PURPOSEIn July 2015, all children aged younger than 6 years gained free access to daytime and out-of-hours general practice services in the Republic of Ireland. Although 30% previously had free access, 70% did not.
METHODSTo examine subsequent changes in service use, we retrospectively analyzed anonymized visitation data from 8 general practices in North Dublin providing daytime service and their local out-of-hours service, comparing the 1 year before and the 1 year after introduction of free care.
RESULTSIn the year after granting of free general practice care for children younger than 6 years, 9.4% more children attended the daytime services and 20.1% more children were seen in the out-of-hours services. Annual number of visits by patients increased by 28.7% for daytime services and by 25.7% for outof-hours services, translating to 6,682 more visits overall. Average visitation rate for children this age increased from 2.77 visits per year to 3.25 visits per year for daytime services, but changed little for out-of-hours services, from 1.52 visits per year to 1.59 visits per year.CONCLUSIONS Offering free childhood general practice services led to a dramatic increase in visits. This increase has implications for future health care service planning in mixed public and privately funded systems.
Purpose:
The aim of SETANTA (Study of HEarT DiseAse and ImmuNiTy After COVID-19 in Ireland) study was to investigate symptom burden and incidence of cardiac abnormalities after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/COVID-19 and correlate these results with immunological response and biomarkers of coagulation.
Methods:
SETANTA was a prospective, single-arm observational cross-sectional study in a primary practice setting, prospectively registered with ClinicalTrials.gov identifier: NCT04823182. Patients with recent COVID-19 infection ≥6 weeks and ≤12 months before enrolment were enrolled. Primary outcomes of interest were markers of cardiac injury detected by cardiac magnetic resonance imaging (MRI), including left ventricular ejection fraction, late gadolinium enhancement and pericardial abnormalities, and serum biomarker levels.
Results:
100 patients (n= 129 approached) were included, 64% were female. Mean age was 45.2 years. The median (interquartile range) time interval between COVID-19 infection and enrolment was 189 [125, 246] days. 83% had at least one persistent symptom. 96% had positive serology for prior SARS-CoV-2 infection. Late gadolinium enhancement, pericardial effusion, was present in 2.2% and 8.3% respectively; left ventricular ejection fraction was below the normal reference limit in 17.4% of patients. Von Willebrand factor antigen was elevated in 32.7% of patients. Fibrinogen and D-Dimer levels were raised in 10.2% and 11.1% of patients, respectively.
Conclusion:
In a cohort of primary practice patients recently recovered from SARS-CoV-2 infection, prevalence of persistent symptoms and markers of abnormal coagulation were high, despite a lower frequency of abnormalities on cardiac MRI compared with prior reports of patients assessed in a hospital setting.
Trial Registration:
Clinicaltrials.gov, NCT04823182 (prospectively registered on 30th March 2021)
p=0.001). SAVR was an independent predictor of moderate-severe PPM (HR 1.80 95% CI 1.25-2.59, p=0.002) as was increased BMI (HR 1.14 per 1kg/m2 increase in BMI), pre-exiting hypertension (HR 2.09) and the use of smaller valve sizes (HR 29.06 for valve sizes 18-23mm). TAVR however was not a predictor of moderate-severe PPM. Inhospital mortality was 3.9% in TAVR versus 6.1% in SAVR group (p=0.171). Two-year outcomes including allcause and cardiovascular mortality, and readmissions were similar in both groups (log rank p>0.05 for all comparisons). Predictors of all-cause 2-year mortality differed between groups although low baseline haemoglobin and post procedure stage 2-3 acute kidney injury were predictors following both SAVR and TAVR. Moderate-severe PPM however, was a predictor of all-cause 2-year mortality after SAVR (HR 1.78; 95% CI 1.10-2.88, p=0.018), but not after TAVR (p=0.737). Conclusions SAVR and TAVR offer similar mid-term outcomes in MO patients with severe AS, however, TAVR offers advantages in terms of periprocedural morbidity and reduced incidence of moderate-severe patient prosthesis mismatch.
the junior doctors in the prescription of MRAs however (p£0.05). Self-reported competency in initiating and up-titrating HF medications is reported in table 2. Of participants who felt comfortable with initiation and up-titration of beta blockers (N=89), only 26% (N=27) correctly identified an optimal target heart rate of less than 70 beats per minute. Twenty-four percent of respondents (N=28) were unaware of a specialist HF service that catered to their institution, and how to refer to it, but 97% (N=113) felt that their practice would benefit from further education on HF pharmacotherapy.
ConclusionThe high prevalence of HF in Ireland and costs associated with admission for decompensation necessitates a sound knowledge of its management amongst generalists. Results of this survey suggest a need, and indeed a demand, for further education and support surrounding pharmacotherapy of stable heart failure.
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