-quality PB endoscopy service can be delivered safely and effectively during the COVID-19 pandemic.

International perspectives

2020 ◽  
pp. 95-110
Author(s):  
Ian Cummins
Keyword(s):  
South Africa ◽  
Initial Period ◽  
The United States ◽  
Gauteng Province ◽  
International Perspectives ◽  
The Usa ◽  
The Uk ◽  
Fiscal Considerations ◽  
The Impact

This chapter will examine deinstitutionalisation in Italy, the United States, and post-apartheid South Africa. In examining the different drivers and outcomes of policies in these areas, similar themes to the UK experience emerge. These include: the role of scandals in the pressure for change, the role of fiscal considerations in the development of policy, an initial period of optimism and the impact of scandals. In Italy, the work of the psychiatrist, Franco Basaglia was seen as a possible blueprint for wider reforms. Basaglia’s work became very influential amongst radicals and the anti-psychiatry movement. The USA was at the forefront of the deinstitutionalisation policy. The links between the closure of psychiatric facilities and the expansion of the use of imprisonment have been most closely examined in this context. Finally, the chapter examines the total policy failure that led to the deaths of one hundred and forty-four patients in Gauteng Province, South Africa in 2014

scholarly journals An evaluation of the impact of biologic therapy on secondary care resource use associated with the management of crohn's disease in the UK

Gut ◽  
2011 ◽  
Vol 60 (Suppl 1) ◽  
pp. A214-A214
Author(s):  
J. O. Lindsay ◽  
S. Bloom ◽  
P. J. Hamlin ◽  
C. Hayward ◽  
F. Percival ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Resource Use ◽  
Secondary Care ◽  
Biologic Therapy ◽  
The Uk ◽  
The Impact

scholarly journals Exploring support needs of people living with diabetes during the coronavirus COVID-19 pandemic: insights from a UK survey.

2021 ◽  
Author(s):  
Sarah Sauchelli ◽  
Julia Bradley ◽  
Clare England ◽  
Aidan Searle ◽  
Alex Whitmarsh
Keyword(s):  
Personal Networks ◽  
Mental Wellbeing ◽  
Self Management ◽  
Healthcare Team ◽  
Healthy Weight ◽  
Subjective Experiences ◽  
The Government ◽  
The Uk ◽  
Consistent Information ◽  
The Impact

Background The coronavirus COVID-19 pandemic has radically compromised healthcare for people living with chronic conditions such as diabetes. Government-imposed restrictions to contain the spread of the virus has forced people to suddenly adjust their lifestyle. This study aimed to capture the impact of the pandemic on people living with diabetes and the views of these individuals on ways in which the information, advice and support they are receiving could be improved. Research design and methods An online anonymous survey was distributed across the UK during the first lockdown and initial easing. The survey comprised questions about confidence in diabetes self-management, resources used to obtain information, advice and support, and opinions on how these could be improved. Open-ended captured subjective experiences. Results The survey was completed by 773 adults living with diabetes (69.2% type 1, 28.5% type 2). There was notable variability in the impact of the pandemic on confidence in self-management, with confidence having deteriorated most commonly in the ability to take care of own mental wellbeing (37.0% respondents) and improved most commonly in maintaining a healthy weight (21.1% respondents). 41.2% of respondents living alone reported not receiving any outside support. The quality of information, advice and support received from the healthcare team was rated poorly by 37.2%. Respondents sought greater communication and tailored advice from their care team, clear and consistent information from the government and news channels, and improved understanding of diabetes and its challenges from their personal networks and employers. Conclusion Adjusting to the COVID-19 pandemic has strained the mental health and wellbeing of people living with diabetes. Diabetes care teams must receive assistance to support these individuals without risking further inequalities in access to healthcare. Equipping personal networks and employers with knowledge on diabetes and skills to support self-management may reduce the burden on the NHS.

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