23 McGrotty, Kathryn
Archives of disease in childhood,
08/2022, Letnik:
107, Številka:
Suppl 2
Journal Article
Recenzirano
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
In assessing the global impact of the COVID-19 pandemic on society, it is important to understand the communities most affected and develop methods of support. Family carers ...provide a vital, yet often invisible role in our society and healthcare system. Identifying research priorities for carers helps establish overall gaps in the research agenda and increases awareness of the role of carers in the community.
Methods
A priority setting partnership methodology was engaged and through collaboration with carers, healthcare professionals and researchers, a participatory process was conducted to identify gaps in the current literature and prioritise research questions and uncertainties. Focus group discussions followed, the first consisted of family carers (n = 5). The second (n = 3) interviewed stakeholders namely healthcare professionals, researchers and policy makers. After collating the data, researchable questions were developed through an iterative process with a Multi Stakeholder Advisory Committee to identify the top 10 research priorities for Family Carers Ireland.
Results
The top 10 researchable questions were distilled from a list of 16 and fit into 7 broad categories. 1) economic impact and financial strain 2) Systemic issues, education, resources and policy 3) technology 4) support services and infrastructure 5) mental health and wellbeing of the carer 6) carers in society 7) Recognition and acknowledgment of the family carer.
Conclusion
The partnership focus of this project allowed the ‘ground-up’ development of research priorities for carers by carers. The COVID-19 pandemic served to magnify systemic issues already present in society, as well as highlight new burdens. As a result, the subsequent development of 10 researchable questions will guide further investigation to improve the support and wellbeing of family carers.
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 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.
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