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Found 2,335 results
  1. Content Article
    The serious and growing workforce crisis in the NHS and social care is the biggest, most pressing threat to the viability of services for people who need them. COVID-19, Brexit, and points based immigration rules have accelerated issues around recruitment, retention, workload, and wellbeing that were already affecting the workforce even before the pandemic. What we need is a relentless focus on implementing solutions, resourcing them properly, and reporting progress, writes David Oliver in this BMJ article.
  2. Content Article
    Amid climbing covid case numbers and with scarce resources, Tara Vijayan describes what it has been like in the US to triage treatments that aim to prevent patients being hospitalised with COVID-19
  3. Content Article
    There has been a lot of discussion about whether the NHS will be overwhelmed this winter, if it is already overwhelmed, or if it is just having yet another “normal” winter crisis and will get through, as it always has, despite the additional pressures from omicron. The sight of the army being deployed in hospitals and ambulance services should be a clue that all is not well, but we are on a “war footing” after all. But can we be more precise about our current state?, writes Katherine Henderson, President of the Royal College of Emergency Medicine, in this BMJ opinion piece. Is the healthcare system delivering the needed level of patient care? The problem of the elective backlog—known and unknown—is well documented. Individual patients have lost months, or even years of good health. They have anxiety, pain, and debilities that limit their ability to engage fully with their families and society. But how about the ability of the NHS to provide safe and effective emergency care to the most seriously ill, distressed, or injured—the emergency part of the urgent and emergency care pathway? What service should we be delivering, and how do we match up to those standards at the moment?
  4. Content Article
    Decision makers should apply insights learnt from people living with chronic illness to collectively managing covid, says Charlotte Augst in this BMJ opinion article.
  5. Content Article
    After nearly two years of pandemic, 5,000 inpatients and 1,000 deaths, the staff of one of the largest hospitals in north-west England are frustrated and exhausted. While ministers talk of encouraging signs that the Omicron wave may be receding in parts of England, staff at the Royal Preston are struggling to keep their heads above water. The hospital has seen a near four-fold increase in Covid patients since Christmas Day, rising to 103 last week. It is one of the largest hospitals in a region with the highest infection levels in the UK and two neighbouring NHS Trusts have declared critical incidents. Despite a recent slowdown in admissions, the “horrendous” levels of staff absence means the pressure is ratcheting up.
  6. Content Article
    There is no longer any scientific doubt about how Covid spreads through the air. Covid spreads like any other airborne respiratory disease. The virus is carried in tiny particles called aerosols, which we breathe out constantly — especially when speaking loudly or singing. The particles stay in the room air like smoke, and if someone has Covid, their exhaled aerosols contain the virus and can infect someone who breathes them in. We stop the disease spreading by stopping people inhaling infected aerosol. In this article for the Guardian, Dr Adam Squires and Prof Christina Pagel detail what we can do to protect ourselves from the airborne spread of Covid. “Filtering facepiece respirator” masks, social distancing and opening windows are short term solutions. Additionally, much can be done by cleaning the air in the room, removing infectious aerosol before it can be inhaled through ventilation and supplement the clean air by filtering out the respiratory aerosol particles using small portable HEPA (“High Efficiency Particle Air”) filter unit.. Longer term, new developments in ultraviolet (UV) technology can safely and efficiently kill airborne pathogens in large spaces such as canteens, gyms or theatre. Infrastructure upgrades and new builds, necessary for zero carbon targets, can combine more energy-efficient ventilation with filtration to lower pollution. In the classroom and the workplace, clean fresh air has wider benefits on health and wellbeing far beyond our current airborne pandemic.
  7. Content Article
    Omicron is inundating a healthcare system that was already buckling under the cumulative toll of every previous surge, writes Ed Yong in an article for the Atlantic. When a healthcare system crumbles, this is what it looks like. Much of what’s wrong happens invisibly. At first, there’s just a lot of waiting. Emergency rooms get so full that “you’ll wait hours and hours, and you may not be able to get surgery when you need it,” says Megan Ranney, an emergency physician in Rhode Island. When patients are seen, they might not get the tests they need, because technicians or necessary chemicals are in short supply. Then delay becomes absence. The little acts of compassion that make hospital stays tolerable disappear. Next go the acts of necessity that make stays survivable. Nurses might be so swamped that they can’t check whether a patient has their pain medications or if a ventilator is working correctly. People who would’ve been fine will get sicker. Eventually, people who would have lived will die. This is not conjecture; it is happening now, across the United States. 
  8. Content Article
    Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system of unknown etiology. Bjornevik et al. tested the hypothesis that MS is caused by Epstein-Barr virus (EBV) in a cohort comprising more than 10 million young adults on active duty in the US military, 955 of whom were diagnosed with MS during their period of service. Risk of MS increased 32-fold after infection with EBV but was not increased after infection with other viruses. These findings cannot be explained by any known risk factor for MS and suggest EBV as the leading cause of MS.
  9. Content Article
    Population-level data on COVID-19 vaccine uptake in pregnancy and SARS-CoV-2 infection outcomes are lacking. Stock et al. describe COVID-19 vaccine uptake and SARS-CoV-2 infection in pregnant women in Scotland, using whole-population data from a national, prospective cohort. They found that vaccine coverage was substantially lower in pregnant women than in the general female population of 18−44 years. Overall, 77.4% of SARS-CoV-2 infections, 90.9% of SARS-CoV-2 associated with hospital admission and 98% SARS-CoV-2 associated with critical care admission, as well as all baby deaths, occurred in pregnant women who were unvaccinated at the time of COVID-19 diagnosis. Addressing low vaccine uptake rates in pregnant women is imperative to protect the health of women and babies in the ongoing pandemic.
  10. Content Article
    The evidence for preventing COVID-19 is lost in translation, writes Dancer et al. in a BMJ Editorial. The world is finally coming to terms with the realisation that transmission of SARS-CoV-2 is airborne. While keeping your distance, wearing a mask, and getting vaccinated have provided much protection, one intervention that would have a significant impact is adequate indoor ventilation. Healthcare, homes, schools, and workplaces should have been encouraged to improve ventilation at the very beginning of the pandemic, but tardy recognition of the airborne route by leading authorities in 2020 stalled any progress that could have been made at that stage.This was compounded by controversies over the terms “droplet” and “aerosol,” as the definition of these dictates different infection prevention strategies, including type of mask. Inserting the term “ventilation” into a COVID-19 policy document might appease readers, but ensuring people get enough fresh air in indoor environments seems to have fallen by the wayside. Why is this? Can we establish the reasons for this seemingly lethargic response to improving indoor air quality?
  11. Content Article
    Spotting and acting on the signs of deterioration in a patient or care home resident is vital to ensuring patient safety. The objective of the national Managing Deterioration Safety Improvement Programme (known as ManDetSIP) is to create and embed the conditions for staff across the healthcare system to improve the safety and outcomes of patients by managing deterioration, and provide a high quality healthcare experience across England.
  12. Content Article
    There is currently limited information on clinical severity phenotypes of symptoms and functional disability in post-coronavirus disease 2019 (COVID) Syndrome (PCS). A370 PCS patients from a dedicated community COVID-19 rehabilitation service was assessed using the COVID-19 Yorkshire Rehabilitation Scale where each symptom or functional difficulty was scored on a 0–10 Likert scale and also compared with before infection. Phenotypes based on symptom severity were extracted to identify any noticeable patterns. The correlation between symptom severity, functional disability, and overall health was explored.
  13. Content Article
    "Patients wait up to 12 hours. Some die waiting. How long must we wait for this dire situation to improve?" The NHS is overwhelmed. Although Covid has shone a bright light on this, it alone did not create these problems. There are multiple reasons for failure writes the'Secret Paramedic' in this Guardian article.
  14. Content Article
    "To healthcare workers in the COVID era, holidays mean death, and we knew Omicron was coming before it had a name. The wave caused by this variant has barely begun, rapidly gathering steam, and we are exhausted, attempting to pull from reserves badly drained by earlier surges." Kathryn Ivey, a critical care nurse at a medical center in Nashville, Tennessee, confronts the Omicron surge filling her hospital.
  15. Content Article
    People who have already been infected by some common cold viruses are less likely to get COVID, according to new results from a study by Kundu et al. funded by the NIHR.
  16. Content Article
    In this article for The Conversation, the authors discuss their latest research findings regarding Covid-19 transmission, outlining the likelihood of catching Covid-19 in different indoor and outdoor scenarios. They demonstrate that speaking, shouting, singing and heavy exercise all increase the likelihood of transmission, and illustrate the impact of ventilation, face coverings and number of people on the risk of catching the virus. The article includes an table summarising their findings and a link to the Covid-19 Aerosol Transmission Estimator developed by the authors. View the full research paper
  17. Content Article
    A new study developed by the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe and the European Commission draws out lessons for strengthening resilience to future health threats. The Health systems resilience during COVID-19: Lessons for building back better study gathers the evidence on how countries have managed (or not managed) to re-engineer how they work, the ways in which they utilise their resources and the methods they use to face and counter the pressures exerted by both COVID and non-COVID challenges.
  18. Content Article
    The Health Services Learning Hub is a dynamic new knowledge platform that will support cross country learning in maintaining essential health services during the COVID-19 pandemic, including the post-pandemic recovery phase. The Health Services Learning Hub supports implementation of the World Health Organization's operational guidance on maintaining essential health services.
  19. Content Article
    A harrowing account from an anonymous physician on why he and colleagues are leaving the medical profession.
  20. Content Article
    When COVID-19 struck, many doctors helped out by willingly changing the way they worked. The BMJ hears some of their stories, including from Michael Farquhar, Paediatric sleep consultant at the Evelina London Children’s Hospital, and Alice Findlay, Retired former emergency medicine consultant at Dartford and Gravesham NHS Trust.
  21. Content Article
    NHS England has set out 10 priorities for the 2022-23 financial year in its annual planning guidance. NHSE chief executive Amanda Pritchard makes clear in the introduction that many of its goals remain contingent on covid, stating: ”The objectives set out in this document are based on a scenario where covid-19 returns to a low level and we are able to make significant progress in the first part of next year.”
  22. Content Article
    Red eyes, ringing ears, sensitivity to light, trouble hearing: although a loss of taste and smell have become well-known sensory symptoms of COVID, accumulating research suggests that vision and hearing are also frequent targets of SARS-COV-2, the virus that causes the disease.
  23. Content Article
    The UK government and devolved administrations, along with the emergency services and other local responders, have clear responsibilities for identifying, assessing, preparing for and responding to emergencies, as well as supporting affected communities to recover. The government has risk management processes in place that aim to identify risks, to ensure that plans are drawn up to mitigate risks and prepare for shocks, and to prevent risks from being overlooked despite short-term pressures. Cabinet Office guidance states that preparedness is the preparation of plans that are flexible enough both to address known risks and to provide a starting point for handling unforeseen events. This report sets out the facts on: the government’s approach to risk management and emergency planning the actions the government took to identify the risk of a pandemic like COVID-19 the actions the government took to prepare for a pandemic like COVID-19 recent developments. The report sets out central government’s risk analysis, planning, and mitigation strategies prior to the arrival of the COVID-19 pandemic, with the aim of drawing out wider learning for the government’s overall risk management approach.
  24. Content Article
    This World Health Organization (WHO) policy brief takes stock of how digital health tools have been used during the COVID-19 pandemic, in order to review what has happened, assess how uptake and use of these tools has been facilitated, identify issues that are emerging, and learn lessons for the longer term to support the sustained use of digital health tools.
  25. Content Article
    COVID-19 is known to cause multi-organ dysfunction in acute infection, with prolonged symptoms experienced by some patients, termed Post-Acute Sequelae of SARSCoV-2 (PASC). However, the burden of infection outside the respiratory tract and time to viral clearance is not well characterised, particularly in the brain. Chertow et al. performed complete autopsies on 44 patients with COVID-19 to map and quantify SARS-CoV-2 distribution, replication, and cell-type specificity across the human body, including brain, from acute infection through over seven months following symptom onset. The study showed that SARS-CoV-2 is widely distributed, even among patients who died with asymptomatic to mild COVID-19, and that virus replication is present in multiple pulmonary and extrapulmonary tissues early in infection. The authors detected persistent SARS-CoV-2 RNA in multiple anatomic sites, including regions throughout the brain, for up to 230 days following symptom onset. Despite extensive distribution of SARS-CoV-2 in the body, the authors observed a paucity of inflammation or direct viral cytopathology outside of the lungs. The data prove that SARS-CoV-2 causes systemic infection and can persist in the body months. * Note: This is a pre-print and has not been peer-reviewed yet.
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