Publications by authors named "David Puddicombe"

Real-time polymerase chain reaction (PCR) for SARS-CoV-2 is the mainstay of COVID-19 diagnosis, yet there are conflicting reports on its diagnostic performance. Wide ranges of false-negative PCR tests have been reported depending on clinical presentation, the timing of testing, specimens tested, testing method, and reference standard used. We aimed to estimate the frequency of discordance between initial nasopharyngeal (NP) PCR and repeat NP sampling PCR and serology in acutely ill patients admitted to the hospital.

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Early and rapid detection of patients with HIV is a key to preventing further transmission. The purpose of this study was to assess the ability of signal-to-cutoff (S/CO) ratio from initial screening fourth-generation HIV serology to predict subsequent confirmation of HIV. Patients with a first-time positive HIV serology (S/CO ratio ≥ 1) from 2012 to 2016 were included.

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Objectives: In 2012, British Columbia (BC) became the first Canadian province to implement an influenza prevention policy requiring healthcare workers (HCW) to either be vaccinated annually against influenza or wear a mask in patient care areas during the influenza season. This study describes an evaluation of influenza policy implementation processes and identifies supports and challenges related to successful policy implementation at the level of healthcare facilities, during the second policy year (2013/14).

Methods: Implementation leaders from 262 long-term care (LTC) and acute care facilities, mostly in three of BC's five regional Health Authorities, were invited to participate in an online survey following the 2013/14 influenza season.

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Background: The purpose of this study was to implement a targeted antimicrobial stewardship intervention for patients with a viral respiratory tract infection.

Methods: This was a quasi-experimental before and after audit and feedback intervention of adult inpatients with a positive polymerase chain reaction for a respiratory virus in 2 acute care hospitals in Vancouver, Canada. Audit and feedback was implemented based on 2 criteria: microbiology (no positive bacterial cultures) and chest imaging (absence of pneumonia or consolidation on radiology dictation).

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Background: Daily bathing with chlorhexidine gluconate (CHG) is increasingly used in intensive care units to prevent hospital-associated infections, but limited evidence exists for noncritical care settings.

Methods: A prospective crossover study was conducted on 4 medical inpatient units in an urban, academic Canadian hospital from May 1, 2014-August 10, 2015. Intervention units used CHG over a 7-month period, including a 1-month wash-in phase, while control units used nonmedicated soap and water bathing.

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We used whole-genome sequencing to investigate a dual-genotype outbreak of measles occurring after the XXI Olympic Winter Games in Vancouver, Canada. By sequencing 27 complete genomes from H1 and D8 genotype measles viruses isolated from outbreak cases, we estimated the virus mutation rate, determined that person-to-person transmission is typically associated with 0 mutations between isolates, and established that a single introduction of H1 virus led to the expansion of the outbreak beyond Vancouver. This is the largest measles genomics project to date, revealing novel aspects of measles virus genetics and providing new insights into transmission of this reemerging viral pathogen.

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Objectives: To estimate the cost effectiveness of alternative planned places of birth.

Design: Economic evaluation with individual level data from the Birthplace national prospective cohort study.

Setting: 142 of 147 trusts providing home birth services, 53 of 56 freestanding midwifery units, 43 of 51 alongside midwifery units, and a random sample of 36 of 180 obstetric units, stratified by unit size and geographical region, in England, over varying periods of time within the study period 1 April 2008 to 30 April 2010.

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Objective: To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies.

Design: Prospective cohort study.

Setting: England: all NHS trusts providing intrapartum care at home, all freestanding midwifery units, all alongside midwifery units (midwife led units on a hospital site with an obstetric unit), and a stratified random sample of obstetric units.

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Objective: To compare offer and uptake of prenatal screening for Down syndrome in women from different social and ethnic backgrounds.

Method: A total of 4800 randomly selected women in England were sent a survey three months after they had given birth; 2960 women responded. Odds ratios (OR) for reported offer and uptake of screening comparing women by area deprivation and ethnicity were calculated.

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