Support and follow-up needs of patients discharged from intensive care after severe COVID-19: a mixed-methods study of the views of UK general practitioners and intensive care staff during the pandemic’s first wave

Objectives To identify follow-up services planned for patients with COVID-19 discharged from intensive care unit (ICU) and to explore the views of ICU staff and general practitioners (GPs) regarding these patients’ future needs and care coordination.Design This is a sequential mixed-methods study using online surveys and semistructured interviews. Interview data were inductively coded and thematically analysed. Survey data were descriptively analysed.Setting GP surgeries and acute National Health Service Trusts in the UK.Participants GPs and clinicians leading care for patients discharged from ICU.Primary and secondary outcomes Usual follow-up practice after ICU discharge, changes in follow-up during the pandemic, and GP awareness of follow-up and support needs of patients discharged from ICU.Results We obtained 170 survey responses and conducted 23 interviews. Over 60% of GPs were unaware of the follow-up services generally provided by their local hospitals and whether or not these were functioning during the pandemic. Eighty per cent of ICUs reported some form of follow-up services, with 25% of these suspending provision during the peak of the pandemic and over half modifying their provision (usually to provide the service remotely). Common themes relating to barriers to provision of follow-up were funding complexities, remit and expertise, and communication between ICU and community services. Discharge documentation was described as poor and lacking key information. Both groups mentioned difficulties accessing services in the community and lack of clarity about who was responsible for referrals and follow-up.Conclusions The pandemic has highlighted long-standing issues of continuity of care and complex funding streams for post-ICU follow-up care. The large cohort of ICU patients admitted due to COVID-19 highlights the need for improved follow-up services and communication between specialists and GPs, not only for patients with COVID-19, but for all those discharged from ICU

Estructuración del proceso de selección de personal de acuerdo al sistema de gestión integral de FECEDA (Fondo de Empleados Oficiales del Departamento del Meta)

El presente trabajo de grado, titulado: “Estructuración del Modelo estratégico de selección de personal de acuerdo al Sistema de Gestión Integral de FECEDA (Fondo de Empleados Oficiales del Departamento del Meta)”; se focaliza en comprender la dinámica de selección de personal en la organización objeto de estudio, acorde a eso visibilizar falencias y desde el aula mater proponer como discentes y futuros profesionales mejorar el proceso llevado a cabo hasta el momento. En lo que es la metodología de la investigación, se parte de un enfoque cuantitativo y este a su vez se nutre de metodologías como la observación no participante, fuentes documentales y cuestionarios. Además, en lo que es el análisis de los resultados se da por sentado que no se convoca paulatinamente personal a razón que se da persistencia en cada puesto de trabajo, lo que hace presumir que el proceso de selección se encuentra bien direccionado. Para finiquitar, se presenta un plan de mejora que puede ser replicado por otras entidades a futuro.The present degree work, entitled: "Structuring the strategic model for personnel selection according to the Comprehensive Management System of FECEDA (Fund of Official Employees of the Meta Department)"; focuses on understanding the dynamics of personnel selection in the organization under study, according to that make visible shortcomings and from the mater classroom propose as students and future professionals to improve the process carried out so far. In what is the research methodology, it starts from a quantitative approach and this in turn is nourished by methodologies such as non-participant observation, documentary sources and questionnaires. In addition, in what is the analysis of the results, it is assumed that personnel are not gradually summoned due to the persistence in each job position, which suggests that the selection process is well directed. To finalize, an improvement plan is presented that can be replicated by other entities in the futur

Reference values for areal bone mineral density among a healthy Mexican population

Objective. Compare the influence of ethnicity in the prevalence of osteopenia and osteoporosis in various Mexican populations using two normal dual X-ray absorptiometry (DXA) reference databases: manufacturer¿s incorporating US Hispanic population and a normal mestizo Mexican population. Material and Methods. MMP included 9 946 subjects participating in an ongoing long-term cohort study focusing on lifestyle and chronic diseases, of which 6 487 MMP males and females aged 7 to 80 years were the normal subjects used to determine bone density T- and Z-scores, following WHO criteria, and peak bone mass values. Abnormal bone mass density values estimated by the manufacturer's and peak bone mass reference values were compared. Results and Conclusions. Our results show that by using the manufacturer´s T-score values in the mestizo Mexican population we are underestimating the number of abnormal bone mass BMD populations

Percepciones maternas sobre las prácticas alimentarias en escolares de Monterrey, México

El objetivo de este estudio fue explorar las percepciones maternas sobre las prácticas alimentarias de niños en edad escolar que presentan diferente estado nutricional residentes en el área metropolitana de Monterrey, Nuevo León, México. Se realizó un estudio cualitativo fenomenológico, mediante entrevistas semi-estructuradas a 91 madres de familia con un hijo entre 6 y 11 años de edad, durante el año 2015 y 2017. Los resultados evidenciaron que las madres de familia fueron las responsables de la adquisición y preparación de las comidas aun cuando tuvieran un empleo. Para la elaboración de los alimentos la madre cocinó según los gustos de la familia siendo esto una forma de expresarles su cariño. Las emociones de las madres con respecto a la aceptación de los alimentos, los gustos, rechazos y el número de comidas diarias que realizan los hijos, varió dependiendo del estado nutricional. La alimentación durante los días de la semana fue diferente a la de los fines de semana. Las prácticas alimentarias fueron parte de acontecimientos y significados sociales aprendidos por las madres de familia y que no siempre estuvieron acorde con los cánones nutricionales establecidos por los expertos

GP wellbeing during the COVID-19 pandemic : a systematic review

BACKGROUND: Doctors' organisations in the UK have reported worrying levels of work-related stress and burnout in the GP workforce for some time, and the COVID-19 pandemic has presented clear new challenges. AIM: To synthesise international evidence exploring the impact of COVID-19 on primary care doctors' mental health and wellbeing, and identify risk factors associated with their psychological wellbeing during this time. DESIGN AND SETTING: Mixed-methods systematic review. METHOD: Six bibliographic databases, Google Scholar, and MedRxiv were searched on 19 November 2020 and 3 June 2021 to identify studies of GP psychological wellbeing during the pandemic. Reference checking was also conducted. Two reviewers selected studies, extracted data, and assessed the quality of studies using standardised tools. Heterogeneity in outcomes, setting, and design prohibited statistical pooling; studies were combined using a convergent integrated thematic synthesis. RESULTS: Thirty-one studies were included. Multiple sources of stress were identified including changed working practices; risk, exposure, and inadequate personal protective equipment (PPE); information overload; pandemic preparedness; and cohesion across sectors. Studies demonstrated an impact on psychological wellbeing, with some GPs experiencing stress, burnout, anxiety, depression, fear of COVID-19, lower job satisfaction, and physical symptoms. Studies reported gender and age differences: women GPs had poorer psychological outcomes across all domains, and older GPs reported greater stress and burnout. Use of outcome measures and reporting practice varied greatly. CONCLUSION: This review of international evidence demonstrates that the COVID-19 pandemic has adversely affected GPs' wellbeing around the world. Further research could explore gender and age differences, identifying interventions targeted to these groups

Meta-analysis of genome-wide association studies of asthma in ethnically diverse North American populations.

Asthma is a common disease with a complex risk architecture including both genetic and environmental factors. We performed a meta-analysis of North American genome-wide association studies of asthma in 5,416 individuals with asthma (cases) including individuals of European American, African American or African Caribbean, and Latino ancestry, with replication in an additional 12,649 individuals from the same ethnic groups. We identified five susceptibility loci. Four were at previously reported loci on 17q21, near IL1RL1, TSLP and IL33, but we report for the first time, to our knowledge, that these loci are associated with asthma risk in three ethnic groups. In addition, we identified a new asthma susceptibility locus at PYHIN1, with the association being specific to individuals of African descent (P = 3.9 × 10(-9)). These results suggest that some asthma susceptibility loci are robust to differences in ancestry when sufficiently large samples sizes are investigated, and that ancestry-specific associations also contribute to the complex genetic architecture of asthma

Mixed Methods EvAluation of the high-volume low-complexity Surgical hUb pRogrammE (MEASURE) : a mixed methods study protocol

ABSTRACT INTRODUCTION: The waiting list for elective surgery in England recently reached over 7.8 million people and waiting time targets have been missed since 2010. The high-volume low complexity (HVLC) surgical hubs programme aims to tackle the backlog of patients awaiting elective surgery treatment in England. This study will evaluate the impact of HVLC surgical hubs on productivity, patient care and the workforce. METHODS AND ANALYSIS: This 4-year project consists of 6 inter-linked work packages (WPs) and is informed by the Consolidated Framework for Implementation Research. WP1: Mapping current and future HVLC provision in England through document analysis, quantitative datasets (e.g., Hospital Episodes Statistics) and interviews with national service leaders. WP2: Exploring the effects of HVLC hubs on key performance outcomes, primarily the volume of low-complexity patients treated, using quasi-experimental methods. WP3: Exploring the impact and implementation of HVLC hubs on patients, health professionals and the local NHS through approximately nine longitudinal, multi-method qualitative case studies. WP4: Assessing productivity of HVLC surgical hubs using the Centre for Health Economics NHS productivity measure and Lord Carter’s operational productivity measure. WP5: Conducting a mixed-methods appraisal will assess the influence of HVLC surgical hubs on the workforce using: qualitative data (WP3) and quantitative data (e.g. NHS England’s workforce statistics and intelligence from WP2). WP6: Analysing the costs and consequences of HVLC surgical hubs will assess their achievements in relation to their resource use to establish value for money. A Patient and Public Involvement Group (PPI) will contribute to study design and materials. ETHICS AND DISSEMINATION: The study has been approved by the East Midlands – Nottingham Research Ethics Committee 23/EM/0231. Dissemination plans include multiple academic and non-academic outputs (e.g. Peer-reviewed journals, conferences, social media) and a continuous, feedback-loop of findings to key stakeholders (e.g. NHS England) to influence policy development. STUDY REGISTRATION: Researchregistry9364

Local and Landscape Factors Determining Occurrence of Phyllostomid Bats in Tropical Secondary Forests

Neotropical forests are being increasingly replaced by a mosaic of patches of different successional stages, agricultural fields and pasture lands. Consequently, the identification of factors shaping the performance of taxa in anthropogenic landscapes is gaining importance, especially for taxa playing critical roles in ecosystem functioning. As phyllostomid bats provide important ecological services through seed dispersal, pollination and control of animal populations, in this study we assessed the relationships between phyllostomid occurrence and the variation in local and landscape level habitat attributes caused by disturbance. We mist-netted phyllostomids in 12 sites representing 4 successional stages of a tropical dry forest (initial, early, intermediate and late). We also quantitatively characterized the habitat attributes at the local (vegetation structure complexity) and the landscape level (forest cover, area and diversity of patches). Two focal scales were considered for landscape characterization: 500 and 1000 m. During 142 sampling nights, we captured 606 individuals representing 15 species and 4 broad guilds. Variation in phyllostomid assemblages, ensembles and populations was associated with variation in local and landscape habitat attributes, and this association was scale-dependent. Specifically, we found a marked guild-specific response, where the abundance of nectarivores tended to be negatively associated with the mean area of dry forest patches, while the abundance of frugivores was positively associated with the percentage of riparian forest. These results are explained by the prevalence of chiropterophilic species in the dry forest and of chiropterochorous species in the riparian forest. Our results indicate that different vegetation classes, as well as a multi-spatial scale approach must be considered for evaluating bat response to variation in landscape attributes. Moreover, for the long-term conservation of phyllostomids in anthropogenic landscapes, we must realize that the management of the habitat at the landscape level is as important as the conservation of particular forest fragments