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With unprecedented times, comes accelerated change. Hospitals in our region have begun to facilitate safe discharge for COVID-19 patients in the form of “The virtual COVID ward”. This has enabled patients to be monitored safely in the community using pulse oximetry, Florence (a telehealth mobile app) and remote consultations. Our objective is to expand upon this model by providing home oxygen therapy for these patients facilitated by telemedicine.
Patients were discharged with an oxygen concentrator if they had an oxygen requirement equal to or less than four litres/minute. Fraction of inspired oxygen needed to be stable and an early warning score of less than four was also required. Once admitted, the Florence app and daily remote consultations were crucial to closely monitor the patient's clinical status. The patient was instructed to enter oxygen saturations and heart rate into the app four times daily. The app would then alert our team if any patients observations deteriorate, triggering immediate assessment.
We have discharged ninety patients to the virtual ward, fifty-six of these with home oxygen. The average age was fifty-seven and the Clinical Frailty Score ranged between one and six. At present, ten patients have been re-admitted, four with increasing oxygen requirements, and six with unrelated symptoms. Two patients had oxygen concentrators installed at home after we were alerted to their desaturation by the Florence App. The re-admission rate is eleven percent, which mirrors that of other virtual wards (who do not provide home oxygen). In total, the ward has saved the trust 627 hospital inpatient ‘days’. Patients report increased satisfaction at playing a meaningful role in monitoring their own healthcare using the app.
Our novel model of supported discharge with oxygen therapy using telehealth demonstrates that it is possible to manage such patients, safely, in the community. Other trusts could utilise this model to reduce inpatient bed occupancy. Looking to the future, could telehealth be utilised further to facilitate other “Virtual wards” in the community?
Current surveillance for healthcare-associated (HA) urinary tract infection (UTI) is focused on catheter-associated infection with hospital onset (HO-CAUTI), yet this surveillance does not represent the full burden of HA-UTI to patients. Our objective was to measure the incidence of potentially HA, community-onset (CO) UTI in a retrospective cohort of hospitalized patients.
Retrospective cohort study.
Academic, quaternary care, referral center.
Hospitalized adults at risk for HA-UTI from May 2009 to December 2011 were included.
Patients who did not experience a UTI during the index hospitalization were followed for 30 days post discharge to identify cases of potentially HA-CO UTI.
We identified 3,273 patients at risk for potentially HA-CO UTI. The incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients. Independent risk factors of HA-CO UTI included paraplegia or quadriplegia (adjusted odds ratio [aOR], 4.6; 95% confidence interval [CI], 1.2–18.0), indwelling catheter during index hospitalization (aOR, 1.5; 95% CI, 1.0–2.3), prior piperacillin-tazobactam prescription (aOR, 2.3; 95% CI, 1.1–4.5), prior penicillin class prescription (aOR, 1.7; 95% CI, 1.0–2.8), and private insurance (aOR, 0.6; 95% CI, 0.4–0.9).
HA-CO UTI may be common within 30 days following hospital discharge. These data suggest that surveillance efforts may need to be expanded to capture the full burden to patients and better inform antibiotic prescribing decisions for patients with a history of hospitalization.
The fields of Global Health and Global Emergency Response have attracted increased interest and study. There has been tremendous growth in the educational opportunities around humanitarian emergencies; however, educational resources have not yet followed the same growth. This book corrects this trend, offering a comprehensive single resource dedicated to health in humanitarian emergencies. Providing an introduction to the public health principles of response to humanitarian emergencies, the text also emphasizes the need to coordinate the public health and emergency clinical response within the architecture of the greater response effort. With contributing authors among some of the world's leading health experts and policy influencers in the field, the content is based on best practices, peer reviewed evidence, and expert consensus. The text acts as a resource for clinical and public health practitioners, graduate-level students, and individuals working in response to humanitarian emergencies for government agencies, international agencies, and NGOs.
Protecting seabirds is a global conservation priority given that 29% of seabird species are threatened with extinction. One of the most acute threats to seabirds is the presence of introduced predators, which depredate seabirds at all life stages, from eggs to adults. Consequently, eradication of invasive predators has been identified as an effective and commonly used approach to seabird conservation. Seabird recovery following the eradication of predators is influenced by complex and interacting environmental and demographic factors, and there are gaps in our understanding of species-specific responses. We reflect on the recovery of seabirds on islands cleared of predators, drawing on the equilibrium theory of island biogeography, and synthesize key influences on recovery reported in the literature. We present a regionally specific case study on the recovery of seabird colonies (n = 98) in the Hauraki Gulf, New Zealand, which is a hotspot of seabird diversity (27 species), with a long history of eradications of invasive predators. We found that on islands cleared of predators seabirds recover over time, and such islands have more diverse seabird assemblages than islands that never had predators. Recovery appears to be influenced by a suite of site- and species-specific factors. Managers may assume that given enough time following eradication of predators, seabirds will recolonize an island. Although time is a factor, proximity to source populations and human activities has a significant effect on recolonization by seabirds, as do demographic traits, colonizing ability and habitat suitability. Therefore, integrating expected site and species-specific recovery responses in the planning of eradications should help guide post-eradication management actions.
This volume publishes a selection of the papers first presented during the Society for Post-Medieval Archaeology's conference Engaging the Recent Past in 2010. This introductory paper seeks to situate the other contributions, placing them in the context of wider processes including the rise of Community Archaeology and the development of an explicit political consciousness in archaeology. Concepts of multivocality and memory are discussed, as are the practices of public participation. The paper argues that a more critical stance needs to be taken towards public engagement in archaeology, and this is discussed in relation to concepts of power and social learning. The paper advocates a move beyond limited participation (confined to particular activities, such as participatory site identification and recording, and to the context of particular projects) and it advocates a move towards participatory governance. Here, the archaeological professional is repositioned as a collaborator engaging with others, including relevant public constituencies and the relevant authorities, in the social process of creating knowledge about the past and defining how historic environments and relationships will be protected, managed or transformed in the future.
This volume arises from the Society for Post-Medieval Archaeology conference Engaging the Recent Past: Public, Political Post-Medieval Archaeology (Glasgow, September 2010). The focus of the conference was the contemporary context of post-medieval archaeology: the values, politics and ethics associated with the recent past, and the practices through which we engage with and construct that past. Contributors to the conference considered these issues in relation to the post-medieval and contemporary archaeologies of the U.K., Ireland and a number of other countries, and they promoted positions founded in a variety of philosophical, political and practice traditions.
This paper will demonstrate, through recent fieldwork and political engagements in Bristol, UK, the potential for a new kind of political archaeology, not based around supporting political parties or facilitating community engagement as ends in themselves, but around creating new kinds of knowledge that can be used to influence politics and politicians at the highest levels.
INTRODUCTION: BIG P, SMALL p
The phrase ‘archaeology is a political act’ is oft repeated, but as with any such definitive phrase when used in academia each word of it has multiple meanings. For instance ‘is’. Well, it is not always. Archaeology can be a political act and archaeology sometimes is a political act, but this is not a universal truth. Likewise, the word archaeology can be taken different ways itself. There is academic archaeology, private sector archaeology, public archaeology, uses of archaeology in the heritage industry and so on, all intrinsically connected, but each with nuances different enough to render universality meaningless.
In this paper, I wish to put forward the possibility that contemporary forms of archaeological thought and investigation can play a role in redefining the ways in which politicians engage with ordinary people and everyday situations. Rather than limiting themselves to facilitating community engagement or lobbying politicians in relation to heritage legislation, I will suggest that archaeologists can move towards using their unique perspectives on contemporary and historic environments to change the very way in which the connection between archaeology and politics is conceived, using archaeological investigation to understand the nature of contemporary politics and feeding this back into the wider system of policy making instead of merely working within the confines of existing heritage legislation.