Funerals in the COVID-19 pandemic – how restrictions might affect the bereaved

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by Dr Alex Burrell, Foundation Year 2 doctor, North Bristol NHS Trust and Dr Lucy Selman, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol

Restrictions on funeral attendance have been put in place to try to prevent the spread of COVID-19. We conducted a rapid systematic review to try to understand what impact these restrictions might have on the bereaved. We found that the impact of funeral practices was not clear-cut: observational studies assessed different outcomes and their results varied. However, there were important lessons from qualitative research. What seems to be most important is helping people create a meaningful personal ritual which provides a sense of social support however they mourn, whether together in person or virtually.

COVID-19 has caused hundreds of thousands of deaths around the world, with over 45,000 confirmed deaths in the UK as of 23 July … Read more

Care homes have long been neglected – the pandemic has shown us how bad things are

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by Dr Lucy Pocock, GP Career Progression Fellow, Centre for Academic Primary Care, University of Bristol

Before COVID-19, there were around 10,000 deaths in care homes in England and Wales every month. Then, between March 27 and April 24 2020, the number more than doubled to 23,113.

The Office for National Statistics (ONS) later reported 17,422 deaths of care home residents from COVID-19 between the end of March and June 5, accounting for 47% of the total number of deaths caused by the virus.

So it is unsurprising that the pandemic has led to much greater interest in what happens inside care homes. As well as the significant increase in the number of residents dying, concerns have been raised about a lack of access to testing and personal protective equipment (PPE), the discharge of coronavirus-positive patients from hospital to care homes, rationalisation of the health … Read more

Involving people with advanced heart failure in setting the research agenda

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Rachel Johnson

 

 

by Dr Rachel Johnson, GP and NIHR Clinical Researcher in Primary Health Care, Centre for Academic Primary Care, University of Bristol

Together with colleagues at the Universities of Bristol, Oxford, Birmingham, Cambridge and Lancaster, I recently completed a James Lind Alliance Priority Setting Partnership for advanced heart failure, funded by the NIHR School for Primary Care Research.

Priority setting partnerships (PSPs) are an established method for involving patients and the public in the first, crucial stage of research – deciding which research questions should be tackled by research studies. The results have just been published in BMJ Open Heart and include a list of the final top 10 priority research questions.

Briefly the process involved:

  • conducting a survey to elicit priority questions from a wide range of stakeholders, including patients, carers and clinicians
  • excluding questions that had already been addressed in the literature
  • ranking the
… Read more

Phone, video and online consultations: will Covid-19 change general practice for ever?

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by Chris Salisbury, Mairead Murphy and Polly Duncan, Centre for Academic Primary Care, University of Bristol

Because of the COVID-19 pandemic, general practices have rapidly shifted to offering consultations remotely by telephone, video or online messaging rather than face-to-face. Many general practices are considering whether they should continue these new ways of working into the future and some commentators are arguing that general practice will be changed forever. Remote consultations could be more convenient for patients and reduce workload pressures on general practices.

Just before the COVID-19 pandemic we wrote a paper which modelled how an increasing use of online, video and telephone consultations would affect GPs’ workload. Our conclusion was that a reduction in workload should not be assumed, and remote consulting could instead lead to an increase in GP workload over time. It all depends on how remote consultations are used.

The paper … Read more

Do web-based self-care interventions reduce health inequalities for people with chronic conditions?

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by Dr Sophie Turnbull, Senior Research Associate, Centre for Academic Primary Care, University of Bristol

Digital interventions have become increasingly popular due to their potential to increase access to healthcare for people with chronic conditions and reduce the burden on a stretched healthcare system.

This has been amplified during the COVID-19 crisis, where much face-to-face support has been reduced or is no longer available. However, there are concerns that digital health provision may exacerbate existing health inequalities.

Chronic or long-term conditions, such as diabetes, are estimated to account for 87% of deaths and have a significant impact on an individual’s quality of life. Even in high-income countries, people with lower socioeconomic status experience chronic illness more commonly and with greater severity than average for the rest of the population.

We also know that people with existing health conditions, in low paid or insecure work and … Read more

Why new guidance on domestic abuse for GPs is vital during COVID-19

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by Dr Eszter Szilassy, Research Fellow, Centre for Academic Primary Care, University of Bristol

GPs and other primary health care professionals play a vital role in addressing domestic violence and abuse (DVA). This is especially true during the current coronavirus pandemic, when individuals and families are isolated from potential sources of help and support.

Home during lockdown may not be a safe place for those affected. In England, the National Domestic Abuse Helpline, run by Refuge, has seen a 50 per cent increase in calls compared to pre-COVID-19, along with a 400 per cent increase in web traffic.

We know that the pandemic is having a detrimental impact on the health and wellbeing of people affected by DVA and their children. Extensive periods of self-isolation and social distancing compounded by increasing uncertainty over jobs and financial security for families may be a dangerous and profoundly … Read more

Finding the best moisturiser for eczema – the impact research can have on everyday lives

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Zoe Wilkins

 

 

by Zoe Wilkins, Trial Administrator, Centre for Academic Primary Care, University of Bristol

It’s safe to say that I knew little about eczema before working as an administrator on the Best Emollients for Eczema (BEE) trial and even less so about emollients, the different types of moisturiser used to treat the condition.

My own children occasionally suffered with very mild eczema; tiny patches here and there that would clear up with a couple of days of moisturisation. So, it was only after starting work on the trial that I began to understand the complexity of this condition. Some suffer seasonal ‘flare-ups’, for others year-round torment, which can be triggered by many different factors.

Although I knew that if you had eczema it was important to keep skin moisturised, I had not heard of the word ‘emollient’ before. Emollient is the medical word for moisturiser and comes in … Read more

Coronavirus: how accurate are coronavirus tests?

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by Dr Jessica Watson, GP and NIHR Doctoral Senior Clinical Research Fellow, Centre for Academic Primary Care, University of Bristol and Dr Penny Whiting, Associate Professor in Clinical Epidemiology, NIHR ARC West and University of Bristol

Coronavirus testing has been the subject of huge interest, frustration and confusion. The UK has come under worldwide criticism for its lack of mass testing, despite the director general of WHO encouraging countries to “test, test, test”. Health Secretary Matt Hancock announced that the UK now aims to test 100,000 people a dayfor COVID-19 by the end of April.

There are two main types of COVID-19 tests. Swab tests, which usually take a sample from the throat or nose, to detect viral RNA. These determine if you currently have COVID-19. Blood tests, which detect antibodies, can determine if you have had COVID-19, and are therefore immune.

No test … Read more

How coronavirus has transformed the grieving process

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Dr Lucy Selman, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol

As I write this, the UK government has just announced that 13,729 people have died in hospitals from COVID-19. Care England estimates more than 1,400 people have now died in care homes. As you read this, those appalling figures will have grown. The national medical director, Stephen Powis, has said that if the UK death tally comes in below 20,000, “we will have done very well”.

As a result, a wave of grief will swell in the coming months, with more and more people experiencing a close bereavement related to COVID-19. The disease brings new challenges in caring for patients and supporting their family and friends. A particularly cruel one is that patients must be isolated to control the spread of infection.

Since a patient’s loved ones are often unable to accompany … Read more

A GP reads ‘The Plague’ during the COVID-19 pandemic

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Prof Gene Feder

 

 

by Gene Feder, GP and Professor of Primary Care, Centre for Academic Primary Care, University of Bristol

The Plague, a novel by Albert Camus, published in 1947, tells the story of Oran, a city struck by bubonic plague. It was an extended metaphor for living under fascism and the way society and individuals behave under occupation.

I found an English translation at the back of a book shelf, having first read it as a teenager over half a century ago. On the title page there is a stamp: ‘Rainbow Library Salzburg THIS BOOK IS A [sic] PROPERTY OF THE UNITED STATES’. My father – working with Holocaust* survivors in Germany and Austria – must have forgotten to return it.

In 2020, it turns out that the book – partially – exemplifies our response to the pandemic du jour: COVID-19.

Everybody knows that pestilences have

… Read more