scholarly journals Observational study of clinico-radiological follow-up of COVID-19 pneumonia: a district general hospital experience in the UK

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
C. A. Musat ◽  
M. Hadzhiivanov ◽  
V. Durkowski ◽  
A. Banerjee ◽  
A. Chiphang ◽  
...  

Abstract Background The British Thoracic Society (BTS) recommends that all patients admitted with COVID-19 pneumonia should have a chest X-ray (CXR) and clinical follow-up at 6 or 12 weeks, depending on the disease severity. Little data is available on long-term CXR follow-up for moderate and severe COVID-19 pneumonia. This study aims to evaluate compliance with clinico-radiological follow-up of patients recovering from COVID-19 pneumonia at a local hospital in the UK, as per the BTS guidance, and to analyse radiological changes at clinical follow-up at 12 weeks, in order to risk-stratify and improve patient outcomes. Methods This is a single-centre retrospective audit of 255 consecutive COVID-19 positive patients admitted to a local hospital in the UK over 5 months between May and October 2020. All CXRs and clinic follow-up at 12 ± 8 weeks were checked on an electronic database. Results Over one in two (131/255) patients had CXR evidence of COVID-19 pneumonia during the initial hospital admission. Half of the patients (60/131) died before CXR or clinic follow-up. Fifty-eight percent (41/71) of the surviving patients had a follow-up CXR, and only two developed respiratory complications- one had residual lung fibrosis, another a pulmonary embolism. Eighty-eight percent (36/41) of the patients had either resolution or improved radiological changes at follow-up. Most patients who had abnormal follow-up CXR were symptomatic (6/8), and many asymptomatic patients at follow-up had a normal CXR (10/12). Conclusions Although there were concerns about interstitial lung disease (ILD) incidence in patients with COVID-19 pneumonia, most of our patients with COVID-19 pneumonia had no pulmonary complications at follow-up with CXR. This emphasises that CXR, a cost-effective investigation, can be used to risk-stratify patients for long term pulmonary complications following their COVID-19 pneumonia. However, we acknowledge the limitations of a low CXR and clinic follow-up rate in our cohort.

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Hoyle ◽  
K Iqbal ◽  
J Henry ◽  
L Hughes ◽  
D Johnson

Abstract Background In anticipation of the UK coronavirus pandemic peak, BOA published new pandemic-specific guidance (“COVID BOAST”) in April 2020. We describe our experience implementing this restructured T&O service in a busy DGH setting during the pandemic peak. Method A rapid retrospective audit was conducted of all patients presenting to our T&O service in April 2020, with particular emphasis compliance with COVID BOAST. Results Our service conducted 511 outpatient reviews, and 95 operative procedures. 94% of outpatients were treated non-operatively. We provided telephone appointments to 12.8% of follow-up patients, and 39% of new patients. 82% of patients were treated with removable casts/splints/boots. 23% of patients were discharged direct from VFC or after one face-to-face fracture clinic review. Residual deformity was consciously accepted in 13% of patients. Theatre throughput fell significantly due to pandemic precautions however, femoral neck fracture volumes remained constant. Conclusions We demonstrate broad compliance with COVID BOAST guidance. The majority of patients were treated non-operatively, including conscious acceptance of residual deformity. Our pre-existing VFC allowed us to provide a significant number of telephone consultations, although despite the practice shift towards removable splintage, face-to-face consultations were required for clinical and/or radiological assessment. The impact of increased conservative management on patients’ long-term outcomes needs further evaluation.


2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Chaudhry ◽  
J Abiola

Abstract Introduction The Covid-19 pandemic has had a global impact on healthcare. As a result, changes have been made to healthcare provision. In the UK, the focus was changed to urgent and emergency treatment only, and therefore a shift from face-to-face consultations to video and telephone consultations was implemented. Our aim was to look at the telephone consultations in our oral and maxillofacial (OMF) department to identify their effectiveness. Method A search was carried out using the electronic patient record for patients booked for consultations in the OMF clinics from the 23rd of March to the 1st of May 2020. Trauma clinics and ad-hoc clinics were excluded. Results 21 clinic codes were found as suitable for inclusion. 185 consultations were booked during the 6-week period. Of these, 165 were via telephone and 20 face-to-face. A total of 75 consultations resulted in discharge and 110 required further follow up or further investigation. Of the 75 patients discharged, 73 of these were via telephone. The main reason for discharge was delivery of benign biopsy results. Conclusions Covid-19 will have long term impacts on healthcare provision. If implemented correctly, virtual consultations carry the potential in making healthcare more accessible.


2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Andrea Wagner ◽  
Christiane Groetsch ◽  
Sibylle Wilfling ◽  
Karl-Michael Schebesch ◽  
Mustafa Kilic ◽  
...  

Abstract Background The modified Boston criteria (mBC) define the probability for the diagnosis of cerebral amyloid angiopathy (CAA). Its initial clinical presentation differs from asymptomatic cerebral microbleedings (cMBs), acute ischemic stroke (AIS), cortical hemosiderosis (cSS), to lobar ICH (lICH). Methods Retrospective analyses and clinical follow-ups of individuals with at least mBC “possible” CAA from 2005 to 2018. Results 149 patients were classified in subgroups due to the index event: lICH (n = 91), AIS (n = 32), > 3 cMBs only (n = 16) and cSS (n = 10). Patients in the lICH subgroup had a significantly higher percentage of single new lICHs compared to other groups, whereas patients in the AIS-group had a significantly higher percentage of multiple new AIS. cMBs as index event predisposed for AIS during follow up (p < 0.0016). Patients of the cMBs- or cSS-group showed significantly more TFNEs (transient focal-neurological episodes) and lower numbers of asymptomatic patients (for epilepsy and TFNEs) at the index event than patients with lICH or AIS (p < 0.0013). At long-term follow-up, the cMBs- and cSS-group were characterized by more TFNEs and fewer asymptomatic patients. Conclusions A new classification system of CAA should add subgroups according to the initial clinical presentation to the mBCs allowing individual prognosis, acute treatment and secondary prophylaxis.


Author(s):  
Ayla C Newton ◽  
Marion Bohatschek ◽  
Andreas Rehm ◽  
Elizabeth Ashby

The Newborn and Infant Physical Examination screening is a national screening programme which aims to identify infants with congenital abnormalities to minimise the risk of long-term complications. It involves a top to toe examination with special focus on the heart, eyes, testes and hips. The hip component of the Newborn and Infant Physical Examination screen aims to pick up infants with developmental dysplasia of the hips and refer them for appropriate treatment in a timely manner. Guidelines for the hip section of have recently changed. This article reviews these changes, the timings of the follow up and investigations, and the diagnosis and management of developmental dysplasia of the hips.


Author(s):  
Andrew Horton ◽  
Mark Broadhurst

Liaison psychiatry is a subspecialty of psychiatry which involves the diag­nosis, treatment, and management of psychiatric illness in patients who have physical illnesses or present with physical symptoms. There is considerable overlap between psychiatric and medical condi­tions which requires close working relationships with medical colleagues. Liaison psychiatry is a fascinating area where the range of psychiatric presentations is wide, every case is different, and there is opportunity to keep up to date with medicine as it evolves. Within the UK there are different models practiced in different areas, ranging from assessment and signposting services to services with provi­sion for long-term outpatient follow-up. There is increasing interest in the provision of liaison services in primary care because of the challenges faced by GPs in treating patients with medically unexplained symptoms. Another driver is the hugely increased morbidity and mortality rates seen in patients with co-morbid physical and mental illnesses who receive the majority of their treatment in secondary care.


2020 ◽  
Vol 106 (8) ◽  
pp. 1589-1595
Author(s):  
Charles Bijon ◽  
Marc Saab ◽  
Thomas Amouyel ◽  
Nadine Sturbois-Nachef ◽  
Elvire Guerre ◽  
...  

Lung Cancer ◽  
2019 ◽  
Vol 127 ◽  
pp. S63-S64
Author(s):  
M. Mccloskey ◽  
C. Yarr ◽  
K. Grant ◽  
M. Doherty ◽  
R. Sharkey ◽  
...  

2002 ◽  
Vol 95 (4) ◽  
pp. 194-197 ◽  
Author(s):  
Siwan Thomas-Gibson ◽  
Catherine Thapar ◽  
Syed G Shah ◽  
Brian P Saunders

Provisional reports from the Intercollegiate British Society of Gastroenterology National Colonoscopy audit show completion rates of 57–77%for the procedure and poor levels of training and supervision. We prospectively audited all aspects of colonoscopy performed at a combined district general hospital and specialist endoscopy unit. Details of referral, examination, endoscopist, complications and follow-up were recorded and patients were sent questionnaires for long-term follow-up. 505 patients (246 male) underwent colonoscopy by 27 different endoscopists. Their median age was 57 years (range 13–92) and 93%were outpatients. 64% patients were symptomatic and 36%were having surveillance or follow-up colonoscopy. The overall caecal intubation rate was 93%, with little difference between surgeons, physicians and experienced trainees (89%, 92%, 94%) and specialist endoscopists (98%). In only one case was an inexperienced trainee (<100 procedures) unsupervised. Pain scores estimated by the endoscopist were well matched with those given by the patient—medians 29 and 26 (maximum 100) respectively. Median satisfaction score was 96 (maximum 100). Polyp pick-up rate was 26.9%and there were 11 new cancers. 16 (3%) minor immediate complications were recorded—5 oversedation, 6 vasovagal attacks, 3 polypectomy haemorrhages and 2 mucosal injuries (neither requiring treatment). 3 patients died within 6 months of follow-up but no death was colonoscopy related. Completion rates in this setting were adequate for all endoscopists studied. Patient satisfaction with the procedure was high and very few immediate or long-term complications were encountered.


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