ObjectiveTo describe primary health care (consultation characteristics and management) for patients contacting their general practitioner (GP) with a respiratory tract infection (RTI) early on in the COVID-19 pandemic in contrasting European countries, with comparison to prepandemic findings.SettingPrimary care in 16 countries (79 practices), when no routine SARS-CoV-2 testing was generally available.Design and participantsBefore (n=4376) and early in the pandemic (n=3301), patients with RTI symptoms were registered in this prospective audit study.Outcome measuresConsultation characteristics (type of contact and use of PPE) and management characteristics (clinical assessments, diagnostic testing, prescribing, advice and referral) were registered. Differences in these characteristics between countries and between pandemic and prepandemic care are described.ResultsCare for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. GPs provided frequent and varied COVID-related advice and more frequently scheduled a follow-up contact (50%, 95% CI 48% to 52%). GPs reported a slightly higher degree of confidence in the likely effectiveness of their management in face-to-face (73% (very) confident, 95% CI 71% to 76%) than in virtual consultations (69%, 95% CI 67% to 71%).ConclusionsDespite between-country variation in consultation characteristics, access to SARS-CoV-2 laboratory testing and medication prescribing, GPs reported a high degree of confidence in managing their patients with RTIs in the emerging pandemic. Insight in the highly variable pandemic responses, as measured in this multicountry audit, can aid in fine-tuning national action and in coordinating a pan-European response during future pandemic threats.
Background With the increasing survival of the congenital heart disease population, there is a growing need for in-depth understanding of blood circulation in these patients. Mock loops provide the opportunity for comprehensive hemodynamic studies without burden and risks for patients. This study aimed to evaluate the ability of the presented mock loop to mimic the hemodynamics of the pulmonary circulation with and without stenosis and the MR compatibility of the system. Methods A pulsatile pump with two chambers, separated by a flexible membrane, was designed and 3D printed. A cough assist device applied an alternating positive and negative pressure on the membrane. One adult, and three pediatric pulmonary bifurcations were 3D printed and incorporated in the setup. Two pediatric models had a 50% stenosis of the left branch. Bilateral compliance chambers allowed for individual compliance tuning. A reservoir determined the diastolic pressure. Two carbon heart valves guaranteed unidirectional flow. The positive pressure on the cough assist device was tuned until an adequate stroke volume was reached with a frequency of 60 bpm. Flow and pressure measurements were performed on the main pulmonary artery and the two branches. The MR compatibility of the setup was evaluated. Results A stroke volume with a cardiac index of 2L/min/m2 was achieved in all models. Physiological pressure curves were generated in both normal and stenotic models. The mock loop was MR compatible. Conclusion This MR compatible mock loop, closely resembles the pulmonary circulation thereby providing a controllable environment for hemodynamic studies.
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