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The COVID-19 pandemic triggered disruptions to health care and lifestyles that could conceivably impact diabetes management. We set out to identify the impact of disruptions caused by COVID-19 on clinical outcomes in people with diabetes. We performed a systematic review of the available literature in the MEDLINE and OVID databases from Jan 1, 2020, to June 7, 2023, and included 138 studies (n>1 000 000 people). All but five studies were judged to be at some risk of bias. All studies compared prepandemic with pandemic periods. All-cause mortality (six studies) and diabetes-related mortality (13 studies) showed consistent increases, and most studies indicated increases in sight loss (six studies). In adult and mixed samples, data generally suggested no difference in diabetic ketoacidosis frequency or severity, whereas in children and adolescents most studies showed increases with some due to new-onset diabetes (69 studies). Data suggested decreases in hospital admissions in adults but increases in diabetes-related admissions to paediatric intensive care units (35 studies). Data were equivocal on diabetic foot ulcer presentations (nine studies), emergency department admissions (nine studies), and overall amputation rates (20 studies). No studies investigated renal failure. Where reported, the impact was most pronounced for females, younger people, and racial and ethnic minority groups. Further studies are needed to investigate the longer-term impact of the pandemic and the on potential differential impacts, which risk further exacerbating existing inequalities within people with diabetes.

BackgroundFew studies have investigated prehospital conveyance of people from ethnic minority communities. Our aim was to identify differences in prehospital conveyance for ethnic minority people compared with white British people in the East Midlands region, United Kingdom (UK).MethodsUsing a cross-sectional design, we analysed retrospective electronic clinical data from a large UK ambulance service, East Midlands Ambulance Service NHS Trust (EMAS), which serves a population of 4.5 million, from 1 January 2018 to 31 December 2021. Patient self-reported ethnicity recorded by ambulance crew in attendance was the exposure using seven categories of white British, EU27 Countries, other white, Asian, black, mixed and any other. The outcome measure was the rate of conveyance to a hospital. Multivariable logistic regression was used to identify predictors of conveyance whilst accounting for sociodemographic characteristics including age, gender, ethnicity, NEWS2 score, socio-economic deprivation, and urban or rural place of attendance.ResultsThere were 2,324,439 patients who received an ambulance attendance including people of White (88.0%), non-White (6.3%) and unknown (5.7%) ethnicity. The proportion of Asian patients (3.8%) who received attendance from the ambulance service was higher than other ethnic minority backgrounds. After adjusting for age, gender, ethnicity, NEWS2 score, socio-economic deprivation, and urban or rural place of residence, Asian patients (Odds Ratio [OR] 0.81, 95% Confidence Interval [CI] 0.80, 0.82, p<0.001), Black patients (OR 0.90, 95% CI 0.88, 0.93, p<0.001), and mixed ethnicity patients (OR 0.92, 95% CI 0.89, 0.95, p<0.001) were significantly less likely than white patients to be conveyed to the hospital by ambulance.ConclusionsThere were significant differences in prehospital conveyance for ethnic minority patients compared with white-British patients. These differences could be related to language and cultural barriers, and a limited understanding of the health system. More action is needed to tackle ethnic inequalities, reduce inequalities, and remove barriers to equal conveyance.

BackgroundMedical emergencies in residential or nursing care homes are common and costly, resulting in ambulance attendance and hospitalisation, with extra pressure on an emergency system severely impacted by the Covid-19 pandemic. The aim of this study was to explore how the number of ambulance attendances to care homes varied before and during Covid-19 pandemic whilst considering the UK national lockdowns.MethodsWe used a cross-sectional study design analysing routine data from electronic clinical records from East Midlands Ambulance Service NHS Trust (EMAS) from 2018 to 2021. An interrupted-time series analysis (ITSA) was used to compare the total number of ambulance attendances to care homes per week before and during the pandemic whilst considering the three UK national lockdown periods. Seasonality (i.e., month of the year), call category, deprivation, and rurality were included as covariates in the model.ResultsThe interrupted time series analysis indicated a significant decrease of 9.9 ambulance attendances to 1956 East Midlands care homes per week during the first lockdown relative to the pre-pandemic period (CI: -19.1, -0.8, p=0.034). This was followed by a significant increase of 13.7 attendances per week in the period between the first two lockdowns (CI: 4.0, 23.5, p=0.006) relative to the first lockdown period. There was no significant change during the second lockdown but there was a significant decrease of 19.7 attendances per week in the third lockdown (CI: -30.5, -9.0, p<0.001) compared to the non-lockdown period preceding it.ConclusionAmbulance attendances to care homes decreased during the Covid-19 pandemic, were significantly reduced in the first and third lockdowns, and remained lower during the pandemic compared to pre-pandemic levels. Further research is needed to investigate the factors that might have influenced this trend including changes in ambulance service policies, ambulance and care home personnel, and increased death rates in care homes.

BackgroundResidents of care homes may be affected by medical emergencies, resulting in ambulance attendance and conveyance to hospital which add extra pressure and costs on an already strained emergency and healthcare system. The aim of this study was to determine the factors predicting conveyance to hospital of care home residents by ambulance services.MethodsWe used a cross-sectional study design analysing routine data from electronic clinical records from East Midlands Ambulance Service NHS Trust (EMAS) from 2018 to 2021. A multivariable multinominal regression model was used to identify the main predictors of conveyance to hospital or referral to community services.ResultsThe data included 170,612 attendances to care homes representing 7.5% of the total number of EMAS attendances between 2018-2021. The main predictors of conveyance to hospital were being male (Relative Risk Ratio [RRR] 1.07, 95% Confidence Interval [CI] 1.03-1.10, p<0.001), aged 70-79 years (RRR 1.09, 95%CI 1.03-1.17, p<0.001) or 80-89 years (RRR 1.10, 95%CI 1.03-1.17, p<0.001), situated in an area of higher deprivation (RRR 1.06, 95%CI 1.03-1.09, p<0.001), or having dispatch categories which included cardiovascular (RRR 11.29, 95%CI 10.43-12.22, p<0,001), trauma including falls (RRR 9.50, 95%CI 8.97-10.05, p<0,001) or neurological (RRR 9.06, 95%CI 8.42-9.75, p<0,001) conditions. Calls made by health care professionals (HCPs) (RRR 15.37, 95%CI 13.41-17.62, p<0,001) or where patients had a higher National Early Warning Score (NEWS2) (RRR 1.23, 95%CI 1.22-1.24, p<0,001) resulted in significantly increased conveyance.ConclusionA series of factors significantly predict conveyance to hospital by ambulance of home care residents. These include HCP referral or NEWS2 confirming that the severity of clinical condition of the patient was associated with significantly increased conveyance. Future interventions to prevent or address certain conditions such as falls or provide enhanced care in care homes may prevent some emergencies or reduce the risk of conveyance to hospital.

BackgroundMedical emergencies in care homes are common and costly, often resulting in calls to emergency services, ambulance attendance, conveyance, and hospital admissions. Over half of emergency transfers to hospital could be prevented with better ongoing care, access to primary care and training of staff. Our aim was to explore ambulance staff experiences of emergencies in care homes.MethodsWe employed a qualitative design. The study involved semi-structured interviews with ambulance staff working at the East Midlands Ambulance Service NHS Trust. Data were analysed thematically using a framework approach.ResultsWe interviewed 15 ambulance staff (including paramedics, technicians, urgent care assistants). Preliminary analysis showed that although good communication with care home staff was considered important, experiences were varied. The importance of good, adequate resident information ready for ambulance staff upon arrival was highlighted. Regarding the decision-making process, participants reported consulting with everyone involved (care home staff, residents, relatives) and making final decisions based on various factors, including the resident/their family’s wishes, medical history, ReSPECT forms, alternative pathways to A&E, and what they considered the most appropriate course of action for the resident. Care home-related factors (access/egress issues; staff training; policies and procedures; and overall quality of care) and Emergency Medical Services-related factors (current pressures on the service; better training needed on working with people with dementia, end-of-life care, etc.; having access to an on-call geriatrician), which impact those who experience emergencies in care homes, were also discussed.ConclusionThis study highlights the main challenges and facilitators that ambulance staff are faced with when dealing with emergencies in care homes. These data present findings of one staff group and triangulation with care home staff, resident and family perspectives would generate further insights. The findings will inform the development of interventions to improve outcomes and experiences of emergencies in care homes.

To our knowledge, this systematic review is the first to assess pharmacy-involved interprofessional education (IPE) simulation activities in establishing current methodological effectiveness using Kirkpatrick’s Evaluation Model. This is a training evaluative model that assesses educational training activities according to 4 levels: reaction, learning, behavior, and results.

Sleep disturbances are prevalent in the UK and globally, with sleep data from across 13 countries suggesting that only 55% of adults are satisfied with their sleep. Disturbed sleep is found in diabetes which is one of the most serious diseases worldwide. Specifically, relationships have been found between glycaemic control and sleep duration and quality. It is currently unclear how diabetes specifically affects sleep stages, and their associated spectral power. This study aims to characterise the relationship between polysomnography-measured specific sleep stages and associated spectral power in adults with diabetes and control participants. This study involved a secondary data analysis of multi-cohort Sleep Heart Health (SHH) data using a matched-pairs design. The sample included 414 participants (211 males, 203 females, mean age (years) 70.0, 95% CI [69.1, 70.9]) 207 with diabetes and 207 matched controls. The results suggest an increase in light sleep in diabetes, specifically NREM stage 2 sleep duration (p = 0.05) and percentage (p = 0.04), with an increase in slow-wave activity (p = 0.03) and delta power (p = 0.04) during NREM stage 1 sleep. Slow-wave sleep duration marginally reduced in diabetes, (p = 0.09), whilst delta power (p < 0.01), slow-wave activity (p = 0.02) and theta power (p < 0.01) in slow-wave sleep also significantly reduced in diabetes compared to control participants. No other changes to sleep stages or associated spectral power were observed. These results suggest a potential homoeostatic influence of sleep on glycaemic control, which should be further explored in future research.

The ‘paediatric inactivity triad’ (PIT) framework consists of three complex inter-related conditions that influence physical inactivity and related health risks. In those living with chronic kidney disease (CKD), a multi-factorial milieu of components likely confound the PIT elements, resulting in a cycle of decreased physical functioning and reduced physical activity. In this review, we explore and summarize previous research on each of the three principal PIT components (exercise deficit disorder, dynapenia, and physical illiteracy) in the pediatric CKD population. We found those living with CKD are significantly physically inactive compared to their peers. Physical inactivity occurs early in the disease process and progressively gets worse as disease burden increases. Although physical activity appears to increase post-transplantation, it remains lower compared to healthy controls. There is limited evidence on interventions to increase physical activity behaviour in this population, and those that have attempted have had negligible effects. Studies reported profound reductions in muscle strength, physical performance, and cardiorespiratory fitness. A small number of exercise-based interventions have shown favourable improvements in physical function and cardiorespiratory fitness, although small sample sizes and methodological issues preclude the generalization of findings. Physical activity must be adapted and individualized to the needs and goals of the children, particularly those with acute and chronic medical needs as is the case in CKD, and further work is needed to define optimal interventions across the life course in this population if we aim to prevent physical activity declining further.

BackgroundMedical emergencies in care homes, both residential and nursing care homes, are common and costly, often resulting in calls to an out-of-hours general practitioner (GP) or Emergency Medical Services (EMS). Ambulance attendance frequently results in conveyance to hospital and the concomitant high costs and risks of, often prolonged, hospitalisation. Previous reviews have focussed on various stakeholder perceptions of transfer to hospital. The aim of this systematic review was to provide a comprehensive synthesis of the perceptions and experiences of care home residents and their family members, who have experienced medical emergencies in a care home setting.MethodsWe searched five electronic databases, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review.ResultsThe search strategy identified 6,140 citations. After removing duplicates and excluding citations based on title and abstract, and full-text screening, ten studies from four countries (Australia, Canada, UK, and US) were included in the review and meta-synthesis. All included studies were considered of acceptable quality. Through an iterative approach, we developed six analytical themes. 1. Infrastructure and process requirements in care homes to prevent and address emergencies; 2. The decision to transfer to hospital – a perfect storm; 3. Challenges of transfer and hospitalisation for older patients; 4. Good communication vital for desirable outcomes; 5. Legal, regulatory and ethical concerns; and 6. Trusting relationships enabled residents to feel safe.ConclusionsThe emergency care experience for care home residents can be enhanced by ensuring resources, staff capacity and processes for high quality care. Building trusting relationships underpinned by good communication and attention to ethical practice were also identified as important factors.