scholarly journals Evaluation of the Implementation of the 4C Mortality Score in United Kingdom hospitals during the second pandemic wave

2021 ◽  
Author(s):  
Andrew E Blunsum ◽  
Jonathan S. Perkins ◽  
Areeb Arshad ◽  
Sukrit Bajpai ◽  
Karen Barclay-Elliott ◽  
...  
Keyword(s):  
United Kingdom ◽  
Clinical Pathways ◽  
Management Decisions ◽  
Hospitalised Patients ◽  
Management Guidance ◽  
Online Calculator ◽  
Pandemic Wave

ABSTRACT The 4C Mortality Score (4C Score) was designed to risk stratify hospitalised patients with COVID-19. We assessed inclusion of 4C Score in COVID-19 management guidance and its documentation in patients' case notes in January 2021 in UK hospitals. 4C Score was included within guidance by 50% of sites, though score documentation in case notes was highly variable. Higher documentation of 4C Score was associated with score integration within admissions proformas, inclusion of 4C Score variables or link to online calculator, and management decisions. Integration of 4C Score within clinical pathways may encourage more widespread use.

scholarly journals SARS-CoV-2 nosocomial infection acquired in a French university hospital during the 1st wave of the Covid-19 pandemic, a prospective study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
A. Landoas ◽  
F. Cazzorla ◽  
M. Gallouche ◽  
S. Larrat ◽  
B. Nemoz ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Prospective Observational Study ◽  
University Hospital ◽  
Healthcare Facilities ◽  
Hospitalised Patients ◽  
Hygiene Measures ◽  
Hygiene Compliance ◽  
A Prospective Study ◽  
Pandemic Wave

Abstract Background In healthcare facilities, nosocomial transmissions of respiratory viruses are a major issue. SARS-CoV-2 is not exempt from nosocomial transmission. Our goals were to describe COVID-19 nosocomial cases during the first pandemic wave among patients in a French university hospital and compliance with hygiene measures. Methods We conducted a prospective observational study in Grenoble Alpes University Hospital from 01/03/2020 to 11/05/2020. We included all hospitalised patients with a documented SARS-CoV-2 diagnosis. Nosocomial case was defined by a delay of 5 days between hospitalisation and first symptoms. Hygiene measures were evaluated between 11/05/2020 and 22/05/2020. Lockdown measures were effective in France on 17/03/2020 and ended on 11/05/2020. Systematic wearing of mask was mandatory for all healthcare workers (HCW) and visits were prohibited in our institution from 13/03/2021 and for the duration of the lockdown period. Results Among 259 patients included, 14 (5.4%) were considered as nosocomial COVID-19. Median time before symptom onset was 25 days (interquartile range: 12–42). Eleven patients (79%) had risk factors for severe COVID-19. Five died (36%) including 4 deaths attributable to COVID-19. Two clusters were identified. The first cluster had 5 cases including 3 nosocomial acquisitions and no tested HCWs were positive. The second cluster had 3 cases including 2 nosocomial cases and 4 HCWs were positive. Surgical mask wearing and hand hygiene compliance were adequate for 95% and 61% of HCWs, respectively. Conclusions The number of nosocomial COVID-19 cases in our hospital was low. Compliance regarding mask wearing, hand hygiene and lockdown measures drastically reduced transmission of the virus. Monitoring of nosocomial COVID-19 cases during the first wave enabled us to determine to what extent the hygiene measures taken were effective and patients protected. Trial registration Study ethics approval was obtained retrospectively on 30 September 2020 (CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand, IRB 5891).

scholarly journals Surgical Management of Non-Metastatic Pancreatic Cancer in the United Kingdom: Results of a Nationwide Survey on Current Practice

2021 ◽  
Vol 11 ◽  
Author(s):  
Georgios Gemenetzis ◽  
Siobhan McKay ◽  
Samir Pathak ◽  
John Moir ◽  
Richard Laing ◽  
...  
Keyword(s):  
United Kingdom ◽  
Surgical Management ◽  
Clinical Pathways ◽  
Locally Advanced ◽  
Nationwide Survey ◽  
Borderline Resectable ◽  
The United Kingdom ◽  
Staging Systems ◽  
National Cohort ◽  
The Uk

BackgroundIt is presently unclear what clinical pathways are followed for patients with non-metastatic PDAC in specialised centres for pancreatic surgery across the United Kingdom (UK).MethodsBetween August 2019 and August 2020 an electronic survey was conducted aiming at a national cohort of pancreatic surgeons in the UK. Participants replied to a list of standardised questions and clinical vignettes, and data were collected and analysed focusing on management preferences, resectability criteria, and contraindications to surgery.ResultsWithin the study period, 65 pancreatic surgeons from 27 specialist centres in the UK (96%) completed the survey. Multidisciplinary team meetings are utilised universally for the management of patients with PDAC, however, different staging systems for resectability classification are being applied. In borderline resectable PDAC, most surgeons were keen to proceed with surgical exploration post NAT, but differences were noted in preferred chemotherapy regimens. Surgeons from standard volume institutions performed fewer vein resections annually and were more likely to deem patients with locally advanced PDAC as unresectable. Intra-institutional variability in patient management was also present and ranging between 20-80%.ConclusionsSignificant variability in the surgical management of non-metastatic PDAC was identified both on inter- and intra-institutional level.

Assessing the Use of Age-Equivalent Scores in Clinical Management

1992 ◽  
Vol 23 (1) ◽  
pp. 6-8 ◽  
Author(s):  
Carol W. Lawrence
Keyword(s):  
Case Management ◽  
Clinical Management ◽  
Management Decisions ◽  
Language Deficits

Speech-language evaluation reports from many institutions present age-equivalent scores as the evidence for speech-language deficits. Yet, the value and interpretation of this measurement criterion requires clinical scrutiny. This article reviews the concept and derivation of age-equivalent scores and presents arguments against their use in case management decisions.

A comparison of the United Kingdom Clinical Aptitude Test (UK-CAT) with a traditional admission selection process

2009 ◽  
pp. 1-6 ◽  
Author(s):  
Nishan Fernando ◽  
Gordon Prescott ◽  
Jennifer Cleland ◽  
Kathryn Greaves ◽  
Hamish McKenzie
Keyword(s):  
United Kingdom ◽  
Selection Process ◽  
Aptitude Test ◽  
The United Kingdom

Zinc Depletion Increases Readmission in Older Patients: An Example of Interactions Between Nutrition and Disease

2017 ◽  
Vol 87 (1-2) ◽  
pp. 10-16 ◽  
Author(s):  
Salah Gariballa ◽  
Awad Alessa
Keyword(s):  
Nutritional Status ◽  
Inductively Coupled Plasma ◽  
Older Patients ◽  
Controlled Trial ◽  
Prognostic Indicators ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Co Morbidity ◽  
The Impact ◽  
Poor Nutrition

Abstract. Background: ill health may lead to poor nutrition and poor nutrition to ill health, so identifying priorities for management still remains a challenge. The aim of this report is to present data on the impact of plasma zinc (Zn) depletion on important health outcomes after adjusting for other poor prognostic indicators in hospitalised patients. Methods: Hospitalised acutely ill older patients who were part of a large randomised controlled trial had their nutritional status assessed using anthropometric, hematological and biochemical data. Plasma Zn concentrations were measured at baseline, 6 weeks and at 6 months using inductively- coupled plasma spectroscopy method. Other clinical outcome measures of health were also measured. Results: A total of 345 patients assessed at baseline, 133 at 6 weeks and 163 at 6 months. At baseline 254 (74%) patients had a plasma Zn concentration below 10.71 μmol/L indicating biochemical depletion. The figures at 6 weeks and 6 months were 86 (65%) and 114 (70%) patients respectively. After adjusting for age, co-morbidity, nutritional status and tissue inflammation measured using CRP, only muscle mass and serum albumin showed significant and independent effects on plasma Zn concentrations. The risk of non-elective readmission in the 6-months follow up period was significantly lower in patients with normal Zn concentrations compared with those diagnosed with Zn depletion (adjusted hazard ratio 0.62 (95% CI: 0.38 to 0.99), p = 0.047. Conclusions: Zn depletion is common and associated with increased risk of readmission in acutely-ill older patients, however, the influence of underlying comorbidity on these results can not excluded.

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