The feasibility of measuring calprotectin from a throat swab as a marker of infections caused by group A streptococcus: a case–control feasibility study

Background Most people with sore throat do not benefit from antibiotic treatment, but nearly three-quarters of those presenting in primary care are prescribed antibiotics. A test that is predictive of bacterial infection could help guide antibiotic prescribing. Calprotectin is a biomarker of neutrophilic inflammation, and may be a useful marker of bacterial throat infections.Aim To assess the feasibility of measuring calprotectin from throat swabs, and assess whether individuals with sore throats likely to be caused by streptococcal infections have apparently higher throat calprotectin levels than other individuals with sore throat and healthy volunteers.Design & setting A proof of concept case–control study was undertaken, which compared primary care patients with sore throats and healthy volunteers.Method Baseline characteristics and throat swabs were collected from 30 primary care patients with suspected streptococcal sore throat, and throat swabs were taken from 10 volunteers without sore throat. Calprotectin level determination and rapid antigen streptococcal testing were conducted on the throat swab eluents. Calprotectin levels in the following groups were compared: volunteers without a sore throat; all patients with a sore throat; patients with a sore throat testing either negative or positive for streptococcal antigen; and those with lower and higher scores on clinical prediction rules for streptococcal sore throat.Results Calprotectin was detected in all throat swab samples. Mean calprotectin levels were numerically higher in patients with sore throat compared with healthy volunteers, and sore throat patients who had group A streptococci antigen detected compared with those who did not.Conclusion Calprotectin can be measured from throat swab samples and levels are consistent with the hypothesis that streptococcal infection leads to higher throat calprotectin levels. This hypothesis will be tested in a larger study.leukocyte L1 antigen complexpharyngitisanti-bacterial agentsgroup A streptococciprimary health carecalprotectinsore throatantibiotic

The efficacy, effectiveness and safety of SARS-CoV-2 disinfection methods (including ozone machines) in educational settings for children and young people

Several non-touch disinfectant methods including ozone, light-based technologies, and hydrogen peroxide are being considered to reduce the risk of SARS-CoV-2 virus transmission to children and young people in educational settings. Concerns have been raised about the evidence of efficacy, effectiveness and safety of these technologies in these settings. We aimed to address the following research questions: What is the evidence for the surface survival of SARS-CoV-2? What is the evidence for the efficacy (in vitro) and real-life effectiveness (in situ) of ozone machines, light-based technologies and hydrogen peroxide vapour as air or surface disinfectants against SARS-CoV-2? What are the potential health effects of ozone, in particular for children and young people and the benefits and harms of using ozone machines

The efficacy, effectiveness and safety of SARS-CoV-2 disinfection methods (including ozone machines) in educational settings for children and young people

While evidence for the importance of transmission of SARS-CoV-2 from contaminated surfaces is limited, ozone disinfection methods have been considered for surface cleaning as a response to stopping the spread of the virus in educational settings. This rapid evidence summary aimed to search the available literature and summarise findings on the surface survival of SARS-CoV-2, efficacy and effectiveness of ozone machines against SARS-CoV-2, and benefits and harms caused by using these cleaning technologies, including their impact on health. Alternative cleaning technologies, such as light-based technologies and hydrogen peroxide vapour, were also investigated. Findings indicate that gaseous ozone can inactivate different bacteria and viruses, although there is a lack of direct evidence investigating the effect of these cleaning methods on SARS-CoV-2 in real-world settings, specifically in schools. However, regarding harm, ozone is a highly reactive oxidising agent, and high concentrations can contribute to decay of building materials, and health issues (mainly respiratory) by direct exposure or by-product formation. Therefore, leading environmental health organisations do not recommend the use of ozone cleaning technologies in real-world settings, such as schools. Research and policy focus may need to shift towards other interventions that could help reduce transmission, and consequently minimise disruption to education

Point of care testing for urinary tract infection in primary care (POETIC): protocol for a randomised controlled trial of the clinical and cost effectiveness of FLEXICULT (TM) informed management of uncomplicated UTI in primary care

BACKGROUND: Urinary tract infections (UTI) are the most frequent bacterial infection affecting women and account for about 15% of antibiotics prescribed in primary care. However, some women with a UTI are not prescribed antibiotics or are prescribed the wrong antibiotics, while many women who do not have a microbiologically confirmed UTI are prescribed antibiotics. Inappropriate antibiotic prescribing unnecessarily increases the risk of side effects and the development of antibiotic resistance, and wastes resources. POETIC is a randomised controlled trial of a Point Of Care Test (POCT) (Flexicult™) guided UTI management strategy for use in primary care, which may help General Practitioners more effectively decide both whether or not to prescribe antibiotics, and if so, to select the most appropriate antibiotic. METHODS/DESIGN: 614 adult female patients will be recruited from four primary care research networks (Wales, England, Spain, the Netherlands) and individually randomised to either POCT guided care or the guideline-informed ‘standard care’ arm. Urine and stool samples (where possible) will be obtained at presentation (day 1) and two weeks later for microbiological analysis. All participants will be followed up on the course of their illness and their quality of life, using a 2 week self-completed symptom diary. At 3 months, a primary care notes review will be conducted for evidence of further evidence of treatment failures, recurrence, complications, hospitalisations and health service costs. The primary objective is to compare appropriate antibiotic use on day 3 between the POCT and standard care arms using multi-level logistic regression to produce an odds ratio and associated 95% confidence interval. Costs of the two management approaches will be assessed in terms of the primary outcome. DISCUSSION: Although the Flexicult™ POCT is used in some countries in routine primary care, it’s clinical and cost effectiveness has never been evaluated in a randomised clinical trial. If shown to be effective, the use of this POCT could benefit individual sufferers and provide evidence for health care authorities to develop evidence based policies to combat the spread and impact of the unprecedented rise of infections caused by antibiotic resistant bacteria in Europe. TRIAL REGISTRATION NUMBER: ISRCTN65200697 (Registered 10 September 2013)

A rapid review of strategies to support learning and wellbeing among 16-19 year old learners who have experienced significant disruption in their education as a result of the COVID-19 pandemic

The COVID-19 pandemic has caused a significant disruption to all levels of education, especially pupils from disadvantaged and vulnerable groups. Students aged 16-19 years are at a crucial time in their lives as they transition into further study or employment. The pandemic has brought together a unique set of conditions, not only involving disruption to education, but also to environmental, economic, social and emotional areas of young people’s and their families’ lives. This rapid review investigated strategies to support learning and wellbeing among 16-19 years old learners engaged in full time education within a college or school setting who have experienced significant gaps in their education as a result of the COVID-19 pandemic

What innovations (including return to practice) would help attract, recruit, or retain NHS clinical staff? A rapid evidence map

National Health Service (NHS) waiting times have significantly increased over the past couple of years, particularly since the emergence of COVID-19. The NHS is currently experiencing an acute workforce shortage, which hampers the ability to deal with increasing waiting times and clearing the backlog resulting from the pandemic. Plans to increase the workforce, by recruiting new staff, retaining the existing NHS clinical workforce, and making return to clinical practice more attractive will require a number of approaches. This Rapid Evidence Map aimed to describe the extent and nature of the available evidence base for innovations (including return to practice) that could help attract, recruit, or retain NHS clinical staff, in order to identify the priorities and actions for a rapid review. Three options were proposed for a subsequent focused Rapid Review and discussed with stakeholders: (1) review of primary studies that have evaluated return to practice schemes; (2) review of reviews of factors that influence retention; (3) review of reviews of interventions for supporting recruitment and retention. A decision was made that option 3 would be useful to inform practice and a rapid review will be undertaken

A rapid review of the effectiveness of interventions and innovations relevant to the Welsh NHS context to support recruitment and retention of clinical staff.

The National Health Service (NHS) is experiencing an acute workforce shortage in every discipline, at a time when waiting times are at a record high and there is a growing backlog resulting from the COVID-19 pandemic. This Rapid Review aimed to explore the effectiveness of interventions or innovations relevant to the Welsh NHS context to support recruitment and retention of clinical staff. The review is based on the findings of existing reviews supplemented by a more in-depth evaluation of included primary studies conducted in the UK or Europe. The review identifies a range of interventions that can be used for enhancing recruitment and retention in Wales, particular in rural areas, and supports multiple-component interventions. The findings highlight the importance of providing and locating undergraduate and post graduate training in rural locations. The findings also corroborate the use of bursary schemes for training, such as those already available for Nursing in Wales. Further, more robust evaluations, based on comparative studies, are required to assess the effectiveness of interventions to support recruitment and retention of clinical staff. There was limited evidence on interventions aimed at allied health professionals. Most of the primary studies included in the reviews used cohort (pre-post test) or cross-sectional designs. Most studies lacked a comparison group and did not use statistical analysis

A rapid review of the effectiveness of alternative education delivery strategies for undergraduate and postgraduate medical, dental, nursing and pharmacy education during the COVID-19 pandemic

Education delivery in higher education institutions was severely affected by the COVID-19 pandemic, especially for healthcare students whose continuing education is imperative to maintain a well-educated healthcare workforce. Emergency remote teaching, without prior contingency planning, was developed and adapted promptly for the circumstances. We investigated the effectiveness of alternative education delivery strategies during the COVID-19 pandemic to ensure medical, dental, nursing and pharmacy students acquired the relevant knowledge to become effective practitioners, able to translate learning into clinical practice, and how this informs either further planned education delivery or adaptations in emergencies

C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations

BACKGROUND: Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD). METHODS: We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD health status) to 6 (extremely poor COPD health status) (to show noninferiority). RESULTS: A total of 653 patients underwent randomization. Fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57.0% vs. 77.4%; adjusted odds ratio, 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was −0.19 points (two-sided 90% CI, −0.33 to −0.05) in favor of the CRP-guided group. The antibiotic prescribing decisions made by clinicians at the initial consultation were ascertained for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were ascertained for 96.9% of the patients. A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation. CONCLUSIONS: CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm

Stakeholder engagement in a rapid review to determine the effectiveness of interventions to attract, recruit and retain social care workers

Background: The UK social care sector is under increased pressure to combat workforce shortages. With recruitment of professionals impacted by Brexit, the COVID-19 pandemic and the cost-of-living crisis, social care needs innovations to attract, recruit and retain staff. Objectives: To work in partnership with stakeholders to determine the effectiveness of interventions to help attract, recruit and retain social workers and social care workers within the UK context. Methods: This rapid review (RR) was conducted by the Wales COVID-19 Evidence Centre (WCEC). The question was submitted by Social Care Wales, and at an initial stakeholder meeting, they provided a strategic overview of the social care situation in Wales outlining the need for the review. A search of available UK literature (including grey literature) from 2017 to 2022 was conducted within 1 week. At the second stakeholder meeting, the research team presented findings from this, to determine the focus of the RR. Results: This RR and subsequent publication was coproduced with the stakeholders over 2 months. Effective interventions to help with the attraction, recruitment and retention of social workers included practice learning, fast-track graduate programmes and apprenticeships. For the wider social care workforce, effective interventions included preemployment training, national recruitment campaigns, care work ambassadors and valuesbased recruitment. Weaknesses in the primary studies included lack of follow-up and objective evaluations of the interventions. Conclusions: The Social Care Wales team used the RR to inform its programme of work for developing the social care workforce across Wales. On stakeholders’ recommendation, findings were presented to the Directors of Social Services, workforce leads, managers and staff within Wales through the Association of Directors of Social Services. Impact was achieved through the inclusion of the review in the monthly summary of advice to the Technical Advisory Cell of Welsh Government, and it was used to inform the Health and Social Care Committee, House of Commons enquiry ‘Workforce: recruitment, training and retention in health and social care’. Patient, public and/or healthcare consumer involvement: The stakeholders included members of the WCEC public partnership group and representatives from Social Care Wales who are the regulator for the social care workforce in Wales