Search the hub

Content includes: What is neonatal herpes? What is the herpes simplex virus? How can a baby catch herpes? What are the signs & symptoms of neonatal herpes? How do I know if my baby has an infection? What is the treatment for neonatal herpes? What can I do to prevent my baby from getting neonatal herpes? I am pregnant or breastfeeding, how can I protect my baby? I have a cold sore, what should I do to make sure I don't pass the virus to a baby? How do I wash my hands properly to help keep babies safe? Follow the link below to Kit Tarka Foundation's website, to find out more.

Azithromycin is an antibiotic known for its anti-inflammatory properties which is already used to treat chronic inflammatory lung disease, or chest infections such as pneumonia. Inflammation, caused by an overly-active immune response, is a key feature of severe COVID-19. Azithromycin was considered a potential treatment for COVID-19 and investigated through an arm of the RECOVERY trial to assess whether the drug had a meaningful benefit amongst hospitalised patients with COVID-19. A preliminary analysis of the data has shown no meaningful clinical benefit of azithromycin in the hospitalised COVID-19 patients randomised to this treatment arm. The data showed no significant difference in the primary endpoint of 28-day mortality (19% azithromycin vs. 19% usual care). While researchers found no evidence of beneficial effects on the risk of progression to mechanical ventilation or length of hospital stay. The results were consistent in different subgroups of patients. However it is not possible to make conclusions about the effectiveness of azithromycin in patients in the community.

Detailed results from the report show: - The regions that have seen the sharpest decline in the number of people referred for routine elective care during the first 8 months of the year are London (37% reduction as compared to 2019), North West (35% reduction) and South East (35% reduction). The South West saw the smallest reduction in the number of people referred for elective care compared to 2019 (29%). The North East and Yorkshire saw a 34% reduction and Midlands and East of England both had a 33% reduction. - Those regions that experienced the lowest rates of COVID-19 during the first wave, namely the South West and East of England, are also those that have made the most progress in reopening elective care services. While there are currently only limited signs that more treatment is being postponed in the regions hardest hit by COVID-19, this may change in the future. - Referrals to clinical areas have declined as follows: oral surgery (43% lower than in 2019, representing 177,591 fewer people) trauma and orthopaedics (42% lower, representing 622,593 fewer people). This includes surgery for hip and knee replacements ophthalmology (41% lower, representing 531,660 fewer people). This includes cataract operations thoracic medicine (29%, or 98,546 fewer people) cardiothoracic surgery (29%, or 7,889 fewer people) neurosurgery (29% lower, or 23,872 fewer people); urology (28% lower, representing 186,119 fewer people).

I believe all clinicians should read this latest report. There is so much to be learned and so many changes in clinical practice that can be made right away. Since 2018, I have been teaching using Oliver's tragic story to promote reflection on best practice in prescribing and in implementing the Mental Capacity Act. I could write a lot here; however, I believe this is a report all clinicians, and especially all prescribers, need to read in full. A summary of how I see this (or indeed how any individual sees it) it will not be adequate.

The HSIB investigation focused on what happens after thrombolysis treatment is given and how venous thromboembolism (VTE) risk is managed as patients recover. They identified issues such as a low rate of intermittent pneumatic compression (IPCs) being fitted despite their success in improving the survival rates of those who are not mobile after a stroke and their recommendation by NICE guidelines. As the investigation progressed, HSIB identified missed opportunities throughout the whole process of care. There is a lack of a national, stroke-specific assessment for VTE that considers the patient’s specific circumstances or determines the level of risk the patient has of blood clots forming. Even if an assessment identifies IPC as a treatment, the case examined in this report reflected a wider picture of confusion over how the devices are recorded i.e. on the patient’s chart and who then is responsible for fitting. The findings also show that national guidelines do not require a follow-up assessment or a check that the VTE preventative measure is in place. Safety recommendation As a result of the national investigation, HSIB have made one safety recommendation to facilitate the development of a stroke specific assessment, a system for the associated treatment to be recorded using a tool to ensure that the relevant information is documented and, importantly, reviewed. Dr Stephen Drage, HSIB Director of Investigations and intensive care unit consultant, said: “The time after a patient is admitted and treated for a stroke is incredibly precarious. It is important that any safety risks in the care process are mitigated to prevent life-threatening blood clots forming to give patients the best chance of making a full recovery. “A number of barriers to the most effective aftercare emerged through our investigation and the safety issues impact not only all specialist units but any wards where stroke recovery takes place in the NHS. The recommendation we have made is aimed at ensuring that VTE risk is managed in a targeted way that ensures that patients are getting the right treatment at the right time.”

Speaking at the NHS Providers conference today Sir Simon Stevens, Chief Executive of the NHS, announced that £10 million will be invested into additional local funding "to help kick start and designate Long Covid clinics in every area across England".[1] Patient safety concerns for Long COVID patients Long Covid patients are people with confirmed or suspected Covid-19 who continue to struggle with prolonged, debilitating and sometimes severe symptoms months later.[2] Many were never admitted to hospital and have instead been trying to manage their symptoms and recovery at home. At Patient Safety Learning we have seen growing evidence that there are many patients suffering from long-lasting symptoms of Covid-19 who are feeling abandoned, confused and without support. We have featured patient insights of this on the hub, our platform for patient safety, such as the experiences of Barbara Melville and Dr Jake Suett.[3] Informed by patients we have also been highlighting the patient safety issues arising from this.[4] In September we heard from many Long Covid patients who have expressed confusion about access post-Covid support clinics. This followed comments from the Health Secretary Matt Hancock MP at the Health and Social Care Select Committee in which he suggested this support was already available.[5] We wrote to Simon Stevens calling on the NHS to publish details of post-Covid support clinics and confirm the timeframe for the implementation of Phase 2 of the ‘Your Covid Recovery’ support portal.[6] Reflections on today’s announcement The NHS announcement today sets out a five-part package of support people living with Long Covid: 1. New guidance commissioned by NHS England from NICE by the end of October on the medical ‘case definition’ of Long Covid. This will include patients who have had Covid who may not have had a hospital admission or a previous positive test. It will be followed by evidence-based NICE clinical guidelines in November on the support that Long Covid patients should receive, enabling NHS doctors, therapists and staff to provide a clear and personalised treatment plan. This will include education materials for GPs and other health professionals to help them refer and signpost patients to the right support. We welcome this measure and plans to update guidance so that it includes patients who may not have had a hospital admission or a previous positive test. We have heard from patients who have expressed their frustrations around the lack of clinical recognition of their illness, exacerbated by receiving a negative test result. This new guidance should enable health care providers in primary and secondary care to properly capture information about patients that have Long Covid. This should help to create a better understanding of how many patients are experiencing this disease and the services they are receiving. It will also be essential to ensure that service providers are appropriately funded to support these patients. 2. The ‘Your Covid Recovery’ – an online rehab service to provide personalised support to patients. Over 100,000 people have used the online hub since it launched in July, which gives people general information and advice on living with long Covid. Phase 2 of the digital platform being developed this Autumn by the University of Leicester will see people able to access a tailored rehabilitation plan. This will enable patients to set goals for their mental and physical health, provide peer to peer support through social community forums, offer an ‘ask the expert’ facility for patients to contact their local rehab service, and allow patients to be monitored by their local rehab teams to ensure that they are on track with their care. This service will be available to anyone suffering symptoms that are likely due to COVID-19, regardless of location or whether they have spent time in hospital. It is most likely that patients will access the service through their GP, but they could also be referred through another healthcare professional following assessment. From our conversations with patients and community support groups, we are aware that concerns remain about the availability of support for those who have been managing their symptoms at home. Patients have highlighted that much of the ‘Your Covid Recovery’ site focuses only on those patients who have been in hospital. It is essential that patients that are living in the community with Long Covid can access advice and guidance specific to their needs. We are concerned that access to information and advice is only accessible through GPs or another healthcare professional following assessment. We need to ensure that this referral route does not become a barrier to Long Covid patients having the information and advice they need. 3. Designated Long Covid clinics, as announced today. This will involve each part of the country designating expert one-stop services in line with an agreed national specification. Post-Covid services will provide joined up care for physical and mental health, with patients having access to: – A physical assessment, which will include diagnostic testing, to identify any potential chronic health issues. – A cognitive assessment, to assess any potential memory, attention, and concentration problems. – A psychological assessment, to see if someone is suffering potentially from depression, anxiety, PTSD, or another mental health condition. Patients could also then be referred from designated clinics into specialist lung disease services, sleep clinics, cardiac services, rehabilitation services, or signposted into IAPT and other mental health services. We welcome this commitment to a one-stop shop approach to support for Long COVID patients. It is important that we recognise that patients may need to access a wide range of services and that patients who are unwell should not have to move between different clinical specialities to get diagnosis and treatment related to their personal needs. The £10m initial investment is to be welcomed as is the national specification; it is important that we do not have a postcode lottery of services. As the infection rate increases, so will the number of patients with Long Covid. The investment in services will need to match patient need, both initial assessment and diagnosis and access to specialist treatment, support services and ongoing rehabilitation. We also note that these appear to be England-only measures and would be keen to clarify what steps are being put in place to support patients in the other three nations of the UK. 4. NIHR-funded research on Long Covid which is working with 10,000 patients to better understand the condition and refine appropriate treatment. This is welcomed and should inform the development of clinical pathways and best practice guidelines. 5. The NHS’s support will be overseen by a new NHS England Long Covid taskforce which will include long Covid patients, medical specialists and researchers. This is a new disease and we do not yet understand how best to support patients with Long Covid. We believe that a multi-disciplinary task force that engages and welcomes patients' insights is essential. What are your thoughts? Further to our initial reflections on this, we would be keen to hear from people living with Long Covid on their thoughts on this announcement. Please share your thoughts with us on the support that is needed on our patient safety platform, the hub. References NHS England and NHS Improvement, NHS To Offer ‘Long Covid’ Sufferers Help at Specialist Centres, 7 October 2020. The symptoms for those with Long COVID vary greatly but many are experiencing rashes, shortness of breath, neurological and gastrointestinal problems, abnormal temperatures, cardiac symptoms, and extreme fatigue. Barbara Melville, Dismissed, unsupported and misdiagnosed: Interview with a COVID-19 ‘long-hauler’, Patient Safety Learning’s the hub, 24 June 2020; Dr Jake Suett, My experience of suspected ‘Long COVID’, Patient Safety Learning’s the hub, 10 July 2020. Patient Safety Learning, Patient safety concerns for Long COVID patients, 6 July 2020. Rt Hon. Matt Hancock MP commented in a select committee that “The NHS set up Long COVID clinics and announced them in July. I am concerned by reports this morning from the Royal College of GPs that not all GPs know how to ensure that people can get into those services. That is something I will take up with the NHS and that I am sure we will be able to resolve”. Health and Social Care Committee, Oral evidence: Social care: funding and workforce, HC 206, 8 September 2020. Patient Safety Learning, Clarity needed on post-COVID clinics: Patient Safety Learning's letter to NHS leader, 11 September 2020.