23 McGrotty, Kathryn
Archives of disease in childhood,
08/2022, Volume:
107, Issue:
Suppl 2
Journal Article
Peer reviewed
AimsTo review the glycaemic control of type 1 diabetic patients attending the paediatric and transition adolescent diabetes clinic within NHS Lanarkshire during the coronavirus pandemic.MethodsA ...quantitative analysis of 348 patients attending the paediatric and transition adolescent diabetes clinics within NHS Lanarkshire was carried out. Data collected included age, sex, date of diagnosis and insulin delivery device. Comparing these measures to the Scottish Index of Multiple Deprivation (SIMD) of the patient. Patient data was anonymised within a single data collection sheet.Results94% of patients across both clinics (n=298) attended a consultation during lockdown, before returning to school in August. Within the paediatric diabetes clinic, results from 199 patients were analysed. 30.65% (n=61) patients experienced a rise in their HbA1c over lockdown whilst 65.32% (n=130) of patients reduced their HbA1c. In this cohort, the mean HbA1c before lockdown compared to after lockdown was 3.77mmol/mol (95% CI 1.93, 5.61; P=0.000). 90 sets of patient data were analysed from the transition adolescent diabetes clinic. 27.78% (n=25) of patients had a rise in their HbA1c and whilst patients from this clinic gained tighter glycaemic control over lockdown. The mean HbA1c pre-lockdown compared to post-lockdown in this clinic reduced by 4.67mmol/mol (CI: +1.35, +7.99, P= 0.006). Patients residing in SIMD quintiles 3-5 had the greatest improvement in HbA1c over lockdown.ConclusionGlycaemic control of patients within the NHS Lanarkshire paediatric diabetes clinics improved over lockdown. There was a mean reduction in HbA1c over the lockdown period. Repeating this audit in a year would be beneficial to see how returning to school and further local lockdowns affected the glycaemic control of paediatric patients.
Abstract Background The COVID-19 pandemic forced healthcare management to make structural adaptations in the interest of infection control. One such adaptation is the introduction of ward-based ...medical teams. The multidisciplinary team (MDT) is one of the cornerstones of geriatric medicine. Therefore, we aimed to explore the perception of the care of the older person MDT on the introduction of ward-based medical teams. Methods Qualitative data was collected on a geriatric ward in October 2020 via written questionnaire. The questionnaire analysed how the transition to ward based medical teams was perceived in terms of inter-professional collaboration and clinical service delivered to patients. Results There were 14 respondents, 10 of whom were nursing staff (71%). 86% strongly agreed that the medical team was more accessible, with most interactions occurring face-to-face. Patient care and safety was thought to have improved, 79% and 71% of respondents respectively. 93% felt they had a better rapport with the medical team. 71% felt the MDT meeting is more effective, 57% believed the meeting had greater impact on patient care. However, 93% felt there was less workspace. 21% believed there were more daily admissions and 57% felt the majority of patient transfers from other wards were inappropriate. Overall 86% favoured ward-based medical teams, with 57% of staff reporting that the change led to increased personal job satisfaction. Conclusion By increasing the geographic proximity of doctors to other professionals, doctors were more accessible, issues were tackled quicker, and there was less time wasted bleeping medical teams. Overall staff favoured a ward-based system. However, there are challenges implementing this system. Particular attention should be paid to the availability of adequate workspace, including telephones and computers. Ward transfers should be minimized as continuity of care can be compromised. Strategies should be implemented so medical charts are available to the MDT during consultant-led ward rounds.
Abstract Background Whilst age and frailty are independently associated with mortality in COVID-19 illness, the underlying immunological mechanisms explaining this remain unexplored. We aimed to ...explore the impact of age and frailty on the acute immune response to COVID-19 illness. Methods We recruited older (aged 65+; n = 33) and younger (aged 20–50; n = 43) participants with acute COVID-19 illness for clinical assessment and detailed immunophenotyping for T-cell, neutrophil, monocyte and inflammatory markers using flow cytometry. We additionally assessed circulating levels of several important pro-inflammatory cytokines. Wilxocon rank-sum, chi-square tests and linear regression were used to examine the impact of age and frailty (Clinical Frailty Score 3–9) on the immune response in COVID-19 illness. Results were compared to age-matched pre-pandemic controls (n = 40). Results COVID-19 illness was associated with a marked pro-inflammatory response (raised CRP, IL-6, IL-2R), lymphopenia and emergency myelopoesis (an expansion of non-classical/intermediate monocytes and immature neutrophils) in both age groups (all P < 0.001). In comparison to younger participants (35.7 ± 8.6 years), older adults (76.7 ± 7.8 years) had a more marked reduction in naïve CD4+ and CD8+ cells and a more marked expansion of activated CD4+, CD8+ and effector CD8+ T-cells (all P < 0.001). These findings were independent of illness severity (all P < 0.001). In comparison to their younger counterparts, older adults had a reduced number of CD10+ neutrophils/non-classical monocytes and greater CRP, IL-6 and IL-2R (P < 0.05), although results were attenuated on adjusting for COVID-19 severity. Frailty was not associated with any significant difference in immune cell population or pro-inflammatory response in acute COVID-19 illness. Conclusion Increasing age, but not frailty status, was associated with reduced naïve T-cells and a more marked expansion of activated/effector T-cells in acute COVID-19 illness. These findings have important implications for understanding impact of age on anti-viral and pro-inflammatory immune responses.
Abstract Background The COVID-19 pandemic disproportionately affected older people and had a profound impact on the nursing home and residential care sector. COVID-19 also exposed weaknesses in how ...our health systems support the nursing home sector that must be addressed. The National Public Health Emergency Team recommended the establishment of an Expert Panel to examine the issues regarding the management of COVID-19 in nursing homes. A report was published in August 2020 that contains a range of recommendations in line with lessons learned and best practice, to be implemented over the following 12–18 months. Methods A review and analysis of the COVID-19 Nursing Homes Expert Panel Report and its 86 recommendations took place to understand the impact of implementing the recommendations on the nursing home sector, to understand the supports required to implement the recommendations and to outline an implementation framework to deliver the recommendations and to realise a sustainable change. Results The impact Assessment revealed the following: 1. Community integration is required where nursing home residents have greater access to services and where adequate supports and collaboration across the continuum of care is realise. 2. A workforce strategy is required that considers recruitment, retention, training and education. 3. A funding model that ensures funding is based on an assessment of resident need and dependency level is required. Conclusion While the long-term timeline and impacts of COVID-19 are still unknown, it is clear that health and social care services need to plan for future healthcare emergencies and the long-term sustainability of the nursing home sector. This pandemic and the Expert Panel’s recommendations have reinforced the urgent need to create systems where collaborative actions and integrated care is resident focussed and will ensure ‘care is better planned, coordinated, delivered and easier to access.
Abstract Background Older people have been disproportionately affected by the COVID-19 pandemic with reports suggesting that many older people deferred seeking healthcare during the pandemic due to ...fear of contracting COVID-19. The aim of this study was to examine trends of emergency department (ED) use by older people during the first wave of the COVID-19 pandemic compared to previous years. Methods The study site is a 1,000-bed university teaching hospital with annual ED new-patient attendance of >50,000. All ED presentations of patients aged ≥70 years from March–August 2020, 2019 and 2018 inclusive (n = 13,989) were reviewed and compared for presenting complaint, Manchester Triage Score, and admission/discharge decision. Results There was a 16% reduction in presentations across the 6 months in 2020 compared to the average of 2018/2019. On average 4 fewer people aged ≥70 years presented to the ED per day in 2020. Much of this was concentrated in March (33% fewer presentations) and April (31% fewer presentations), when the country was in ‘lockdown’, i.e. non-essential journeys were banned. There was a 20% reduction in patients presenting with stroke and cardiac complaints. In the three months following easing of restrictions, there was a 25% increase in falls and orthopaedic injuries when compared to 2018/2019. Conclusion This study demonstrates a significant decline in the number of older people presenting to the ED for unscheduled care, including for potentially time-dependent illnesses such as stroke or cardiac complaints. Presenting to the ED remains the most frequent route by which unwell older people access acute hospital care and it is vitally important that they continue to do so in a timely manner when necessary. Given the possibility of further lockdowns and restrictions, this message needs to be communicated to older people clearly by healthcare professionals and governmental bodies to mitigate against adverse outcomes related to delayed or deferred care.
Abstract Background The COVID-19 pandemic fundamentally changed the way rehabilitation services are delivered, with focus placed on individual in-room therapy and cessation of group sessions. Sparks ...Innovation and National Lottery funding was obtained to implement the ‘In-Room Rehabilitation and Well-being Initiative’. This provided patients with individual physiotherapy equipment to use in their room thus maximizing time spent active during periods of isolation. We aim to describe service innovation occurring in a post-acute geriatric rehabilitation hospital during the COVID-19 era, and the resultant patient outcomes. Methods Rehabilitation was provided to patients in-line with evidence-based practice and national infection prevention and control guidelines. Patients who were deemed appropriate by the multi-disciplinary team were provided with in-room therapy equipment. Prospective data was collected on service and patient outcomes. Functional outcome measurements were collected on admission and discharge and compared using a paired t-test. Results Rehabilitation was provided to 260 patients, average age 80.5 years (range 63–98) with 46.5% male. The majority of patients were admitted with ortho-geriatric diagnoses or general deconditioning following illness (70%). The patients were complex with multiple medical, functional, and psychosocial care needs, as indicated by an average Rehabilitation Complexity Score of 11/20, with 100% of patients requiring daily therapy. Average length of stay (LOS) was 30.7 days (range 3–169), with 85% of patients discharged home. Performance in activities of daily living (Barthel Index: 62 vs 79, p < 0.0001), and mobility (Cumulative Ambulatory Score: 3.8 vs 5.3, p < 0.0001) significantly improved from admission to discharge. Conclusion Despite ward closures, disruption to rehabilitation due to COVID-19 illness, and limitations on group therapies, our service achieved positive patient outcomes through innovation and delivery of high-quality evidence-based rehabilitation. Compared to the past eight years, 2020 had the lowest LOS and highest number of patients discharged home.
Abstract Background Simulation-based medical education (SBME) is emerging as a key method of medical education, particularly in the setting of the COVID-19 pandemic. As part of a simulation ...development competition (SimStars) run by the National Doctors Training and Planning Unit and the South–South West Hospital Group, we brought together an inter-disciplinary team to develop a simulation scenario on hip fracture. Methods Our development team consisted of members of the Geriatric Medicine and Orthopaedic Departments. We developed a scenario that can be adapted to suit the needs of learners in orthopaedics, medicine, or nursing. We ran the simulation on a medical ward with one candidate and four facilitators from the Geriatric Medicine Department. The candidate (medical SHO) was presented with a patient (facilitator one), who had sustained a hip fracture following a fall. The candidate was directed to elicit a falls and bone health history, screen for delirium, and suggest further investigations and management. Subsequently, feedback was sought from all participants. Results The simulation took twenty minutes, debriefing took fifteen minutes. All considered, the simulation an enjoyable and feasible method for teaching and learning, and a novel way to promote team-building. The candidate felt competent in some areas, reporting that the scenario provided positive reinforcement. She reported feeling supported in identifying areas for further learning. The facilitators also considered this method a useful way to highlight a candidate’s learning needs and direct further teaching. The candidate requested further SBME-based sessions. Conclusion This SBME session in Ortho-Geriatrics was well-received by the candidate and facilitators. All participants enjoyed teaching and learning through this medium. Areas of high competency were reinforced and areas for future learning were identified. Further SBME was requested across more topics and for simulation training to be brought in as part of formal training.
