Secondary Care Hospital Research Articles

Assessment of Oxygen Supply-Demand Imbalance and Outcomes Among Patients With Type 2 Myocardial Infarction

Type 2 myocardial infarction occurs owing to multiple factors associated with myocardial oxygen supply-demand imbalance, which may confer different risks of adverse outcomes. To evaluate the prevalence and outcomes of different factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial infarction. In this secondary analysis of a stepped-wedge, cluster randomized clinical trial conducted at 10 secondary and tertiary care hospitals in Scotland, 6096 patients with an adjudicated diagnosis of type 1 or type 2 myocardial infarction from June 10, 2013, to March 3, 2016, were identified, and the findings were reported on August 28, 2018. The trial enrolled consecutive patients with suspected acute coronary syndrome. The diagnosis of myocardial infarction was adjudicated according to the Fourth Universal Definition of Myocardial Infarction and the primary factor associated with oxygen supply-demand imbalance in type 2 myocardial infarction was defined. This secondary analysis was not prespecified. Statistical analysis was performed from July 7 to 30, 2020. Implementation of a high-sensitivity cardiac troponin I assay. All-cause death at 1 year according to the factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial infarction. Of 6096 patients (2602 women [43%]; median age, 70 years [IQR, 58-80 years]), 4981 patients had type 1 myocardial infarction, and 1115 patients had type 2 myocardial infarction. The most common factor associated with oxygen supply-demand imbalance was tachyarrhythmia (616 of 1115 [55%]), followed by hypoxemia (219 of 1115 [20%]), anemia (95 of 1115 [9%]), hypotension (89 of 1115 [8%]), severe hypertension (61 of 1115 [5%]), and coronary mechanisms (35 of 1115 [3%]). At 1 year, all-cause mortality occurred for 15% of patients (720 of 4981) with type 1 myocardial infarction and 23% of patients (285 of 1115) with type 2 myocardial infarction. Compared with patients with type 1 myocardial infarction, those with type 2 myocardial infarction owing to hypoxemia (adjusted odds ratio [aOR], 2.35; 95% CI, 1.72-3.18) and anemia (aOR, 1.83; 95% CI, 1.14-2.88) were at greatest risk of death, whereas those with type 2 myocardial infarction owing to tachyarrhythmia (aOR, 0.83; 95% CI, 0.65-1.06) or coronary mechanisms (aOR, 1.07; 95% CI, 0.17-3.86) were at similar risk of death as patients with type 1 myocardial infarction. In this secondary analysis of a randomized clinical trial, mortality after type 2 myocardial infarction was associated with the underlying etiologic factor associated with oxygen supply-demand imbalance. Most type 2 myocardial infarctions were associated with tachyarrhythmia, with better prognosis, whereas hypoxemia and anemia accounted for one-third of cases, with double the mortality of type 1 myocardial infarction. These differential outcomes should be considered by clinicians when determining which cases need to be managed if patient outcomes are to improve. ClinicalTrials.gov Identifier: NCT01852123.

A feasibility randomised controlled trial of a Fibromyalgia Self-management Programme for adults in a community setting with a nested qualitative study (FALCON)

BackgroundFibromyalgia is a condition associated with widespread musculoskeletal pain, fatigue and sleep problems. Fibromyalgia treatment guidelines recommend non-pharmacological interventions and the development of self-management skills. An example of a programme that fits these guidelines is the Fibromyalgia Self-management Programme (FSMP) which consists of one 2.5-hour weekly session over six successive weeks and includes education about fibromyalgia, goal setting, pacing, sleep hygiene and nutritional advice. The FSMP is currently provided in a secondary care hospital setting and co-delivered by a multidisciplinary team. Delivery in a primary care setting has the potential to improve the accessibility of the programme to people with fibromyalgia. Therefore, this feasibility study aimed to determine the practicality and acceptability of conducting a future definitive randomised controlled trial of the FSMP in a community setting.MethodAn exploratory, parallel-arm, one-to-one, randomised controlled trial. Participants were recruited from general practices across South West England, and the FSMP was co-delivered by physiotherapists and occupational therapists across two community sites. To determine the outcome measures for a future definitive trial several were tested. The Revised Fibromyalgia Impact Questionnaire, Arthritis Self-Efficacy Scale-8, Chalder Fatigue Scale, Short form 36, 5-Level EQ-5D version and Jenkins Sleep Scale were collected at baseline, 6 weeks and 6 months. Semi-structured interviews were conducted with patient participants, occupational therapists and physiotherapists to explore the acceptability and feasibility of delivering the FSMP in a community setting.ResultsA total of 74 participants were randomised to the FSMP intervention (n = 38) or control arm (n = 36). Attrition from the trial was 42% (31/74) at 6 months. A large proportion of those randomised to the intervention arm (34%, 13/38) failed to attend any sessions with six of the 13 withdrawing before the intervention commenced. The proportion of missing values was small for each of the outcome measures. Three overarching themes were derived from the interview data; (1) barriers and facilitators to attending the FSMP; (2) FSMP content, delivery and supporting documentation; and (3) trial processes.ConclusionIt is feasible to recruit people with fibromyalgia from Primary Care to participate in a randomised controlled trial testing the FSMP in a community setting. However, improvement in trial attrition and engagement with the intervention is needed.Trial registrationThe trial is registered with ISRCTN registry and was assigned on 29/04/2019. The registration number is ISRCTN10824225.

MET-PREVENT: metformin to improve physical performance in older people with sarcopenia and physical prefrailty/frailty – protocol for a double-blind, randomised controlled proof-of-concept trial

IntroductionSkeletal muscle dysfunction is central to both sarcopenia and physical frailty, which are associated with a wide range of adverse outcomes including falls and fractures, longer hospital stays, dependency and...

A Prospective Study on Hypertension-Revealing it to be a key factor for various Medical Complications, their Management and Prevalence in a Secondary Care Hospital

Background: High blood pressure or HTN is a heterogeneous group of disorder characterized by a persistent increase in blood pressure due to the force of blood pushing against the blood vessel walls, which develops over time due to unhealthy lifestyle choices, lack of awareness accompanied by low levels of treatment and uncontrolled rates lead to mortality. Globally Hypertension (HTN) affects two-third of the population resulting in 10.4 million deaths annually. Despite several initiatives, the prevalence of HTN and its adverse impact on cardiovascular, renal, and cerebrovascular morbidity and mortality are globally increasing.
 Objectives: The objective of the study is to detect the adverse outcomes of uncontrolled hypertension and review the treatment patterns in the management of hypertension to reduce its further complications. To assess whether the higher prevalence of undiagnosed hypertension or poor adherence to antihypertensive therapy or both may explain the higher prevalence of hypertensive complications.
 Results: In the study, the prevalence of hypertension was found to be 46% among the patient population with males (52.5%) being more prevalent than females (47.5%). Among all age groups, individuals aged 50-69 years were highly affected. From the study, it was found that a greater number of patients fall in the category of stage-2 hypertension (38.75%) followed by hypertension crisis (28.75%), stage-1 hypertension (25%), and normal (7.5%). More patients with uncontrolled hypertension experienced cardiovascular complications (55%) when compared to cerebrovascular (27.5%) and renal (17.5%) complications. The choice of antihypertensive drugs used in the management were diuretics (43.75%), CCB (41.25%), ARB (37.5%), BB (32.5%), B+A (11.25%), ACEI (6.25%), CS (3.75%), and AAB (2.5%). The most commonly prescribed drugs in the study were Furosemide (11.25%), Telmisartan (11.25%), Amlodipine (7.5%), and Metoprolol (6.25%).
 Conclusion: The study concludes that most of the patients with uncontrolled hypertension were suffering from cardiovascular complications with least being affected by renal and cerebrovascular complications. A regular and moderate degree of physical activity in combination with good lifestyle choices may have a good impact on hypertension control thus preventing further complications. However, blood pressure control is obtained in some individuals, while in some blood pressure was still elevated after the drug management due to the presence of co-morbid conditions and poor lifestyle modifications.

KAP Study on Responsiveness among Nursing Officers in Secondary care hospitals, Central Province, Sri Lanka

KAP Study on Responsiveness among Nursing Officers in Secondary care hospitals, Central Province, Sri Lanka

Study of the Morbidity Pattern Among Geriatric Patients Attending a Secondary Care Hospital in Bhubaneswar, Odisha

Study of the Morbidity Pattern Among Geriatric Patients Attending a Secondary Care Hospital in Bhubaneswar, Odisha

Pulmonary Barotrauma in COVID-19 Patients: Experience From a Secondary Care Hospital in Oman.

BackgroundDuring the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many patients developed pulmonary barotrauma either self-inflicted or ventilator-induced. In pulmonary barotrauma, air leaks into extra-alveolar tissue resulting in pneumomediastinum, subcutaneous emphysema, pneumothorax, and pneumoperitoneum.MethodsAfter obtaining institutional approval, we retrospectively reviewed data from March 1, 2021, to September 31, 2021. Being a retrospective study, informed consent was not applicable. Patient data were collected from the Al Shifa patient information portal, which is an electronic medical record system available to all hospitals in the Ministry of Health, Oman. After identifying patients with pulmonary barotrauma, the following details were recorded and entered into an Excel sheet (Microsoft Corporation, Albuquerque, New Mexico) and a database was created, which contained the following: age, sex, smoking history, comorbidities, type, location, mode of barotrauma, mode of ventilation, length of intensive care unit (ICU) stay, interventions performed, and overall outcome (survived/deceased).ResultsA total of 529 patients with COVID-19 pneumonia were admitted from March 2021 to September 2021 to the ICU. Twenty-eight patients developed barotrauma of variable severity and required interventions like the placement of intercostal drains. Out of 28, five patients developed spontaneous barotrauma, 14 patients had barotrauma after initiation of non-invasive ventilation, and nine patients had barotrauma as a result of invasive ventilation. The median number of days in the ICU was 19.5 (interquartile range: 12.5-26.5). Of the 28 patients, eight patients survived and were discharged from the hospital.ConclusionIn this single-center, retrospective study at a secondary care hospital in Oman, we described our experience with patients who suffered pulmonary barotrauma during their ICU admission. We have also presented the incidence of spontaneous versus ventilator-induced barotrauma, the length of stay of these patients, the outcomes in terms of survival or death, the need for tracheostomy, secondary infections, and interventions performed as indicated.

COVID-19 Survivors' Intensive Care Unit Experiences and Their Possible Effects on Mental Health: A Qualitative Study.

It is known that being hospitalized in the intensive care unit (ICU) for any reason is a risk factor for future psychiatric problems. This qualitative study aims to identify the experiences of coronavirus disease 2019 (COVID-19) ICU survivors and provide insights for relevant mental health problems after being discharged. Participants were COVID-19 patients discharged from ICUs of a secondary care hospital. The experiences of 21 ICU survivors were evaluated using Colaizzi's 7-step approach, which were determined by the purposeful sampling method. There were three themes generated from the interviews as "emotions on COVID-19 diagnosis," "feelings about ICU stay and health care providers," and "life in the shadow of COVID-19." Two subthemes for every single theme were generated, and a total of 19 codes were extracted. It is essential to understand the individual's unique experiences in designing preventive interventions and apply individual preventive mental health interventions during ICU stay.

EE3 Cost-Effectiveness of Intravenous Antibiotics Therapy for Children with Acute Gastroenteritis in a Secondary Care Hospital in South India

Acute Gastroenteritis is a common ailment affecting children contributing towards various direct costs, indirect costs, and symptom-associated decreased quality of life. Antibiotics are not advocated as a mainstay of treatment. Although it is widely prescribed in Kerala due to poor recourses for differential diagnosis. So, we aimed to compare the Cost-effectiveness of IV Antibiotics therapy for children with acute gastroenteritis in a secondary care hospital in South India.

Are all thermometers equal? A study of three infrared thermometers to detect fever in an African outpatient clinic.

Infrared thermometry has certain advantages over traditional oral thermometry including quick, non-invasive administration and an absence of required consumables. This study compared the performance of tympanic, temporal artery and forehead contactless thermometers with traditional oral electronic thermometer as the reference in measuring temperature in outpatients in a Nigerian secondary care hospital. A convenience sample of 100 male and 100 female adult patients (Mean age = 38.46 years, SD = 16.33 years) were recruited from a secondary care hospital in Kano, Nigeria. Temperature measurements were taken from each patient using the tympanic, temporal artery and contactless thermometers and oral electronic thermometer. Data was analyzed to assess bias and limits using scatterplots and Bland-Altman charts while sensitivity analysis was done using ROC curves. The tympanic and temporal artery thermometers systematically gave higher temperature readings compared to the oral electronic thermometer. The contactless thermometer gave lower readings compared to the oral electronic thermometer. The temporal artery thermometer had the highest sensitivity (88%) and specificity (88%) among the three infrared thermometers. The contactless thermometer showed a low sensitivity of 13% to detect fever greater than 38 °C. Our study shows that replacing oral thermometers with infrared thermometers must be done with caution despite the associated convenience and cost savings.

The Elevation of Double-Lumen Tube Cuff Pressure During Lung Surgery: A Single-Center Prospective Observational Study☆,☆

Excessive tracheal tube cuff pressure can cause postoperative complications; however, the variations in the double-lumen tube cuff pressure in lung surgery have not been investigated. This study aimed to determine the incidence and variations in excess double- lumen tube cuff pressure during one-lung ventilation. A prospective observational study. Single secondary-care hospital. Patients aged ≥18 years scheduled for elective lung surgery using a left-sided double-lumen tube. None MEASUREMENTS AND MAIN RESULTS: Each cuff of the double-lumen tube was connected to a pressure transducer, and the cuff pressure was continuously measured. The excess cuff pressure and its duration (%) were defined as ≥22 mmHg, and the ratio of the duration of excess cuff pressure to the duration of one-lung ventilation, respectively. In total, 147 patients were included in the final analysis. Eighty patients (54.5%) developed cuff pressure elevation in either cuff and 28 patients (19%) in both cuffs. Younger age, male sex, and left-sided surgery were associated with elevated bronchial cuff pressure. Concurrently, younger age, maximal peak inspiratory pressure, and obstructive respiratory dysfunction were associated with an elevated tracheal cuff pressure. A duration of excess cuff pressure >50% in either cuff was found in 34 patients (23%), and both cuffs in 5 patients (3.4%). The correlation between the duration of tracheal and bronchial excess cuff pressure was poor. A high incidence and long duration of excess tracheal and bronchial cuff pressure were observed during one-lung ventilation for lung surgery.

Evaluation of the Appropriate Use of Coronary Computed Tomography Angiography: A Retrospective, Single-Center Analysis.

Purpose: We assessed the application of appropriate use criteria of coronary computed tomography angiography (CCTA) in comparison to invasive coronary angiography results and revascularization rates in patients with coronary artery disease (CAD). Methods: 1305 patients referred to invasive coronary angiography (ICA) after CCTA were evaluated retrospectively. The primary indication for CCTA was assessed according to the consensus for intermediate-risk (15–85% pre-test probability) into appropriate (A), inappropriate (I), and uncertain while referring to published guidelines. Patients’ risk factors, angina, and heart failure symptoms (Canadian Cardiovascular Society classification (CCSC), New York Heart Association (NYHA); clinical data; and ICA results were gathered. Results: Of 1305 patients referred to CCTA prior to ICA, 496 (38.0%) were appropriate, 766 (56.9%) inappropriate, and 43 (3.3%) uncertain. Of 766 patients with inappropriate CCTA referrals, 370 (48.3%) were classified as “inappropriately low” (<15% pre-test probability) and 396 (51.7%) as “inappropriately high” (>85%) in regard to the recommended CCTA utilization. Sub-analysis of the adherence to the appropriate use criteria did not differ between the source of the referring physicians (intramural tertiary, private practice primary care, or external secondary care hospitals). Obstructive CAD with subsequent revascularization rates (total of 39.2%) did not differ significantly between the appropriate (38.3%), inappropriate (41.0%), or uncertain (23.3%) groups (p = 0.068). Conclusion: The total coronary revascularization rate after CCTA was 39.2% and not different among low, intermediate, and pre-test probability groups. These findings support the role of CCTA as an excellent gatekeeper in patients with suspected obstructive CAD even beyond pre-test probability calculation models.

Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology

ObjectivesTo determine the disease burden of acute lower respiratory tract disease (aLRTD) and its subsets (pneumonia, lower respiratory tract infection (LRTI) and heart failure) in hospitalised adults in Bristol, UK.SettingSingle-centre,...

Comparison of demographic, clinical and laboratory characteristics between first and second COVID-19 waves in a secondary care hospital in Qatar: a retrospective study

ObjectiveTo compare the patient profile and outcomes in Qatar during the first and second waves of the COVID-19 pandemic.SettingA retrospective observational study was conducted comparing the demographic, clinical and laboratory...

PERCEIVED STRESS, DEPRESSION AND MEDICATION ADHERENCE AMONG HYPERTENSIVE PATIENTS ATTENDING A SECONDARY CARE HOSPITAL IN LAGOS, NIGERIA

Objective: Hypertension is a significant public health problem as it accounts for 19.2% of all deaths globally and 16.4% of all deaths in low- and middle-income countries. Poor medication adherence negatively impacts hypertension control and has been associated with negative self-care behavior such as seen in perceived stress and depression. This study sought to investigate the prevalence of perceived stress, depression, and their association with the level of medication adherence amongst hypertensive patients attending a secondary care hospital in Lagos, Nigeria. Design and Methods: Descriptive cross-sectional design was adopted, and an interviewer-based questionnaire was administered for this study. Perceived stress, Depression and Medication Adherence were evaluated using the Perceived Stress Scale(PSS-10), Patient Health Questionnaire(PHQ-9) and Hill-Bone Compliance Scale. Data was analyzed by using Epi Info Version 7 and presented using frequency tables. T-test was used to compare continuous variables while the Chi-square and Fishers Exact test were used to compare categorical variables. Significance level was set at p &lt; 0.05. Results: 331 hypertensive patients (221 women, 66.8%) were included in this study (Mean age of 60.0 ± 13.9 years). 77% had average to high levels of perceived stress (PSS-10 score of &gt; 12) while 55% had varying levels of depression. Mean score on Hill-Bone Compliance Scale was 20.1 ± 3.7. Income level, Number of drugs used daily were significantly associated with perceived stress (p &lt; 0.05,p &lt; 0.01). Younger age, Female Gender, Presence of co-morbidities and Number of drugs used daily were significantly associated with depression(p &lt; 0.01,p &lt; 0.05,p &lt; 0.05,p &lt; 0.01). Perceived stress and depression were significantly associated with lower levels of medication adherence (p &lt; 0.05; p &lt; 0.01). Conclusion: This study lends credence to the idea that perceived stress and depression results in negative self-care behavior that adversely impacts medication adherence. Greater awareness of the potential for psychological distress in hypertensive patients must be emphasized to all physicians. Improving medication adherence rates requires collaborative care with intensified screening and appropriate management for social and psychological stressors.

Gestational Diabetes Mellitus Among Pregnant Women Attending Ante-natal Clinic at a Secondary Care Health Facility in Haryana, India.

Introduction: Gestational diabetes has serious health effects during pregnancy and childbirth. We estimated the occurrence of gestational diabetes mellitus (GDM) among pregnant women in a secondary care hospital in Haryana.Methods: It was a hospital-based cross-sectional study, done in an ante-natal clinic (ANC) at a sub-district hospital (SDH), Faridabad district of Haryana, India. Eligible pregnant women attending the ANC clinic were recruited. An oral glucose tolerance test (OGTT) with 75 g of glucose was done with a collection of blood for fasting blood sugar (FBS) and two-hour post-OGTT blood glucose. A pre-tested semi-structured interview schedule was administered. Both the modified International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) and the Diabetes in Pregnancy Study Group of India (DIPSI) criteria were used. Data were presented as percentages, means, standard deviation, and 95% confidence interval (CI). Bi-variable and multi-variable logistic regressions were done. The level of significance was set at 0.05.Results: Of the 623 eligible participants, 66.1% were within the 20-25 age group. The GDM was found in 14.1% (95%CI: 11.5-17.1) participants as per modified IADPSG criteria and 6.7% (95%CI: 4.9-9.0) participants as per DIPSI criteria, respectively. Increasing age [adjusted odds ratio (AOR): 1.24 (95% CI: 1.05-1.47), p=0.008] and increasing years of schooling [AOR: 1.19 (1.01-1.41), p=0.032] were significantly associated with GDM by DIPSI criteria. Family history of DM was also found to have an increased odds with GDM using modified IADPSG criteria [AOR 2.87 (95% CI: 1.09-7.54), p=0.032]. Conclusion: Considerable proportion of pregnant women were found to have GDM in a Sub-district hospital at Ballabgarh in north India. The study highlighted the need and generated evidence about the feasibility of GDM screening utilizing routine staff in a secondary care facility.

Hypertension control in Kerala, India: A prescription-based study at primary and secondary level health care institutions

ObjectiveWe undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India. MethodsThis cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One practitioner was selected from each institution. Data on institutional and provider factors were collected using a structured questionnaire. Prescriptions were photographically captured and data on disease status and drugs prescribed were recorded. Factors associated with disease control were identified using binary logistic regression. ResultsTotally 4679 prescriptions were included for analysis. For hypertension-only patients, control levels were 31.5% and was significantly higher in public hospitals (Adjusted odds ratio (AOR) 1.96, 95% confidence intervals (CI) 1.50–2.57). Among patients with diabetes only, diabetes control was seen in 36.6%. When both conditions were present, control was achieved in only 17.0% patients. Being prescribed two or more drugs indicated lower control, whatever the respective condition. Among antihypertensive prescriptions rationality of 26.7% were questioned, such as lack of Renin Angiotensin System (RAS) inhibitor in diabetic hypertensives, dual RAS blockage, and indication for beta-blocker monotherapy. ConclusionsIn this prescription-based study in Kerala, India, a majority of hypertensive patients did not have controlled blood pressure levels, particularly if diabetes coexisted. This has serious implications as Kerala is the state with the highest burden of hypertension in India. Several prescription patterns were of questionable rationality. Further research and actions on rationality of anti-hypertensive prescriptions and barriers to treatment intensification is warranted.

Validity and reliability of a Korean version of the Consultation and Relational Empathy (CARE) measure

BackgroundNo validated tool is available to assess patients’ perception of physician empathy in Korea. The objective of this study was to establish a Korean version of the Consultation and Relational Empathy (CARE) measure—originally developed in English and widely used internationally—and to examine its reliability and validity.MethodsThe CARE measure was translated into Korean and tested on 240 patients from one secondary care hospital and one tertiary care hospital in Korea. Internal consistency by Cronbach’s alpha, exploratory analysis, and confirmatory factor analysis were conducted to verify the 10 items of the Korean CARE measure.ResultsThe Korean CARE measure demonstrated high acceptability and face validity, excellent internal reliability (Cronbach’s alpha = 0.97) and moderate test-retest reliability (Pearson correlation coefficient = 0.53; Spearman correlation coefficient = 0.51). Distribution of scores showed negative skewedness. Corrected item-total correlations ranged from 0.77–0.92, indicating homogeneity. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.949, and Bartlett’s test of sphericity was good (χ2 = 3157.11, P < 0.001). Factor analysis yielded a single dimensional structure of physician empathy with all factor loadings exceeding 0.80 and showing excellent goodness of fit.ConclusionThis study supports the reliability and validity of the Korean CARE measure in a university hospital setting in Korea.

The challenge of care coordination by midwives during the COVID-19 pandemic: a national descriptive survey

BackgroundAs part of a decades-long process of restructuring primary care, independent (also known as community) healthcare workers are being encouraged to work in groups to facilitate their coordination and continuity of care in France. French independent midwives perform about half of the early prenatal interviews that identify mothers' needs during pregnancy and then refer them to the appropriate resources. The French government, however, structured the COVID-19 pandemic response around public health institutions and did not directly mobilise these community healthcare workers during the lockdown phase. These responses have raised questions about their role within the healthcare system in crises. This survey’s main objectives were to estimate the proportion of independent midwives who experienced new difficulties in referring women to healthcare facilities or other caregivers and in collaborating with hospitals during the first stage of this pandemic. The secondary objective was to estimate the proportion, according to their mode of practice, of independent midwives who considered that all the women under their care had risked harm due to failed or delayed referral to care.MethodsWe conducted an online national survey addressed to independent midwives in France from 29 April to 15 May 2020, around the end of the first lockdown (17 March–11 May, 2020).ResultsOf the 5264 registered independent midwives in France, 1491 (28.3%) responded; 64.7% reported new or greater problems during the pandemic in referring women to health facilities or care-providers, social workers in particular, and 71.0% reported new difficulties collaborating with hospitals. Nearly half (46.2%) the respondents considered that all the women in their care had experienced, to varying degrees, a lack of or delay in care that could have affected their health. This proportion did not differ according to the midwives’ form of practice: solo practice, group practice with other midwives only, or group practice with at least two types of healthcare professionals.ConclusionsThe pandemic has degraded the quality of pregnant women’s care in France and challenged the French model of care, which is highly compartmentalised between an almost exclusively independent primary care (community) sector and a predominantly salaried secondary care (hospital) sector.

General anxiety predictors among frontline warriors of COVID

COVID-19 pandemic has increased the generalized anxiety among Healthcare workers, The cross sectional questionnaire based study aimed to determine the generalized anxiety disorders among the Healthcare workers working in secondary and tertiary care hospitals. GAD-7 scale and Perceived stress scale were used to assess anxiety. Non parametric statistics were applied to estimate the difference among the groups. A total of 270 Male 150 (55%) and Female 120 (44%) Healthcare workers responded to this survey. In Healthcare workers, the Doctors are revealed the more anxious and depression suffered than the other healthcare workers who participated in this study.