Risk of death from unintended administration of sodium nitrite

NHS England | August 2020 | Risk of death from unintended administration of sodium nitrite

A National Patient Safety Alert has been issued on the risk of death from unintended administration of sodium nitrite.

About this alert

Sodium nitrite has one licensed indication: as an antidote to cyanide poisoning. It can cause significant side effects and is categorised as highly toxic. It should only be available in Emergency Departments.

Incidents have been reported where sodium nitrate was inadvertently administered instead of sodium bicarbonate, and other sodium containing injections. As the packaging and labelling of sodium bicarbonate ampoules are similar to unlicensed sodium nitrite ampoules, mis-selection errors are likely to be due to the inadvertent supply of sodium nitrite outside of Emergency Departments.

NHS acute trusts are asked to remove sodium nitrate injections from all clinical areas except Emergency Departments, and replace unlicensed sodium nitrite ampoules with licensed sodium nitrite vials. Pharmacies and Emergency Departments are also asked to change procedures and storage policies for all ‘specialist antidotes’.

Full details from NHS England

Department of Health and Social Care: Tackling obesity: empowering adults and children to live healthier lives

The Department of Health and Social Care| July 2020 | Tackling obesity: empowering adults and children to live healthier lives

Department of Health and Social Care have announced a new set of policies that starts to change this environment; to empower people to make the healthier choices they want to make and give the full support of the NHS to people who are overweight and who want to lose weight. It is the start of this government’s effort to shift healthcare to focus more on public health and prevention.

Helping people to achieve and maintain a healthy weight is one of the most important things we can do to improve our nation’s health.

Full details from the Department of Health and Social Care

COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England #covid19rftlks

Mafham, M. M., et al. (2020). COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. The Lancet.

Summary

Background

Several countries affected by the COVID-19 pandemic have reported a substantial drop in the number of patients attending the emergency department with acute coronary syndromes and a reduced number of cardiac procedures. We aimed to understand the scale, nature, and duration of changes to admissions for different types of acute coronary syndrome in England and to evaluate whether in-hospital management of patients has been affected as a result of the COVID-19 pandemic.

Methods

We analysed data on hospital admissions in England for types of acute coronary syndrome from Jan 1, 2019, to May 24, 2020, that were recorded in the Secondary Uses Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), myocardial infarction of unknown type, or other acute coronary syndromes (including unstable angina). We identified revascularisation procedures undertaken during these admissions (ie, coronary angiography without percutaneous coronary intervention [PCI], PCI, and coronary artery bypass graft surgery). We calculated the numbers of weekly admissions and procedures undertaken; percentage reductions in weekly admissions and across subgroups were also calculated, with 95% CIs.

Findings

Hospital admissions for acute coronary syndrome declined from mid-February, 2020, falling from a 2019 baseline rate of 3017 admissions per week to 1813 per week by the end of March, 2020, a reduction of 40% (95% CI 37–43). This decline was partly reversed during April and May, 2020, such that by the last week of May, 2020, there were 2522 admissions, representing a 16% (95% CI 13–20) reduction from baseline. During the period of declining admissions, there were reductions in the numbers of admissions for all types of acute coronary syndrome, including both STEMI and NSTEMI, but relative and absolute reductions were larger for NSTEMI, with 1267 admissions per week in 2019 and 733 per week by the end of March, 2020, a percent reduction of 42% (95% CI 38–46). In parallel, reductions were recorded in the number of PCI procedures for patients with both STEMI (438 PCI procedures per week in 2019 vs 346 by the end of March, 2020; percent reduction 21%, 95% CI 12–29) and NSTEMI (383 PCI procedures per week in 2019 vs 240 by the end of March, 2020; percent reduction 37%, 29–45). The median length of stay among patients with acute coronary syndrome fell from 4 days (IQR 2–9) in 2019 to 3 days (1–5) by the end of March, 2020.

Interpretation

Compared with the weekly average in 2019, there was a substantial reduction in the weekly numbers of patients with acute coronary syndrome who were admitted to hospital in England by the end of March, 2020, which had been partly reversed by the end of May, 2020. The reduced number of admissions during this period is likely to have resulted in increases in out-of-hospital deaths and long-term complications of myocardial infarction and missed opportunities to offer secondary prevention treatment for patients with coronary heart disease. The full extent of the effect of COVID-19 on the management of patients with acute coronary syndrome will continue to be assessed by updating these analyses.

COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England

Drug vignettes: Tocilizumab #covid19rftlks

Centre for Evidence-based Medicine | August 2020 | Drug vignettes: Tocilizumab

Patients with severe COVID-19 can develop cytokine release syndrome (“cytokine storm”) and are reported to have high circulating IL-6 concentrations. Tocilizumab is a recombinant humanized anti-human IgG1 monoclonal antibody directed against the interleukin-6 receptor (IL-6R). It has therefore been proposed to be of value in the management of severe COVID-19.

Full details from CEBM

COVID‐19 and cutaneous manifestations: A systematic review #covid19rftlks

Zhao Q, Fang X, Pang Z, Zhang B, Liu H, Zhang F. COVID-19 and cutaneous manifestations: A systematic review [published online ahead of print, 2020 Jun 28]. J Eur Acad Dermatol Venereol. 2020;10.1111/jdv.16778. doi:10.1111/jdv.16778

The cutaneous manifestations of COVID‐19 patients have been increasingly reported, but not summarized, and the potential mechanisms remain to be investigated. Herein, we performed a comprehensive review of literatures (from inception to May 30, 2020) using PubMed, CNKI, medRxiv, and bioRxiv with the terms “((novel coronavirus) OR (2019 novel coronavirus) OR (2019‐nCoV) OR (Coronavirus disease 2019) OR (COVID‐19) OR (SARS‐CoV‐2)) AND ((Dermatology) OR (skin) OR (rash) OR (cutaneous))” and “((ACE2) OR (Angiotensin‐converting enzyme)) AND ((skin) OR (epidermis) OR (dermis))”. Totally, 44 articles met the inclusion criteria. A total of 507 patients with cutaneous manifestations were summarized, and 96.25% patients were from Europe. The average age of the patients was 49.03 (range: 5‐91) with a female ratio of 60.44%. The skin lesions were polymorphic, and erythema, chilblain‐like and urticarial lesions were most common, occurring on an average of 9.92 days (range: 1‐30) after the onset of systemic symptoms. The receptor of SARS‐CoV‐2, ACE2, was found to be expressed on skin, mainly on keratinocytes. Our review systematically presented the clinical characteristics of 507 patients and showed that skin might be the potential target of the infection according to ACE2 expression. More work should be done to better understand the underlying pathogenesis.

The full paper is available from PubMed

After-care needs of inpatients recovering from COVID-19 #covid19rftlks

NHS England | July 2020| After-care needs of inpatients recovering from COVID-19

This guidance supports primary care and community health services to meet the immediate and longer-term care needs of patients discharged following an acute episode of COVID-19, by describing the typical expected health care needs of these patients, post-discharge.

After-care needs of inpatients recovering from COVID-19

UK Biobank reveals substantial variation in rates of previous COVID-19 infection across the UK #covid19rftlks

UK Biobank | July 2020| UK Biobank reveals substantial variation in rates of previous COVID-19 infection across the UK

UK Biobank recently published the first results from a major government-backed study of the extent of previous infection with SARS-CoV-2 in different populations across the UK. It found evidence of previous infection in 7.1% of the study population, but with large variation in the rates between different parts of the UK and between different demographic groups.

Image source: ukbiobank.ac.uk

First Results

These first results provide a snapshot for May and June of past SARS-CoV-2 infection, revealing that:

  • Overall in the study, 7.1% of the participants had been infected previously
  • There was no difference in the rates of previous infection between men and women, but the rates were higher in younger people (ranging from 10.8% in those under 30 to 5.4% in those over 70)
  • Previous infection was most common among participants who live in London (10.4%), and least common among those who live in the South-West of England and Scotland (4.4% in both)
  • Participants living in areas with higher levels of socio-economic deprivation had a higher rate (8.9%) of previous infection than those who live in more affluent areas of the country (6.1%)
  • The rate of previous infection was higher among participants of Black (11.3%) and South Asian (9.0%) ethnicity than among those of White ethnicity (6.9%)

As a result of these independent trends, rates of previous infection were particularly high in certain sub-groups. For example, the rate was 18.4% in participants from ethnic minority groups who are aged under 30 and living in London. However, the differences between ethnic groups were not explained fully by where people lived or by their age.

Further detail on the results are available in the full report:UK Biobank SARS-CoV-2 Serology Study

Full details are available from the UK Biobank

The Health Foundation: Communicating about long-term health during the pandemic #covid19rftlks

The Health Foundation | July 2020 | Communicating about long-term health during the pandemic

The coronavirus (COVID-19) pandemic compels us all to think differently about what our society needs to be healthy. It is highlighting and heightening the inequalities that affect our health. And it’s shining fresh light on how our social, economic and environmental circumstances – the wider determinants of health – shape our health and wellbeing. COVID-19 is having an unacceptably uneven impact. For many in the public health community, it’s yet more compelling evidence of the need for a concerted focus on health inequalities and the wider determinants of health.

Full details are available from The Health Foundation

Communicating about long-term health during the pandemic

Cancer Research UK: Cancer Patient Experience Survey 2020 The impact of COVID-19 on cancer patients in the UK #covid19rftlks

Cancer Research UK| July 2020| Cancer Patient Experience Survey 2020 The impact of COVID-19 on cancer patients in the UK

Taken from the Executive Summary

Overall for many cancer patients the COVID-19 pandemic appears to have had a significant impact on their testing and treatment, and most notably their care:

• 40 % of cancer patients surveyed reported that their testing had been impacted.

•One- third of patients surveyed reported that their treatment had been impacted.

• 2 in 3 cancer patients reported that their cancer care had been impacted.

• Ratings of overall cancer care as ‘very good’ decreased from 75% ‘before lockdown started’ to 37% ‘after lockdown started’.

• Possible significant differences in experience were found by region in England for testing, treatment and care (p less than .01).

• Possible significant[1] differences in experience for care was flagged for social economic status (SES), nation, region and cancer type (p less than .01).

• 71% of cancer patients stated that they had been treated in the same hospital as usual, with no significant differences by SES, cancer type, nation or region.

This has resulted in a negative impact on the emotional well-being of many cancer patients:

• The most common emotions reported were ‘anxious’ and ‘frustrated’. This was consistent for all patients surveyed, those who reported to have their testing and treatment impacted, and across breakdowns (SES, nation region and cancer type).

• ‘Catching COVID-19’ and ‘becoming seriously ill from COVID-19’ were the most selected concerns, and there was a lot of frustration reported in the open text comments

Full report available from Cancer Research UK

Children’s Society: Pandemic leaves 1.1m teenagers unhappy with their lives


Children’s Society | August 2020| Pandemic leaves 1.1m teenagers unhappy with their lives

The Children’s Society annual survey of children’s well-being was conducted between April and June by just over 2,000 young people and their parents. The survey indicates that almost a fifth of children (18%) are dissatisfied with their lives.

 That is a marked increase in a figure which has ranged from 10 per cent to 13 per cent over the last five years.

The Children’s Society says the coronavirus crisis and lockdown is likely to explain the worrying surge. Its report, Life On Hold, also found that half of parents (50%) expected coronavirus to harm their children’s happiness over the coming year.

The Children’s Society identifies a number of actions, and calls for:

National measurement of children’s well-being to help inform plans to make a positive difference – as it does already for young people aged over 16 and adults.

A review of schooling by the Department for Education to ensure pupils’ well-being is considered not just in the short-term as schools re-open – but becomes a permanent priority underpinning all aspects of school life including the National Curriculum, exams and behaviour management.

More investment in open-access community mental health services where children can get support with their emotional well-being. This should be part of an early intervention strategy backed by dedicated local grants.

Better financial support for low-income families; for instance, £10 per week increases in child benefit, the child element of child tax credit and Universal Credit; scrapping the benefit cap and two-child limit; tackling the five-week wait for Universal Credit by offering advance payments as grants rather than loans.

Press release Pandemic leaves 1.1m teenagers unhappy with their lives

Life on hold: Children’s Well-being and COVID-19