Demographic and Clinical Presentation of Hospitalised Patients with SARS-CoV-2 During the First Omicron Wave

Introduction: The objectives of this retrospective study were to describe clinical presentations and mortality outcomes of hospitalised patients with the COVID-19 Omicron variant within two acute district general hospitals, and to evaluate demographic factors associated with these presentations and mortality. Methods: Data was obtained over a month in 2021–2022 from multi-ethnic patients who were hospitalised and detected to have severe acute respiratory syndrome coronavirus 2 Omicron infection. Details included socio-demographic characteristics, vaccination, and mortality. Patients were subdivided into three groups: Group 1 were admitted with true COVID-19 pneumonitis, Group 2 had incidental COVID-19 on admission screening, and Group 3 were negative on admission but developed COVID-19 over 7 days post-admission. Results: Of 553 patients, only 24.1% (133/553) were in Group 1, 58.2% (322/553) in Group 2, and 17.7% (98/553) in Group 3. Patients in Group 1 and Group 3 were significantly older than those in Group 2 (p less than 0.001). Thirty percent of patients from Black, Asian, and minority ethnic backgrounds had COVID-19 pneumonitis compared with 19% of those with White ethnicity (p=0.002). Twenty percent of patients were admitted within nonmedical specialties, i.e., surgical specialties, paediatrics, and obstetrics. Of 36 requiring critical care, 21 were in Group 1. Of those patients, 20/21 (95%) were unvaccinated and seven of the 21 who died were all unvaccinated (100%). Common COVID-19 presentations included delirium, falls, seizures, chronic obstructive pulmonary disease, and antenatal problems. Overall, 13.7% (76/553) patients died and 4.7% (26/553) were directly attributable to COVID-19. Conclusions: This large, multi-ethnic study has described clinical presentations and mortality of hospitalised patients with Omicron. It has determined socio-demographic factors associated with these presentations, including ethnicity and vaccination rates. The study provides useful information for future COVID-19 studies examining outcomes and presentations of Omicron and future COVID-19 variants

Olanzapine and pulmonary embolism, a rare association: a case report

Venous thromboembolism is a very common pathological process for which there are many well known (and less well-known) predisposing factors. Likewise, olanzapine is a commonly used anti-psychotic medication

Post-stroke impairments : natural history and associations with long-term stroke outcomes

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Systematic Process to Determine Clinical Harm From Delayed Communication Between Primary and Secondary Healthcare

Introduction: Timely written communication between primary and secondary healthcare providers is paramount to ensure effective patient care. In 2020, there was a technical issue between two interconnected electronic patient record (EPR) systems that were used by a large hospital trust and the local community partners. The trust provides healthcare to a diverse multiethnic inner-city population across three inner-city London boroughs from two extremely busy acute district general hospitals. Consequently, over a four-month period, 58,521 outpatient clinic letters were not electronically sent to general practitioners following clinic appointments. This issue affected 27.9% of the total number of outpatient clinic letters sent during this period and 42,251 individual patients. This paper describes the structure, methodological process, and outcomes of the review process established to examine the harm that may have resulted due to the delay. Methodology: Senior clinicians examined the letters following training to ensure a standardized consistent approach to the evaluation. They searched whether any actions that had been requested to be undertaken by primary care had been completed in a timely fashion. Thereafter, they indicated whether in their opinion there was any potential “predefined" harm. All letters that were identified as “potential" harm were reexamined by the leads to determine that the harm or inaction was truly accurate. The trust then contacted the patient to apologize and urgently expedite the outstanding action. Patients were not contacted in those situations where no actions were required or already undertaken (99.5%), as this could potentially cause unnecessary anxiety. If an actual harm was detected, it would then be declared as a serious incident and investigated appropriately, including a duty of candor (if the harm was moderate or severe). A “clinical harm review panel" convened regularly to monitor the quality of this process and thereby provide quality assurance. Governance of the process of review was assured by this panel being overseen by a regularly convened regionwide group. Results: 58,521 letters were evaluated over three months by 36 evaluators. No serious untoward incidents were identified, but 1,323 inactions were identified from these letters. These were then all cross-checked with information from EPR. Consequently, only 327 were deemed to be inactions that required further contact with the patient (of the 58,521 letters evaluated, this constituted 0.56%). Certain departments made more requests compared to others (e.g., cardiology, dermatology, and gastroenterology). Most surgical specialties did not generate any actions. Reassuringly, no letters related to cancer had any outstanding actions. The frequency of actions not enacted due to the delay was as follows: did not attend (n=3), medication change (n=173), blood tests (n=73), other investigations (n=31), onward referral (n=47). An audit trail of all outstanding actions has been maintained to allow monitoring in case there was any query in future. We also reviewed those patients who had died to investigate whether the death could be in any way linked to nonreceipt of the letter. There were 367 deaths, and an independent review revealed that no deaths were linked to the nonreceipt of the letter. Ten percent of the deaths (n=36) had a full structured clinical review to further validate the process. Discussion: This paper has described a systematic process of analyzing a large cohort of electronic correspondence to determine any potential harm to patients that may occur due to the delay in communication between primary and secondary care. The structured methodology, well supported by relevant community stakeholders and closely monitored by the clinical harm review panel, could serve as a template to other organizations that may face similar incidents in future

Characterizing Thrombotic Complication Risk Factors Associated With COVID-19 via Heterogeneous Patient Data: Retrospective Observational Study

BackgroundCOVID-19 has been observed to be associated with venous and arterial thrombosis. The inflammatory disease prolongs hospitalization, and preexisting comorbidities can intensity the thrombotic burden in patients with COVID-19. However, venous thromboembolism, arterial thrombosis, and other vascular complications may go unnoticed in critical care settings. Early risk stratification is paramount in the COVID-19 patient population for proactive monitoring of thrombotic complications. ObjectiveThe aim of this exploratory research was to characterize thrombotic complication risk factors associated with COVID-19 using information from electronic health record (EHR) and insurance claims databases. The goal is to develop an approach for analysis using real-world data evidence that can be generalized to characterize thrombotic complications and additional conditions in other clinical settings as well, such as pneumonia or acute respiratory distress syndrome in COVID-19 patients or in the intensive care unit. MethodsWe extracted deidentified patient data from the insurance claims database IBM MarketScan, and formulated hypotheses on thrombotic complications in patients with COVID-19 with respect to patient demographic and clinical factors using logistic regression. The hypotheses were then verified with analysis of deidentified patient data from the Research Patient Data Registry (RPDR) Mass General Brigham (MGB) patient EHR database. Data were analyzed according to odds ratios, 95% CIs, and P values. ResultsThe analysis identified significant predictors (P1. The results from RPDR validated the IBM MarketScan findings, as they were largely consistent and afford mutual enrichment. ConclusionsThe analysis approach adopted in this study can work across heterogeneous databases from diverse organizations and thus facilitates collaboration. Searching through millions of patient records, the analysis helped to identify factors influencing a phenotype. Use of thrombotic complications in COVID-19 patients represents only a case study; however, the same design can be used across other disease areas by extracting corresponding disease-specific patient data from available databases

Correction to: Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

International audienceIn this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected