Impact of the COVID-19 pandemic on the National Telehealth Service for triage and referral in Sweden: a national retrospective observational study

Objectives
Telehealth, the provision of healthcare through digital communication, has been proposed as a potential solution to meet the increasing demand for healthcare, particularly in the setting of the COVID-19 pandemic. Sweden has an established national telehealth service for triage and referral by phone (1177) since 2013 which has the potential to meet this increasing demand. However, little is known about the development and retention in demand during and after the pandemic in Sweden. The objective of this study was to investigate the utilisation of the national telehealth service in Sweden before, during and after the pandemic in relation to emergency department (ED) visits.

Methods
This was a retrospective observational study of telephone calls to the national telehealth service in Sweden. We collected the number of calls, number of answered calls and visits to ED in Sweden from 2017 through 2021, aggregated by month. The difference in number of calls and visits was analysed using Student’s t-test for related samples.

Results
Data were collected from all 21 healthcare regions in Sweden, serving 10.5 million citizens. The average number of monthly calls was 48 (SD 10) calls per 1000 citizens. The first month of the pandemic, March 2020, had the highest monthly calls per capita during the whole study period: 62 (diff 14, 95% CI 9 to 19, p

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Outcomes for women with diabetes admitted for labour care to midwifery units in the UK: a national prospective cohort study and survey of practice using the UK Midwifery Study System (UKMidSS)

Objectives
To describe outcomes in women admitted for labour care to midwifery units with gestational or pre-existing diabetes, compare outcomes with other women admitted to the same units and describe admission and care guidance in midwifery units typically admitting women with diabetes.

Design
A national cohort study and a survey of practice.

Setting
We used the UK Midwifery Study System to collect data from midwifery units in the UK between October 2021 and February 2023.

Participants
Women with a diagnosis of diabetes admitted for labour care to a midwifery unit were compared with a cohort of women without diabetes admitted for labour care to the same units.

Primary and secondary outcome measures
The primary outcome was a composite measure of maternal outcome reflecting the need for obstetric care (one or more of augmentation, instrumental birth, caesarean birth, maternal blood transfusion, third or fourth-degree perineal tear, maternal admission to higher level care). We also investigated a number of secondary maternal and neonatal outcomes.

Results
Overall, 420 (0.7% (95% CI 0.67% to 0.82%) of the 56 648 women admitted to midwifery units in the study period were recorded as having diabetes, most (84%) with diet-controlled gestational diabetes. Women with diabetes were no more likely than comparison women to experience the composite primary outcome (18.7% vs 20.7%, adjusted relative risk=1.31, 95% CI 0.96 to 1.80). We found no statistically significant differences between the two groups for the secondary maternal and neonatal outcomes investigated: augmentation, postpartum haemorrhage >1.5 L, shoulder dystocia, maternal blood transfusion and maternal admission for higher level care, Apgar

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Screening Frequency and Spontaneous Breathing Trial Techniques

This randomized clinical trial compares the effects of screening frequency (once-daily vs more frequent screening) and spontaneous breathing trial techniques (pressure-supported vs T-piece spontaneous breathing trial) on the time to successful extubation among critically ill adults who required invasive mechanical ventilation.

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Kidney Transplant Outcomes From Donors Who Received Dialysis—Reply

In Reply In response to specific points raised by Drs Yang and Tebbutt, kidney donors in our study received in-center hemodialysis during their hospitalization at the time of donation. Warm ischemic time was calculated as the number of minutes from withdrawal to cross-clamp time in donors after cardiac death. The donors after cardiac death who had undergone dialysis (n = 35) had similar warm ischemic time (median, 28 minutes [IQR, 22.5-34.0 minutes]) vs the 35 donors after cardiac death who had not undergone dialysis (median, 27 minutes [IQR, 21.0-31.0 minutes]) (standardized mean difference, 0.08).

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Considerations of Lay Health Worker Intervention Among Patients With Advanced Cancer—Reply

In Reply We thank Kang and Wu for the questions they raised. Our study reported on long-term follow-up, nearly 10 years after the first patient was randomized to a 6-month lay health worker–led advance care planning education and engagement intervention layered onto usual cancer care (intervention group) vs usual cancer care alone (control group). All patients randomized to the intervention group received the intervention for a duration of 6 months or until death, whichever was first, by 1 lay health worker with a Bachelors of Arts degree. The results report on the sustained associated benefit of the intervention on several key outcomes nearly 10 years after the intervention was completed for the participants. We agree that more evidence is needed regarding the scalability of such an intervention. Hence, our team has several ongoing multisite trials to evaluate whether the intervention is effective on these key outcomes at scale.

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Antipsychotic Monotherapy vs Polytherapy for Pneumonia Risk—Reply

In Reply We thank Kikuchi and colleagues for their interest in our article in this issue of JAMA Psychiatry and welcome the opportunity to address their comments. In our article, we report relatively high pneumonia risks during the use of antipsychotics with high anticholinergic burden prescribed in high doses. Antipsychotics prescribed in monotherapy were associated with pneumonia risk, whereas polytherapy (≥2 antipsychotics used simultaneously) was not.

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Relevant Data Missing in Electronic Cigarette vs Varenicline Study—Reply

In Reply We appreciate the Letter to the Editor from Farber regarding our randomized clinical trial on the effectiveness of electronic cigarettes in smoking cessation. Data presentation plays an important role in medical publications. Guidelines such as the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline with its extensions provide a useful framework for presenting the main findings of a randomized clinical trial. We have adhered to these guidelines. For clinical trials published in JAMA Internal Medicine, study results must be reported consistently with what was prespecified in their trial design, as documented in the trial registration, protocol, and statistical analysis plan. In our article, the prespecified primary outcome (confirmed 7-day combustible cigarette smoking abstinence on week 26) took priority and precedence over all other data presentations.

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