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At various stages of the COVID-19 pandemic, face coverings have been recommended and encouraged as one of the interventions to reduce transmission of the SARS-CoV-2 virus. However, in the earlier stages of the pandemic, decisions on face coverings relied primarily on evidence based on other viral respiratory infections. More direct evidence on the use of face coverings with COVID-19 developed in tandem with the pandemic.
Health Technology Wales undertook an ultra-rapid review to inform national guidelines, the work assessed the evidence on the effectiveness of face coverings to reduce SARS-CoV-2 transmission. We also reviewed evidence on the efficacy of different types of face coverings.
We conducted a systematic literature search for evidence to address (i) the effectiveness of face coverings to reduce the spread of COVID-19 in the community, and (ii) the efficacy of different types of face coverings designed for use in community settings. We identified a rapid review in 2021 by Public Health England that closely aligned with our review questions. This provided the main source for identifying relevant studies, supplemented by a search for publications following their search date.
We identified two evidence reviews (including the Public Health England review) that examined the effectiveness of face coverings on reducing transmission of SARS-CoV-2; reporting on 31 and 39 studies, respectively. Two further primary studies were published after the two evidence review searches were included. Overall, the evidence suggested that face coverings may provide benefits in preventing SARS-CoV-2 transmission, although the higher-quality studies suggested that these benefits may be modest. Medical masks appeared to have higher efficacy than fabric masks, although the evidence was mixed.
At the time of this review, evidence on the effectiveness of face coverings remains limited and conclusions rely on low-quality sources of evidence with high risk of bias, although higher-quality evidence points to some benefit. Face coverings may play a role in preventing transmission of SARS-CoV-2, particularly as part of a bundle of other preventative measures.
The authors designed a simulation training programme for foundation doctors beginning psychiatry placements across a large mental health trust. The simulation training aimed to improve the confidence, competence, and well-being of foundation doctors through exposing them to realistic psychiatry scenarios and teaching clinical skills in a safe environment.
Four clinical scenarios were filmed with a 360-degree camera, professional actress, and doctors working in psychiatry. The scenarios depicted the journey of a patient being admitted onto a psychiatry ward from the community. Various clinical skills were embedded into the videos including psychiatric history taking, risk assessment, managing acute distress, managing comorbid physical and mental health problems, using the Mental Health Act, and teamwork with colleagues. All videos were delivered to learners using simulation with head-mounted-displays (HMDs). Each video lasted 6–8 minutes and was accompanied by pre-briefing and de-briefing with experienced psychiatrists for a further 15–20 minutes. Participants rated their confidence regarding several skills in psychiatry on Likert scales from 1 to 5 immediately before and after the session. Wilcoxon signed rank tests were conducted to detect statistically significant differences in learner's median confidence ratings before and after the training. Free-text questions explored trainee's most and least favourite aspects of the simulation. A survey also was distributed to learners 2-months after the training to assess how it had influenced their clinical practice.
20 foundation doctors completed the training and provided feedback. Following the simulation training, there were statistically significant improvements in foundation doctor's confidence in: completing psychiatric assessments (p < 0.01), managing physical health problems in psychiatry (p < 0.05), managing acute distress (p < 0.01), reporting information to senior colleagues (p < 0.05), and containing anxiety when communicating with patients (p < 0.05). Trainees highlighted the debriefing, group discussions, and “interactive” simulation videos as the most useful aspects of the training. Some trainees enjoyed viewing the 360-degree videos, whilst others found the HMDs difficult to use. Of the 8 trainees who completed feedback 2 months after the training, 7 (87.5%) felt that it had helped them in their current roles. All trainees agreed (37.5%) or strongly agreed (62.5%) that the simulation scenarios were closely aligned to real-life clinical encounters.
Simulation training in psychiatry using 360-degree videos and HMDs is generally well-received amongst foundation doctors. Embedding simulation training into placement induction can improve the confidence and skills of junior doctors starting psychiatry placements.
We investigated risk factors associated with COVID-19 by conducting a retrospective, frequency-matched case-control study, with three sampling periods (August–October 2020). We compared cases completing routine contact tracing to asymptomatic population controls. Multivariable analyses estimated adjusted odds ratios (aORs) for non-household community settings. Meta-analyses using random effects provided pooled odds ratios (pORs). Working in healthcare (pOR 2.87; aORs 2.72, 2.81, 3.08, for study periods 1–3 respectively), social care (pOR 4.15; aORs 2.46, 5.06, 5.41, for study periods 1–3 respectively) or hospitality (pOR 2.36; aORs 2.01, 2.54, 2.63, for study periods 1–3 respectively) were associated with increased odds of being a COVID-19 case. Additionally, working in bars, pubs and restaurants, warehouse settings, construction, educational settings were significantly associated. While definitively determining where transmission occurs is impossible, we provide evidence that in certain sectors, the impact of mitigation measures may only be partial and reinforcement of measures should be considered in these settings.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) has high morbidity and mortality in older adults and people with dementia. Infection control and prevention measures potentially reduce transmission within hospitals.
We aimed to replicate our earlier study of London mental health in-patients to examine changes in clinical guidance and practice and associated COVID-19 prevalence and outcomes between COVID-19 waves 1 and 2 (1 March to 30 April 2020 and 14 December 2020 to 15 February 2021).
We collected the 2 month period prevalence of wave 2 of COVID-19 in older (≥65 years) in-patients and those with dementia, as well as patients’ characteristics, management and outcomes, including vaccinations. We compared these results with those of our wave 1 study.
Sites reported that routine testing and personal protective equipment were available, and routine patient isolation on admission occurred throughout wave 2. COVID-19 infection occurred in 91/358 (25%; 95% CI 21–30%) v. 131/344, (38%; 95% CI 33–43%) P < 0.001 in wave 1. Hospitals identified more asymptomatic carriers (26/91; 29% v. 16/130; 12%) and fewer deaths (12/91; 13% v. 19/131; 15%; odds ratio = 0.92; 0.37–1.81) compared with wave 1. The patient vaccination uptake rate was 49/58 (85%).
Patients in psychiatric in-patient settings, mostly admitted without known SARS-CoV-2 infection, had a high risk of infection compared with people in the community but lower than that during wave 1. Availability of infection control measures in line with a policy of parity of esteem between mental and physical health appears to have lowered within-hospital COVID-19 infections and deaths. Cautious management of vulnerable patient groups including mental health patients may reduce the future impact of COVID-19.
To explore the level of supervision between training and non-training posts at LSCFT.
• Supervision is defined as ‘provision of guidance and feedback on matters of personal, professional and educational development in the context of a trainees' experience of providing safe and appropriate patient care’.
• Along with the trainees, doctors working in non-training posts such as staff grade, specialty doctors, trust grade doctors (TJD)and MTI (Medical training initiative) doctors form an integral part of patient care in the NHS.
• A mixed method approach was adopted with both qualitative and quantitative data collected simultaneously in the form of an online questionnaire.
• An anonymous online questionnaire was sent to junior doctors currently in training and non-training posts at LSCFT in 2019 using Meridian software.
1- Quantitative Data: - Participants included were doctors in training post such as Foundation Doctors (5), Psychiatry Core Trainees (6), GP STs (2) and doctors in non-training post such as TJD (4), Specialty Doctors (2) and MTI doctors (4). Based on the Meridian score, 84% of doctors were satisfied with the supervision. It was found that 72% of doctors received weekly supervisions, 10% monthly (1 TJD, 1 Foundation trainee) and16% bi-monthly (1 MTI, 1 SAS, 2 CTs). The data suggested that there was no difference in the frequency of supervisions between training and non-training posts at LSCFT.
2- Qualitative Data: - The feedback was common as there was no major difference between training and non-training doctors.
• Positives – WPBAs, discussion on reflections, management of complex cases and medication, personal issues affecting work.
• Negatives – Limited discussion on QI, Audit, Research and Psychotherapy.
- More specific help, need more support at times.
1. To prepare a checklist of contents to be discussed during supervision.
2. To prepare a timeline chart of supervision.
3. Preparing a ‘menu’ of QI projects that junior doctors can sign up to at the start of each post.
4. To formulate training packages available to support junior doctors with QI/Audits.
Neurosurgical services in the UK are organised regionally into 34 acute neuroscience centres. Brain injury, both traumatic and non-traumatic, is common, and patients often present to local hospitals requiring further treatment in a neuroscience centre. Between April 2014 and June 2015, 15 820 patients suffered a traumatic brain injury in the UK. Of these, 6258 were transferred directly to a neuroscience centre, 5880 were not admitted to a neuroscience centre and 3682 underwent a secondary transfer from the admitting hospital to a neuroscience centre.1 In addition to traumatic brain injury, indications for non-traumatic causes of brain injury requiring acute transfer to a neuroscience centre continue to increase.
Management strategies for pulmonary atresia with intact ventricular septum are variable and are based on right ventricular morphology and associated abnormalities. Catheter perforation of the pulmonary valve provides an alternative strategy to surgery in the neonatal period. We sought to assess the long-term outcome in terms of survival, re-intervention, and functional ventricular outcome in the setting of a 26-year single-centre experience of low threshold inclusion criteria for percutaneous valvotomy.
Methods and results:
Retrospective analysis of patients diagnosed with pulmonary atresia with intact ventricular septum from 1990 to 2016 at a tertiary referral centre, was performed. Of 71 patients, 48 were brought to the catheterisation laboratory for intervention. Catheter valvotomy was successful in 45 patients (94%). Twenty-three patients (51%) also underwent ductus arteriosus stenting. The length of intensive care and hospital stay was significantly shorter, and early re-interventions were significantly reduced in the catheterisation group. There were eight deaths (17%); all within 35 days of the procedure. Of the survivors, only one has required a Fontan circulation. Twenty-eight patients (74%) have undergone biventricular repair and nine patients (24%) have one-and-a-half ventricle circulation. Following successful valvotomy, 80% of patients required further catheter-based or surgical interventions.
A low threshold for initial interventional management yielded a high rate of successful biventricular circulations. Although mortality was low in patients who survived the peri-procedural period, the rate of re-intervention remained high in all groups.
This chapter tells the story of a research-engagement project called Making, Mapping and Mobilising in Merthyr (otherwise known as the 4Ms project). The project explored young people's sense of place and well-being while growing up in Merthyr Tydfil (hereafter referred to as Merthyr), a small post-industrial ex-mining and steel-making town of roughly 58,000 people in the South Wales Valleys. Once a hub of industrial activity and innovation, along with other geographically close regions, Merthyr has experienced a deep social rupture in recent years owing to deindustrialisation and the closure of ironworks, coal mines and manufacturing industries that had served as cultural links underpinning the rhythms and rituals of Valleys life (Walkerdine and Jimenez, 2011; Ivinson, 2014). Our project took place predominantly in a housing estate based on a design reputed to have been inspired in the 1950s by romantic Italian hilltop villages. The estate expanded in the 1970s, and by the 2000s, had become dilapidated and a place with high levels of unemployment. In a context of tightening austerity, this housing estate and the people living there have been subject to stigmatising media accounts fuelled by television's ‘poverty porn’ industry (Tyler, 2015) and, at times, by local residents themselves (Byrne et al, 2016; Thomas, 2016). The ‘realities’ of poverty tend to be portrayed in popular media through no-hope narratives of despair (Thomas, 2016; Thomas et al, 2018).
In contrast to other projects in the Productive Margins programme, the 4Ms project did not set out to investigate a specific element of regulation. Rather, we approached regulation as it occurred through the everyday experiences of living in a place that is in many ways at the margins, in terms of the explicit as well as the hidden effects and affects of poverty. The initial aim of the project was thus to attune to young people's knowledge as experts of living in this post-industrial place and to co-create research methods and encounters in order to find out how a range of regulatory regimes mediate and impact on their everyday lives.
The 4Ms project took shape across a series of three overlapping phases. We began by exploring the affective contours of the young people's neighbourhoods (Thomas, 2016).
Addressing inequalities between mental and physical healthcare in older adult healthcare is imperative for safe patient care. This evaluation of services at The Harbour mental health hospital, Blackpool, UK gives insight into parity of esteem and prompts investigation into the clinical decisions of doctors working in older adult mental healthcare.
Pulmonary valve stenosis is common in patients with Noonan’s syndrome. The response to balloon valvoplasty varies.
We assessed the correlation between re-intervention rate, immediate response, and the progress of the valve gradient over time after intervention.
This is a retrospective study conducted from 1995 to 2014.
Of 14 patients identified, seven had re-intervention 28±54 months (range 3–149, median 3.3) after valvoplasty. These patients did not have a significant decrease in gradient after intervention. Their gradient subsequently decreased during follow-up and then became static before increasing years after intervention. In contrast, the gradient of patients not requiring further intervention continually reduced over time. Demographics did not differ between these groups.
We could not identify predisposing factors for long-term success of pulmonary valvoplasty in Noonan’s patients, but the trajectory of gradients differs significantly between patients needing re-intervention from those who remain free from re-intervention.
We describe the successful use of recombinant factor VIIa (rFVIIa) in the control of massive haemoptysis in a 17-year-old patient with a Fontan circulation. The patient was intubated and ventilated in the ICU with deteriorating gas exchange. Conventional methods to control the haemoptysis were ineffective, and rFVIIa was successfully administered as a rescue therapy. rFVIIa is a powerful pro-thrombotic agent, which is only licensed in haemophiliacs with acquired inhibitors to anticoagulation. It has been used off-license in the treatment of massive haemorrhage, although a Cochrane review did not show any significant benefit; however, it may have a role as a rescue therapy where alternatives options have been exhausted after careful risk–benefit analysis.
This study extends the limited body of research exploring the association between psychological resources and performance under pressure. It was anticipated that participants’ general self-efficacy and resilience would positively influence skill acquisition rate more under high pressure, than low pressure. Eighty-one undergraduate students (Mage = 22.93; SD = 7.53; 50.6% female) participated in a learning task: to fly a flight simulator. The within-subjects variable was the participant's ability to steadily control the aircraft roll across six trials. Psychological pressure was manipulated between-subjects and general self-efficacy and resilience were measured moderator variables. Findings indicated that under high pressure, higher levels of general self-efficacy and perceived resilience predicted faster initial skill acquisition compared to those with lower levels of these resources. In contrast, in the low-pressure condition, the skill acquisition rate was the same irrespective of psychological resources. This research highlights the importance of psychological resources in pressured training contexts.
We aimed to compare the procedural and mid-term performance of a specifically designed self-expanding stent with balloon-expandable stents in patients undergoing hybrid palliation for hypoplastic left heart syndrome and its variants.
The lack of specifically designed stents has led to off-label use of coronary, biliary, or peripheral stents in the neonatal ductus arteriosus. Recently, a self-expanding stent, specifically designed for use in hypoplastic left heart syndrome, has become available.
We carried out a retrospective cohort comparison of 69 neonates who underwent hybrid ductal stenting with balloon-expandable and self-expanding stents from December, 2005 to July, 2014.
In total, 43 balloon-expandable stents were implanted in 41 neonates and more recently 47 self-expanding stents in 28 neonates. In the balloon-expandable stents group, stent-related complications occurred in nine patients (22%), compared with one patient in the self-expanding stent group (4%). During follow-up, percutaneous re-intervention related to the ductal stent was performed in five patients (17%) in the balloon-expandable stent group and seven patients (28%) in self-expanding stents group.
Hybrid ductal stenting with self-expanding stents produced favourable results when compared with the results obtained with balloon-expandable stents. Immediate additional interventions and follow-up re-interventions were similar in both groups with complications more common in those with balloon-expandable stents.