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

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.

Download Full-text

Experiences and impact of international medical volunteering: a multi-country mixed methods study

BMJ Open ◽

10.1136/bmjopen-2020-041599 ◽

2021 ◽

Vol 11 (3) ◽

pp. e041599 ◽

Cited By ~ 1

Author(s):

Mary McCauley ◽

Joanna Raven ◽

Nynke van den Broek

Keyword(s):

Low Income ◽

Online Survey ◽

Positive Impact ◽

Healthcare Providers ◽

International Medical ◽

Middle Income ◽

Use Of Resources ◽

The Uk ◽

Medical Volunteers ◽

The Impact

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe.ParticipantsMedical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138).Outcome measuresExpectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC.ResultsUK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development.ConclusionHealthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers’ knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.

Download Full-text

Impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases in the UK: a mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2021-048772 ◽

2021 ◽

Vol 11 (6) ◽

pp. e048772

Author(s):

Toby O Smith ◽

Pippa Belderson ◽

Jack R Dainty ◽

Linda Birt ◽

Karen Durrant ◽

...

Keyword(s):

Mixed Methods ◽

Qualitative Study ◽

Online Survey ◽

Musculoskeletal Diseases ◽

Community Dwelling ◽

Secondary Outcome ◽

Healthcare Provision ◽

Social Restriction ◽

The Uk ◽

The Impact

ObjectivesTo determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time.DesignMixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study.SettingUK online survey and interviews with community-dwelling individuals in the East of England.ParticipantsPeople in the UK with RMDs were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study.Primary and secondary outcome measuresThe online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant’s perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens and how they experienced changes in their social networks.Results703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs 6% reported a decrease). This was significantly worse for those aged 18–60 years compared with older participants (p=0.017). The qualitative findings from 26 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home.ConclusionsPeople with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK.

Download Full-text

How fast should social restrictions be eased in England as COVID-19 vaccinations are rolled out?

10.22541/au.161570484.42882509/v2 ◽

2021 ◽

Author(s):

David Miles ◽

Adrian Heald ◽

Mike Stedman

Keyword(s):

Healthcare Services ◽

Key Factors ◽

Healthcare Provision ◽

Factors Affecting ◽

Education Outcomes ◽

Trade Offs ◽

Standards Of Living ◽

Life Years ◽

The Uk ◽

The Impact

Vaccination against the COVID-19 virus began in December 2020 in the UK and is now running at 5% population/week. High Levels of social restrictions were implemented for the third time in January 2021 to control the second wave and resulting increases in hospitalisations and deaths. Easing those restrictions must balance multiple challenging priorities, weighing the risk of more deaths and hospitalisations against damage done to mental health, incomes and standards of living, education outcomes and provision of non-Covid-19 healthcare. Weekly and monthly officially published values in 2020/21 were used to estimate the impact of seasonality and social restrictions on the spread of COVID-19 by age group, on the economy and healthcare services. These factors were combined with the estimated impact of vaccinations and immunity from past infections into a model that retrospectively reflected the actual numbers of reported deaths closely both in 2020 and early 2021. It was applied prospectively to the next 6 months to evaluate the impact of different speeds of easing social restrictions. The results show vaccinations are significantly reducing the number of hospitalisations and deaths. The central estimate is that relative to a rapid easing, the avoided loss of 57,000 life years from a strategy of relatively slow easing over the next 4 months comes at a cost in terms of GDP reduction of around £0.4 million/life-year loss avoided. This is over 10 times higher than the usual limit the NHS uses for spending against Quality Adjusted Life Years (QALYs) saved. Alternative assumptions for key factors affecting give significantly different trade-offs between costs and benefits of different speeds of easing. Disruption of non-Covid-19 Healthcare provision also increases in times of higher levels of social restrictions. In most cases, the results favour a somewhat faster easing of restrictions in England than current policy implies.

Download Full-text

Short‐term outcomes in children following emergency department visits for minor injuries sustained at home

Injury Epidemiology ◽

10.1186/s40621-021-00307-z ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Matthew J Molloy ◽

Wendy Shields ◽

Molly W Stevens ◽

Andrea C Gielen

Keyword(s):

Emergency Department ◽

Pediatric Population ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

Short Term ◽

Minor Injury ◽

Minor Injuries ◽

A Minor ◽

The Impact ◽

At Home

Abstract Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Download Full-text

The elections and campaign styles influence the spread of COVID-19 pandemic: lessons learned from Kerala, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20214285 ◽

2021 ◽

Vol 8 (11) ◽

pp. 5441

Author(s):

Praveenlal Kuttichira ◽

Pulikkottil Rapheal Varghese ◽

Presthiena Lofi E. L. ◽

Prasad A. B.

Keyword(s):

Repeated Measures ◽

Local Area ◽

Lessons Learned ◽

Cross Sectional ◽

Daily Number ◽

Indian State ◽

Cross Sectional Design ◽

Post Hoc ◽

The Impact ◽

Second Wave

Background: The pandemic caused by SARS-Cov-2 and its variants whack the world with overlapping waves. Kerala is the Indian state which successfully curbed the first wave of COVID-19, getting noticed when daunted by the second wave. The aim of this study was to assess the impact of two elections held in Kerala on the transmission of COVID-19 from October 1st, 2020 to May 5th, 2021.Methods: The study employed a retrospective cross-sectional design with publicly available data. The test positivity (TPR) and daily number of cases (DNC) collected from governmental websites of Kerala, India and COVID-19 dashboards entered in MS Excel 2007 and analysed using IBM SPSS version 25. Biweekly average of TPR and DNC was analysed in descriptive statistics and DNC at different periods in the context of elections were analysed using repeated-measures ANOVA with Greenhouse-Geisser correction and post hoc test of Bonferroni correction.Results: The findings showed that the daily number of COVID-19 cases increased after both local body and assembly elections, but a statistically significant increase was found after the assembly election [mean difference= 1069 (357.047-1782.419) at p=0.002 from the pre-election period].Conclusions: The study revealed that the conduct of elections in stages and organizing campaigns limiting to the local area following COVID protocols had a demonstrable positive effect against the potential of pandemic spread.

Download Full-text

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

British Journal of Surgery ◽

10.1093/bjs/znab259.502 ◽

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.

Download Full-text

Frailty in major trauma study (FRAIL-T): a study protocol to determine the feasibility of nurse-led frailty assessment in elderly trauma and the impact on outcome in patients with major trauma

BMJ Open ◽

10.1136/bmjopen-2020-038082 ◽

2020 ◽

Vol 10 (8) ◽

pp. e038082

Author(s):

Heather Jarman ◽

Robert Crouch ◽

Mark Baxter ◽

Elaine Cole ◽

Bebhinn Dillane ◽

...

Keyword(s):

Older People ◽

Best Practice ◽

Major Trauma ◽

Assessment Tool ◽

Traumatic Injury ◽

Time Frame ◽

Mortality And Morbidity ◽

Frailty Assessment ◽

The Uk ◽

The Impact

IntroductionThe burden of frailty on older people is easily recognisable by increasing mortality and morbidity, longer hospital stays and adverse discharge locations. In the UK, frailty screening has recently become part of the best practice commissioning tariff within National Health Service England, yet there is no evidence or consensus as to who should carry out this assessment or within which time frame. As major trauma is an increasing burden for older people, there is a need to focus clinician’s attention on early identification of frailty in the emergency department (ED) in patients with major trauma as a way to underpin frailty specific major trauma pathways, to optimise recovery and improve patient experience. Throughout the patient with major trauma pathway, nurses are perhaps best placed to conduct timely clinical assessments working with the patient, family and multidisciplinary team to influence ongoing care. This study aims to determine the feasibility of nurse-led assessment of frailty in patients aged 65 years or more admitted to major trauma centres (MTCs).Methods and analysisThis is a prospective observational study conducted across five UK MTCs, enrolling 370 participants over 9 months. The primary aim is to determine the feasibility of nurse-led frailty assessment in MTC EDs in patients aged 65 years or more following traumatic injury. The prevalence of frailty and the best assessment tool for use in the ED will be determined. Other outcome measures include quality of life and frailty assessment 6 months after injury, mortality and discharge outcomes.Ethics and disseminationThe study was given ethical approval by the Social Care Research Ethics Committee (REC no 19/IEC08/0006). Findings will be published in scientific journals and presented to national and international conferences.Trial registration numberISRCTN10671514.

Download Full-text

The impact of COVID-19 on self-management behaviours and healthcare access for people with inflammatory arthritis

BMC Rheumatology ◽

10.1186/s41927-021-00231-1 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Emma Caton ◽

Hema Chaplin ◽

Lewis Carpenter ◽

Melissa Sweeney ◽

Hsiu Yen Tung ◽

...

Keyword(s):

Inflammatory Arthritis ◽

Healthcare Access ◽

Self Management ◽

Severe Illness ◽

Structured Interviews ◽

Healthcare Provision ◽

June July ◽

The Uk ◽

The Impact

Abstract Background Inflammatory arthritis (IA) patients have been identified as at greater risk of severe illness from COVID-19. It is likely that lockdown restrictions (enforced by the UK government in response to the COVID-19 pandemic) and subsequent changes made to healthcare provision could impact patients’ abilities to effectively manage their condition. The aim of this study was to qualitatively explore the impact of COVID-19 on self-management behaviours and healthcare access for people with IA. Methods Semi-structured interviews were conducted with 21 IA patients in June-July 2020, with nine follow-up interviews in November 2020. Interview schedules were developed with a Patient Research Partner and explored participants’ experiences of the COVID-19 pandemic. Interviews were conducted via telephone and analysed using inductive thematic analysis. Results Participants were aged between 24 and 79 years (mean = 50.1, SD = 15.8), largely female (71%) and White British (86%). Four initial themes were identified: (1) Impact of COVID-19 on medication adherence, (2) Impact of COVID-19 on physical activity, (3) Impact of COVID-19 on diet, and (4) Impact of COVID-19 on healthcare access and delivery. Subthemes focused on positive and negative changes made to these areas, as well as behaviours which remained consistent. Follow-up interviews highlighted differences in participants’ experiences during the two lockdown periods. Conclusion COVID-19 has affected patients’ abilities to manage their IA. Healthcare professionals need to recognise the ongoing impact of COVID-19 on patient self-management and healthcare access to ensure that adequate understanding and support is available to patients who may have inadequate disease control as a result.

Download Full-text

PrimaryCare@COVID-19: the implementation of digital monitoring services for patients with chronic diseases during the Covid-19 pandemic (Preprint)

10.2196/preprints.24181 ◽

2020 ◽

Author(s):

Luis Velez Lapão ◽

Mariana Santos ◽

Melanie Maia ◽

Vasco Pedrosa ◽

Jorge Seixas ◽

...

Keyword(s):

Chronic Diseases ◽

Primary Healthcare ◽

Primary Care Physicians ◽

Design Science ◽

Digital Health ◽

Healthcare Providers ◽

Healthcare Services ◽

Healthcare Provision ◽

The Impact ◽

Primary Healthcare Centers

BACKGROUND The COVID-19 pandemic is straining health systems and disrupting the delivery of healthcare services, in particular for the elderly and those with chronic conditions, who are particularly vulnerable to COVID-19 infection. OBJECTIVE The aim of this project is to support primary healthcare provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. METHODS The project followed the 6 steps of the Design Science implementation methodology framework: problem identification and motivation, definition of the objectives aligned with Goal-oriented care, artefact design and development, solution demonstration, evaluation, and communication. RESULTS The digital platform was developed for the specific objectives of the project and successfully piloted in three primary healthcare centers in the Lisbon Health Region. The health professionals were able to safely and thoroughly manage their first patients remotely with high degrees of satisfaction. The first COVID-19 messages were sent to the patients, addressing infodemic issues. CONCLUSIONS Although still in the first steps of implementation, we are seeing promising results with a positive uptake by healthcare providers and patients. Further research is planned to evaluate the impact on patient’s health related outcomes. We are confident that this platform could be scaled-up to all primary healthcare centers in Portugal in the next months, ready to tackle a second wave of COVID-19.

Download Full-text

Impact of COVID-19 on UK stress echocardiography practice: insights from the EVAREST sites

Echo Research and Practice ◽

10.1530/erp-20-0043 ◽

2021 ◽

Author(s):

Cameron Dockerill ◽

William Woodward ◽

Annabelle McCourt ◽

Cristiana Monteiro ◽

Elena Benedetto ◽

...

Keyword(s):

Stress Echocardiography ◽

Healthcare Delivery ◽

Major Change ◽

Exercise Stress ◽

Transmission Risk ◽

Clinical Tests ◽

Patient Screening ◽

The Uk ◽

The Impact ◽

Second Wave

Healthcare delivery is being transformed by COVID-19 to reduce transmission risk but continued delivery of routine clinical tests is essential. Stress echocardiography is one of the most widely used cardiac tests in the NHS. We assessed the impact of the first (W1) and second (W2) waves of the pandemic on ability to deliver stress echocardiography. Clinical echocardiography teams in 31 NHS hospitals participating in the EVAREST study were asked in July and November 2020 to complete a survey on the structure and delivery of stress echocardiography as well as impact on patients and staff. Results were compared to stress echocardiography activity in the same centre during January 2020. 24 and 19 NHS hospitals completed the survey in July and November, respectively. A 55% reduction in the number of studies performed was reported in W1, recovering to exceed pre-COVID rates in W2. The major change was in mode of stress delivery. 70% of sites stopped their exercise stress service in W1, compared to 19% in W2. In those still using exercise during W1, 50% were wearing FFP3/N95 masks, falling to 38% in W2. There was also significant variability in patient screening practices with 7 different pre-screening questionnaires used in W1 and 6 in W2. Stress echocardiography delivery restarted effectively after COVID-19 with adaptations to reduce transmission that means activity has been able to continue, and exceed, pre-COVID-19 levels during the second wave. Further standardisation of protocols for patient screening and PPE may help further improve consistency of practice within the UK.

Download Full-text