77 EXPERIENCES OF OLDER PEOPLE AND CARERS REFERRED TO AMBULATORY OUTREACH TEAM WITHIN INTEGRATED CARE PROGRAMME FOR OLDER PERSONS (ICPOP) SERVICE

Background

Ambulatory outreach services are part of new pathways to reduce reliance on secondary care as outlined in the Integrated Care Programme for Older Persons. Multidisciplinary outreach teams provide urgent medical and rehabilitation services in the person’s home to stabilise a health crisis.

Methods

The study aimed to explore the experiences of older people accessing a ambulatory outreach service and identify development opportunities. Interpretive description, an inductive analytic approach, was used to seek an understanding of clinical phenomena that illuminate their characteristics, patterns and structure. Data collection used qualitative telephone interviews. A purposeful sample of older people and carers were recruited following discharge from the outreach service over a three-month period.

Results

Sixteen participants (patients n=9 and carers n=7) were interviewed, 77% were female with a mean age of 83 years. Three major themes and seven sub-themes were identified:

Theme 1: Gratitude for specialised care: a) Moment of crisis “It was absolutely brilliant”; b) Care in my home: physical and psychological benefits

Theme 2: Living with and managing complexity: c) Resilience and resignation: living in the moment “Well she’s doing good at the moment, God forbids if there is more injuries”, d) Work of patients: maintain motivation & control; task and service boundaries e) Work of Families “We’re doing it so far”.

Theme 3:Scope for pro-active planning & Integration: f) What happens next? an unpredictable future; h) Integration with GP & community, g) Unspoken plan- sub-conscious advanced care planning “Nobody makes the decision on their own they call someone else”

Conclusion

The Outreach Team was highly valued by participants and was seen as vital in regaining functional capability and confidence to cope. Future developments need to examine task and service boundaries that undermine resilience, post outreach follow-up, integration with primary care, and opportunities for advanced care conversations.

Early social distancing policies in Europe, changes in mobility & COVID-19 case trajectories: Insights from Spring 2020

BACKGROUND

Social distancing have been widely used to mitigate community spread of SARS-CoV-2. We sought to quantify the impact of COVID-19 social distancing policies across 27 European counties in spring 2020 on population mobility and the subsequent trajectory of disease.

METHODS

We obtained data on national social distancing policies from the Oxford COVID-19 Government Response Tracker and aggregated and anonymized mobility data from Google. We used a pre-post comparison and two linear mixed-effects models to first assess the relationship between implementation of national policies and observed changes in mobility, and then to assess the relationship between changes in mobility and rates of COVID-19 infections in subsequent weeks.

RESULTS

Compared to a pre-COVID baseline, Spain saw the largest decrease in aggregate population mobility (~70%), as measured by the time spent away from residence, while Sweden saw the smallest decrease (~20%). The largest declines in mobility were associated with mandatory stay-at-home orders, followed by mandatory workplace closures, school closures, and non-mandatory workplace closures. While mandatory shelter-in-place orders were associated with 16.7% less mobility (95% CI: -23.7% to -9.7%), non-mandatory orders were only associated with an 8.4% decrease (95% CI: -14.9% to -1.8%). Large-gathering bans were associated with the smallest change in mobility compared with other policy types. Changes in mobility were in turn associated with changes in COVID-19 case growth. For example, a 10% decrease in time spent away from places of residence was associated with 11.8% (95% CI: 3.8%, 19.1%) fewer new COVID-19 cases.

DISCUSSION

This comprehensive evaluation across Europe suggests that mandatory stay-at-home orders and workplace closures had the largest impacts on population mobility and subsequent COVID-19 cases at the onset of the pandemic. With a better understanding of policies' relative performance, countries can more effectively invest in, and target, early nonpharmacological interventions.

Impacts of social distancing policies on mobility and COVID-19 case growth in the US

Social distancing remains an important strategy to combat the COVID-19 pandemic in the United States. However, the impacts of specific state-level policies on mobility and subsequent COVID-19 case trajectories have not been completely quantified. Using anonymized and aggregated mobility data from opted-in Google users, we found that state-level emergency declarations resulted in a 9.9% reduction in time spent away from places of residence. Implementation of one or more social distancing policies resulted in an additional 24.5% reduction in mobility the following week, and subsequent shelter-in-place mandates yielded an additional 29.0% reduction. Decreases in mobility were associated with substantial reductions in case growth two to four weeks later. For example, a 10% reduction in mobility was associated with a 17.5% reduction in case growth two weeks later. Given the continued reliance on social distancing policies to limit the spread of COVID-19, these results may be helpful to public health officials trying to balance infection control with the economic and social consequences of these policies.

Burkholderia pseudomallei multi-centre study to establish EUCAST MIC and zone diameter distributions and epidemiological cut-off values

OBJECTIVES

Melioidosis, caused by Burkholderia pseudomallei, requires intensive antimicrobial treatment. However, standardized antimicrobial susceptibility testing (AST) methodology based on modern principles for determining breakpoints and ascertaining performance of methods are lacking for B. pseudomallei. This study aimed to establish MIC and zone diameter distributions on which to set epidemiological cut-off (ECOFF) values for B. pseudomallei using standard EUCAST methodology for non-fastidious organisms.

METHODS

Non-consecutive, non-duplicate clinical B. pseudomallei isolates (9-70 per centre) were tested at eight study centres against eight antimicrobials by broth microdilution (BMD) and the EUCAST disc diffusion method. Isolates without and with suspected resistance mechanisms were deliberately selected. The EUCAST Development Laboratory ensured the quality of study materials, and provided guidance on performance of the tests and interpretation of results. Aggregated results were analysed according to EUCAST recommendations to determine ECOFFs.

RESULTS

MIC and zone diameter distributions were generated using BMD and disc diffusion results obtained for 361 B. pseudomallei isolates. MIC and zone diameter ECOFFs (mg/L; mm) were determined for amoxicillin-clavulanic acid (8; 22), ceftazidime (8; 22), imipenem (2; 29), meropenem (2; 26), doxycycline (2; none), tetracycline (8; 23), chloramphenicol (8; 22) and trimethoprim-sulfamethoxazole (4; 28).

CONCLUSIONS

We have validated the use of standard BMD and disc diffusion methodology for AST of B. pseudomallei. The MIC and zone diameter distributions generated in this study allowed us to establish MIC and zone diameter ECOFFs for the antimicrobials studied. These ECOFFs served as background data for EUCAST to set clinical MIC and zone diameter breakpoints for B. pseudomallei.

Serotype distribution of Campylobacter jejuni and Campylobacter coli isolated from hospitalized patients with diarrhea in central Australia

Campylobacter jejuni and/or Campylobacter coli was cultured from 218 of 1,078 patients of all age groups admitted to Alice Springs Hospital, Alice Springs, central Australia, between July 1988 and June 1989 for treatment of diarrhea. One hundred sixty-six Campylobacter colonies from 127 patients were subjected to O serotyping by using the Penner typing scheme. All except 29 colonies could be serotyped. A total of 46 serotypes were identified, and the predominant serotypes were O:8, 17, O:22, O:1,44, and O:19. A large proportion of colonies reacted with more than one antiserum, and nine serotypes had antigenic compositions not observed previously. Several patients had multiple infections with more than one serotype, and some patients were shown for the first time to be infected with up to three different serotypes. Repeated reinfections with different serotypes were seen in some patients. In some patients, provided it was not due to reinfection with the same serotype, long-term excretion of the same serotype was seen, and for the first time, one patient showed evidence of excretion of the same serotype for up to 73 days.

Biotypes of Proteus rettgeri

Examination of 729 isolates of Proteus rettgeri showed that 674 reacted positively in tests for phenylalanine deamination, indole production, growth on citrate, and acid production from meso-inositol, and negatively for L-ornithine decarboxylation and acid production from lactose, maltose, D-xylose, and L-arabinose. Only 51 isolates differed in one, and four differed in two of these ten reactions, which were taken as the core characteristics of the species. On the basis of additional tests (acid production from salicin, L-rhamnose, D-mannitol, adonitol, and D-arabitol), the 729 isolates could be separated into five groups. Goups 1, 2, 3, and 4 could be further separated on the basis of the reaction with meso-erythritol, and group 5 could be subdivided on the basis of reaction with D-mannitol. Two metabolically distinct kinds of P. rettgeri were recognized. Isolates of the first kind (groups 1, 2, 3, and 4) each utilized both adonitol and D-arabitol and most utilized meso-erythritol. Isolates of the other kind (group 5) were negative with the three polyhydric alcohols but resembled, in their reactions, some strains of Providencia stuartii. These may be intermediates between P. rettgeri that catabolize these substrates and the Providencia.

Serotyping of Proteus rettgeri on the basis of O antigens

A serotyping system for Proteus rettgeri on the basis of 72 O antigens has been developed in a study of 324 strains obtained from widely distributed sources. In the investigation of the interrelations among the 72 O-type strains by cross-titration of each of the 72 anti-O sera with antigen of each of the O-type strains, both reciprocal and nonreciprocal (unilateral) reactions were observed. The presence of the Kunin common enterobacterial antigen (CA) was noted in each strain of P. rettgeri examined, and the unilateral reactions of two antisera were shown to be due to antibody present against CA. This indicated that CA was in the immunogenic state in two strains of this species. A second common antigen resembling CA in some respects but differing in specificity and in its agglutinability was shown to be the cause of unilateral reactions in a third antiserum. In other cases, unilateral reactive antibodies appeared to be directed against antigens that remained undefined. Each reciprocal reaction was investigated to determine the nature of the interrelations between interacting strains, and the definition of these led to the development of procedures for the production of absorbed anti-O sera with greater specificity. The serotyping scheme has increased the number of strains that may be typed through their O antigens, and its application in epidemiological investigations of infections due to P. rettgeri is indicated.