British Sleep Society: the COVID-19 pandemic response

The current pandemic caused by a novel coronavirus, named COVID-19, holds the entire world to ransom. A proportion of the infected patients becomes critically ill, with millions being infected and hundreds of thousands who have died so far. In some countries, national lockdown restrictions are being slowly lifted, but the World Health Organization (WHO) still registers increasing numbers of confirmed COVID-19 infections across its membership states. Against this background, the BSS brought together doctors from the respiratory and critical care response teams in Wuhan, China and London, UK in a webinar to exchange their knowledge and expertise and discuss current best practice in the management of patients with COVID-19. Following their presentations, sleep experts from the Executive Committee of the BSS discussed the impact of the pandemic and lockdown on sleep and shared practical advice regarding sleep health

Impact of the novel coronavirus (COVID-19) pandemic on sleep

Background: The COVID-19 pandemic has led to significant changes in daily routines and lifestyle worldwide and mental health issues have emerged as a consequence. We aimed to assess the presence of sleep disturbances during the lockdown in the general population. Methods: Cross-sectional, online survey-based study on adults living through the COVID-19 pandemic. The questionnaire included demographics and specific questions assessing the impact of the pandemic/ lockdown on sleep, daytime functioning and mental health in the general population. Identification of sleep pattern changes and specific sleep-related symptoms was the primary outcome, and secondary outcomes involved identifying sleep disturbances for predefined cohorts (participants reporting impact on mental health, self-isolation, keyworker status, suspected COVID-19 or ongoing COVID-19 symptoms). Results: In total, 843 participants were included in the analysis. The majority were female (67.4%), middle aged [52 years (40–63 years)], white (92.2%) and overweight to obese [BMI 29.4 kg/m2 (24.1–35.5 kg/m2)]; 69.4% reported a change in their sleep pattern, less than half (44.7%) had refreshing sleep, and 45.6% were sleepier than before the lockdown; 33.9% had to self-isolate, 65.2% reported an impact on their mental health and 25.9% were drinking more alcohol during the lockdown. More frequently reported observations specific to sleep were ‘disrupted sleep’ (42.3%), ‘falling asleep unintentionally’ (35.2%), ‘difficulties falling’/‘staying asleep’ (30.9% and 30.8%, respectively) and ‘later bedtimes’ (30.0%). Respondents with suspected COVID-19 had more nightmares and abnormal sleep rhythms. An impact on mental health was strongly associated with sleep-related alterations. Conclusions: Sleep disturbances have affected a substantial proportion of the general population during the COVID-19 pandemic lockdown. These are significantly associated with a self-assessed impact on mental health, but may also be related to suspected COVID-19 status, changes in habits and self-isolation

"Education is the passport to the future": Enabling today's medical teachers to prepare tomorrow's respiratory health practitioners

No abstract available

Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation

© 2015, Canadian Anesthesiologists\u27 Society. Purpose: Tranexamic acid (TXA) therapy can reduce red blood cell (RBC) transfusion; however, this therapy remains underutilized in many surgical patient populations. We assessed whether implementation of a protocol to facilitate universal administration of TXA in patients undergoing total hip or knee arthroplasty would reduce the incidence of RBC transfusion without increasing adverse clinical outcomes. Methods: We implemented a quality of care policy to provide universal administration of intravenous TXA at a dose of 20 mg·kg−1iv to all eligible patients undergoing total hip or knee arthroplasty from October 21, 2013 to April 30, 2014. We compared data from an equal number of patients before and after protocol implementation (n = 422 per group). The primary outcome was RBC transfusion with secondary outcomes including postoperative hemoglobin concentration (Hb) and length of hospital stay. Adverse events were identified from the electronic medical records. Data were analyzed by a Chi square test and adjusted logistic and linear regression analysis. Results: Implementation of the protocol resulted in an increase in TXA utilization from 45.8% to 95.3% [change 49.5%; 95% confidence interval (CI), 44.1 to 54.5; P \u3c 0.001]. This change was associated with a reduction in the rate of RBC transfusion from 8.8% to 5.2%, (change −3.6%; 95% CI, −0.1 to −7.0; P = 0.043). Pre- and post-protocol mean [standard deviation (SD)] Hb values were similar, including the nadir Hb prior to RBC transfusion [72 (8) g·L−1vs 70 (8) g·L−1, respectively; mean difference −1 g·L−1; 95% CI, −3 to 5; P = 0.569]. Length of stay was not altered, and no increase in adverse events was observed. Conclusions: Implementation of a perioperative TXA protocol was associated with both an increase in TXA use and a reduction in RBC transfusion following hip or knee arthroplasty. Adverse events and length of hospital stay were not influenced by the protocol