The wider impact of the pandemic最新文献

{"title":"P100 Impact of the COVID-19 pandemic on health services utilisation in a lung cancer screening cohort","authors":"A. Creamer, J. Dickson, C. Horst, S. Tisi, H. Hall, P. Verghese, R. Prendecki, J. McCabe, K. Phua, S. Mehta, K. Gyertson, A. Mullin, J. Teague, L. Farrelly, A. Hackshaw, S. Janes","doi":"10.1136/thorax-2021-btsabstracts.209","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.209","url":null,"abstract":"P100 Table 1Factors influencing reduced utilisation of healthcare services during the covid-19 pandemicConclusions40% of individuals in a cohort at high risk of lung cancer and respiratory comorbidities reported reduced utilisation of health care services due to the COVID-19 pandemic.Limitations to our data include the lung health check questions not distinguishing between primary and secondary care or routine and urgent visits, and self-reported co-morbidity data limited to selected respiratory conditions. Nevertheless, we provide evidence for the scale of the problem and highlight that individuals with chronic respiratory conditions are particularly likely to be impacted.Please refer to page A193 for declarations of interest related to this abstract.","PeriodicalId":286165,"journal":{"name":"The wider impact of the pandemic","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129268937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P109 Infection control policies during the COVID-19 pandemic were effective in limiting morbidity and mortality associated with nosocomial viral transmission at a large NHS respiratory department","authors":"H. Aung, K. Kyaw, R. Free, J. Blount, D. Jenkins, J. Tang, S. Range, P. Haldar, G. Woltmann","doi":"10.1136/thorax-2021-btsabstracts.218","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.218","url":null,"abstract":"IntroductionPrevention of nosocomial transmission was a priority for NHS hospital teams during the SARS-COV-2 pandemic. However, infection control policies were developed in the face of uncertainty about duration of infectivity, routes of transmission, and safety of shared admission spaces. We retrospectively reviewed all hospital admissions to the University Hospitals of Leicester (UHL) respiratory department, which managed more than 30% of UHL patients with a diagnosis of COVID-19 between March 2020 and March 2021to determine the proportion of cases with laboratory evidence of healthcare associated infection (HCAI) and mortality within 28 days of PCR conversionMethodsThis was a retrospective cohort study performed using a bespoke database collating COVID-19 throat swab (TS) PCR results for UHL (COVTRACK). Nosocomial transmission was identified by demonstrating PCR conversions during admission and categorized into definite (conversion time > 14 days) or probable (conversion time 8–14 days). In depth records based analysis was undertaken for patients admitted to respiratory medicine (RM) and deceased within 28 days after conversion.ResultsOut of 10485 patients admitted to the Respiratory Department at UHL, 2054 (19.6%) were COVID-19 spell positive, including 57 with probable (41) or definite HCAI (16). 23 patients (7 with definite HCAI) died within 28 days of PCR conversion (0.22%, of total admitted, 1.1% of COVID19 positive), with 21 (91%) deaths in the 2nd wave. Compared with non-COVID admissions not acquiring nosocomial infection, HCAI was significantly associated with older age (mean difference (95%CI) 11.5 (7.5–15.5) years), length of stay (median LOS 18 Vs 1 day) and multiple ward occupancy (median 3 vs 1 ward);all analyses p<0.001.DiscussionOur analysis suggests HCAI with SARS-COV-2 contributed a very small fraction of COVID-19 related morbidity and mortality at our department and in the majority the trajectory of care was not changed. Despite the high numbers of highly infectious cases during the 1st and 2nd wave, we successfully implemented a suite of infection control measures that effectively mitigated risk. High throughput in admission areas, multiple ward moves, and prolonged hospital stay were significant risk factors associated with HCAI.","PeriodicalId":286165,"journal":{"name":"The wider impact of the pandemic","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130429257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P104 COVID-19 mortality in cancer patients on systemic anti-cancer treatments during the second UK SARS-CoV-2 wave","authors":"S. Waring, G. Gamtiksulashvili, S. Kumar, A. D'Souza, S. Jiwani, O. Taylor, G. Collins, Y. Narayan, K. Patrick, A. Sethuraman, S. Naik, S. Kuckreja, R. Ragatha, M. Anwar, U. Ekeowa, P. Russell","doi":"10.1136/thorax-2021-btsabstracts.213","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.213","url":null,"abstract":"P104 Table 1Mortality rate after presentation of COVID-19 by: tumour type, time from cancer diagnosis, cancer stage, progression of disease, and systemic anti-cancer treatment (SACT). Number mortality number mortality% odds ratio Cancer type Solid organ 75 28 37.3 1.32 Lung 18 11 61.1 4.66** Haematological 29 11 37.9 1.47 Time from diagnosis <12 months 55 25 45.5 2.32** >12 months 67 25 37.3 1.25 STAGE AT DIAGNOSIS 4 46 23 50.0 2.82*** 3 26 13 50.0 2.17 2 14 5 35.7 1.22 1 31 8 25.8 0.77 0 5 1 20.0 0.46 disease progression (<3 months BEFORE COVID-19) Yes 38 22 57.9 4.60*** No 84 28 33.3 1.07 SACT (<3 months BEFORE COVID-19) Yes 53 69 34.0 1.49 No 69 32 46.4 1.80** *p<0.05 **p<0.01 ***p<0.001ConclusionAmong patients with cancer and COVID-19, mortality was high and associated with cancer-specific features. There was no evidence cancer patients on systemic anti-cancer treatments possessed higher mortality from COVID-19 disease, which correlates with findings from COVID-19 and cancer registries1. Patients that did not receive SACT within 3 months before COVID-19 and therefore more likely to have palliative treatment did demonstrate high mortality. Larger studies are needed to confirm the risk of mortality and timing of SACT before COVID-19 disease.ReferenceLee AJ, et al. British Journal of Cancer 2021;124:1777–1784.","PeriodicalId":286165,"journal":{"name":"The wider impact of the pandemic","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123388962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P108 Annual physiotherapy reviews in a specialist respiratory clinic for bronchiectasis: the impact of COVID-19 on an already strained workforce","authors":"F. Livingstone, R. Wagstaff, F. Rauf, A. Sullivan, L. Gardiner, R. Colclough","doi":"10.1136/thorax-2021-btsabstracts.217","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.217","url":null,"abstract":"P108 Table 1Delivery of annual physiotherapy reviews before and during COVID-19Year Patients for review Patients reviewed % patients reviewed 31/03/2019–2020 392 226 57.7 01/04/2020–2021 408 130 31.9 ConclusionThe respiratory workforce has been central in the acute response to COVID-19, whilst reduced provision of pulmonary rehabilitation and specialist respiratory clinics has led to a significant reduction in access to care for patients with chronic respiratory conditions reliant on highly specialised management. It is anticipated that the consequences on chronic disease burden will continue to unfold long after the pandemic has been controlled.This research identifies a significant unmet need of physiotherapy within a specialist respiratory service, exacerbated by COVID-19. A wider exploration into respiratory workforce nationally will help to further understand the increased need in a COVID-19 world.ReferencesBTS. British Thoracic Society Guidelines for Bronchiectasis in Adults. Thorax, 2019 December;74(1):3.Chudasama Y., et al. Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals. Diabetes Metab Syndr. 2020;14(5):965–967.NHS. The NHS Long Term Plan. 2019. [Online] Available at: www.longtermplan.nhs.uk [Accessed 15 June 2021].","PeriodicalId":286165,"journal":{"name":"The wider impact of the pandemic","volume":"25 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131652769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P106 The impact of technician-led virtual spirometry sessions on the availability and quality of home spirometry results in a virtual Cystic Fibrosis clinic","authors":"C. Long, T. Modzelewski, NJ Bell","doi":"10.1136/thorax-2021-btsabstracts.215","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.215","url":null,"abstract":"IntroductionSpirometry is an essential component of monitoring the health of people with Cystic Fibrosis (CF). Since the Covid-19 pandemic, most consultations have been conducted via video conferencing. All appropriate patients were given MIR Spirobank® portable spirometers (MIR Medical International Research Srl) and asked to send in readings before each clinic. We noticed a fall in the number and quality of spirometry reports available to clinicians in virtual clinics compared to face-to-face reviews. We set out to improve this through a Respiratory Physiologist-led virtual spirometry clinic.MethodsSpirobank® spirometry reports (including grading of quality using ATS/ERS criteria1) provided by patients attending virtual CF clinics in our CF centre in January 2021 were reviewed. Following this review, a virtual spirometry clinic was established (running before the main clinic) in which the patient performs spirometry via the ‘Live Video Exam’ app on their mobile device, coached by a Physiologist who is able to see the patient via their mobile phone camera and view spirometry flow loops in real time, downloading results ready for the subsequent clinic. Review of spirometry available for clinics in May 2021 was then performed and the number and quality of reports available compared.ResultsSpirometry reports were available for 35 out of 70 appointments for patients with Spirobank® devices in January 2021, of which 26/70 (37%) were ATS grade A or B. In May 2021, 50 patients with devices had clinic appointments: 9 provided reports independently (7 grade A or B), 37 were coached by a physiologist (31 A or B), and 4 did not attend or declined a coaching session.ConclusionWithout coaching, only 37% patients with a Spirobank® device provided ATS grade A or B spirometry for virtual CF clinics;this increased to 76% with the introduction of pre-clinic online Respiratory Physiologist coaching sessions.We plan to review how the number and quality of reports provided with and without coaching changes as patient experience in the use of home spirometers increases.ReferenceStandardization of Spirometry 2019 Update. American Journal of Respiratory & Critical Care Medicine 2019;200(8):e70–e88.","PeriodicalId":286165,"journal":{"name":"The wider impact of the pandemic","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124400544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P102 Psychosocial themes of the impact of the COVID-19 pandemic and shielding in adults and children with early-onset neuromuscular disorders and their families","authors":"L. Spurr, H. Tan, R. Wakeman, M. Chatwin, A. Simonds","doi":"10.1136/thorax-2021-btsabstracts.211","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.211","url":null,"abstract":"IntroductionMost patients with early-onset neuromuscular disorders (NMDs) were advised to shield during the pandemic due to assumptions that treatments e.g. corticosteroids, or complications e.g. pre-existing respiratory failure would increase COVID-19 risk. It remains poorly understood how those with NMDs and their families approached and responded to risk mitigating strategies e.g. shielding. We aimed to determine themes describing the psychosocial impact of the COVID-19 pandemic and measures taken to reduce risk in this population.MethodsIn-depth questionnaires specifically designed to meet research aims were completed by telephone between September 17th and December 31st 2020 by patients with NMDs or their parent. Inductive thematic analysis was performed to first code transcriptions of audio recordings of questionnaires then develop candidate themes by exploring coded data. Candidate themes were evaluated against the original data set before defining final themes: participant validation was sought to provide additional confirmation of accuracy.Results40 questionnaires were completed: patients were 70% male, aged 2 to 48 years with NMDs e.g. muscular dystrophies, spinal muscular atrophy. 80% required long-term non-invasive or tracheostomy ventilation. Three themes were identified: 1) concern regarding the health impact of COVID-19;2) perceptions of strategies to prevent SARS-CoV-2 transmission;3) psychological impact of the COVID-19 pandemic. Anxiety, fear and worry were the most frequently reported emotions, particularly in relation to health risk of COVID-19, but level and pervasiveness fluctuated during the pandemic. Strict adherence to shielding was reported at the start of the pandemic but was often relaxed due to 1) official guidance, 2) emerging evidence of less severe outcomes in children and NMD cohorts, and 3) unsustainability of limited social contact including cessation or reduction in personal care. Concern about hospital attendance during the pandemic, and anxiety regarding perceived lack of access to Intensive Care were common.ConclusionsMeasures to reduce transmission of COVID-19 have disproportionally affected patients with NMDs and their families. For most, negative psychosocial impacts have and will continue to improve, particularly due to the success of the vaccination programme. These aspects should be considered when advising patients and families on risk and risk-mitigating strategies during the current and future pandemics.","PeriodicalId":286165,"journal":{"name":"The wider impact of the pandemic","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123611824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P99 COPD patients’ knowledge, training and adherence with inhalation therapies during COVID-19","authors":"A. Rohatgi, S. Meah, O. Usmani","doi":"10.1136/thorax-2021-btsabstracts.208","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.208","url":null,"abstract":"P99 Table 1Changes in self-reported knowledge, training, and adherence regarding inhaled therapies during COVID-19. Pattern analysis of participants reporting change in adherence indicates the role of patient emotions, beliefs, and experiences. Six reasons inducing adherence-promoting or adherence-limiting behaviour were identified.Participant identifier Change in knowledge Change in training Change in adherence Reason(s) for change in adherence 2 No change No change Fear of contracting COVID-19 22 Decreased Decreased Worsening of symptoms during COVID-19 30 No change No change Fear of contracting COVID-19;Worsening of symptoms during COVID-19 38 No change No change Increased Motivation from awareness of COPD as a COVID-19 risk factor 49 Increased No change Perception of high therapeutic benefit from new prescription during COVID-19;Motivation from awareness of COPD as a COVID-19 risk factor 17 Decreased Decreased Social isolation/depression and neglectful of COPD treatment during COVID-19 23 No change No change Decreased Improvement in symptoms during COVID-19 28 No change Decreased Social isolation/depression and neglectful of COPD treatment during COVID-19 ConclusionsDisparities between patients’ perceived and actual knowledge, deficiencies in training delivered, and potential for more appropriate inhalation device selection exist. COVID-19 induces bidirectional change in adherence;the impacts of ‘shielding’ and disruption to routine care may limit positive change. Although a larger study is required to confirm statistical significance, these findings warrant improved patient education provision.","PeriodicalId":286165,"journal":{"name":"The wider impact of the pandemic","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125016623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P111 The impact of COVID-19 on a tertiary interventional bronchoscopy service","authors":"A. Bhamani, Ryan Basith Fasih Khan, R. Shea, R. Thakrar, S. Janes, N. Navani","doi":"10.1136/thorax-2021-btsabstracts.220","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.220","url":null,"abstract":"P111 Figure 1Monthly percentage change in referrals during pandemic from pre-pandemic year. National trend in COVID-19 cases in background for comparison[Figure omitted. See PDF]ConclusionsThe data shows the impact of the pandemic on our tertiary service with an increase in referrals over the year following the first lockdown. More patients required emergency inpatient transfers and a higher proportion required airway stents reflecting more advanced and symptomatic disease. Unsurprisingly, the busiest months followed the national peaks of COVID-19 cases. The public health messaging required to control the pandemic, although necessary, coupled with an overlap of symptoms has resulted in an increase in presentations of life-threatening MCAO. This highlights the importance of early detection of lung cancer and recognition of symptoms of central airway obstruction.","PeriodicalId":286165,"journal":{"name":"The wider impact of the pandemic","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122640655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P101 Mortality in patients requiring home mechanical ventilation during the COVID-19 pandemic: experiences of a regional specialist ventilation unit","authors":"R. D'Cruz, N. Shah, A. Learoyd, O. J. Elias, M. Mackie, N. Weston, G. Kaltsakas, E. Suh, P. Marino, M. Ramsay, S. Srivastava, H. Pattani, J. Steier, N. Hart, P. Murphy","doi":"10.1136/thorax-2021-btsabstracts.210","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.210","url":null,"abstract":"P101 Figure 1(A) Monthly mortality of patients under Lane Fox Respiratory Service follow-up, dotted lines represent upper and lower bounds of 95% confidence intervals (B) Proportion of home mechanical ventilation (HMV) users in each disease category who died between 1st March and 30th ApriI by year[Figure omitted. See PDF]ConclusionsDeaths amongst HMV users at our regional ventilation centre were highest in the first two months following the onset of the COVID-19 pandemic. A subsequent fall in mortality may relate to effective shielding advice following national lockdown and departmental guidance offered. The majority of deaths were in patients with obesity-related respiratory failure. These data support previous observations that obesity is a major risk factor for adverse outcomes in patients with COVID-19.","PeriodicalId":286165,"journal":{"name":"The wider impact of the pandemic","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123612419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P112 The impact of Covid-19 pandemic on lung cancer diagnosis and treatment at St George’s Hospital","authors":"D. Jajbhay, J. Arberry, J. Gates, J. Panguiton, E. Yarham, Y. Ong, A. Draper","doi":"10.1136/thorax-2021-btsabstracts.221","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.221","url":null,"abstract":"P112 Figure 1Lung cancer by clinical stage pre and during COVID-19 pandemic[Figure omitted. See PDF]ConclusionThe Covid pandemic had a major impact on our lung cancer service. A noticeable reduction in early stage (IA1- IIB) lung cancers were seen from 126 (44%) to 81 (39%). It can be postulated that during the Covid-19 pandemic, there was a reduction in routine CT scanning for other organs, which often picks up incidental early stage lung cancers. So far there has not been an increase in the numbers of later stage cases, but it can be hypothesised that these patients may present in the coming months as they are unlikely to become symptomatic within a year with early lung cancers. There is an important cohort of patients with early stage disease suitable for radical treatment that may have been missed since Covid-19 started and measures should be put in place to try to identify them as soon as possible.","PeriodicalId":286165,"journal":{"name":"The wider impact of the pandemic","volume":"283 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124527438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}