Aim COVID-19 clinical presentation is heterogeneous, ranging from asymptomatic to severe cases. While there are a number of early publications relating to risk factors for COVID-19 infection, low sample size and heterogeneity in study design impacted consolidation of early findings. There is a pressing need to identify the factors which predispose patients to severe cases of COVID-19. For rapid and widespread risk stratification, these factors should be easily obtainable, inexpensive, and avoid invasive clinical procedures. The aim of our study is to fill this knowledge gap by systematically mapping all the available evidence on the association of various clinical, demographic, and lifestyle variables with the risk of specific adverse outcomes in patients with COVID-19. Methods The systematic review was conducted using standardized methodology, searching two electronic databases (PubMed and SCOPUS) for relevant literature published between 1st January 2020 and 9th July 2020. Included studies reported characteristics of patients with COVID-19 while reporting outcomes relating to disease severity. In the case of sufficient comparable data, meta-analyses were conducted to estimate risk of each variable. Results Seventy-six studies were identified, with a total of 17,860,001 patients across 14 countries. The studies were highly heterogeneous in terms of the sample under study, outcomes, and risk measures reported. A large number of risk factors were presented for COVID-19. Commonly reported variables for adverse outcome from COVID-19 comprised patient characteristics, including age >75 (OR: 2.65, 95% CI: 1.81–3.90), male sex (OR: 2.05, 95% CI: 1.39–3.04) and severe obesity (OR: 2.57, 95% CI: 1.31–5.05). Active cancer (OR: 1.46, 95% CI: 1.04–2.04) was associated with increased risk of severe outcome. A number of common symptoms and vital measures (respiratory rate and SpO2) also suggested elevated risk profiles. Conclusions Based on the findings of this study, a range of easily assessed parameters are valuable to predict elevated risk of severe illness and mortality as a result of COVID-19, including patient characteristics and detailed comorbidities, alongside the novel inclusion of real-time symptoms and vital measurements.

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

AimCOVID-19 clinical presentation is heterogeneous, ranging from asymptomatic to severe cases. While there are a number of early publications relating to risk factors for COVID-19 infection, low sample size and heterogeneity in study design impacted consolidation of early findings. There is a pressing need to identify the factors which predispose patients to severe cases of COVID-19. For rapid and widespread risk stratification, these factors should be easily obtainable, inexpensive, and avoid invasive clinical procedures. The aim of our study is to fill this knowledge gap by systematically mapping all the available evidence on the association of various clinical, demographic, and lifestyle variables with the risk of specific adverse outcomes in patients with COVID-19.MethodsThe systematic review was conducted using standardized methodology, searching three electronic databases (PubMed, Embase, and Web of Science) for relevant literature published between 1st January 2020 and 9th July 2020. Included studies reported characteristics of patients with COVID-19 while reporting outcomes relating to disease severity. In the case of sufficient comparable data, meta-analyses were conducted to estimate risk of each variable.ResultsSeventy-six studies were identified, with a total of 17,860,001 patients across 14 countries. The studies were highly heterogeneous in terms of the sample under study, outcomes, and risk measures reported. A large number of risk factors were presented for COVID-19. Commonly reported variables for adverse outcome from COVID-19 comprised patient characteristics, including age >75 (OR = 2.65 (1.81–3.90)), male sex (OR = 2.05(1.39–3.04)) and severe obesity (OR = 2.57 (1.31–5.05)). Active cancer (OR = 1.46 (1.04–2.04)) was associated with increased risk of severe outcome. A number of common symptoms and vital measures (respiratory rate and SpO2) also suggested elevated risk profiles.ConclusionsBased on the findings of this study, a range of easily assessed parameters are valuable to predict elevated risk of severe illness and mortality as a result of COVID-19, including patient characteristics and detailed comorbidities, alongside the novel inclusion of real-time symptoms and vital measurements.

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(250 words):Purpose: To investigate adolescents' (11-15 years) experience of their general practitioner (GP), whether poor reported GP experience was associated with worse physical and mental health measures and whether poor previous GP experience was linked to lower utilisation of these services. Methods:We used logistic regression to analyse data from the 2014 Health Behaviour in Schoolaged Children study. Four aspects of recent care experience were studied: feeling at ease, feeling treated with respect, satisfaction with doctor's explanation, and feeling able to discuss personal matters. Five dichotomised measures of health status were used: ever self-harmed; fair or poor selfreported health; frequent (at least weekly) low mood, sleeping problems or headaches.Results: 4149/5335 students reported having visiting their GP within the past year. Of these 91.8% felt treated with respect, 78.7% felt at ease, 85.7% were satisfied with explanation and 53.9% felt able to discuss personal matters. After adjusting for ethnicity, age, gender and family affluence score, poor experience on any indicator was strongly associated with increased risk of self-harm (Adjusted Odds Ratio (AOR) range 2.01-2·70 all p<0·001); feeling low (1·53-2·11, all p<0·001) and sleeping problems (AOR range 1.49-1.91, all p<=0.001). Poor experience on all indicators, except discussing personal matters, was associated with worse self-reported health. Conclusions:Nearly half of this large, national study of adolescents did not feel able to discuss personal matters with their doctor. There was a consistent, strong association between reported lack of good GP experience and poor health measures. Implications and Contribution (50 words):These findings show a strong association between poor healthcare experience and poor health.Adolescents with the greatest need report poorer experience of care, which may further exacerbate their health problems. Further research is needed to investigate the extent to which higher quality services can address these disparities and improve outcomes. Main manuscript:Adolescence is a key stage of the life course when lifelong health behaviours and attitudes to health care can be established.(1) Meeting the distinct healthcare needs of this age group is an important public health investment. (2) Unmet healthcare need in adolescence is linked to a range of increased health risks, and longitudinal data show that it is an independent predictor of poor mental and physical health outcomes as well as on-going unmet healthcare need in adulthood. (3) Compared to many other countries, English adolescents have potentially good access to general practice services (English GPs are similar to family physicians, having responsibility for primary care needs of their patients), as the English National Health Service (NHS) offers comprehensive health services, free at the point of use. However, concerns have been raised about the quality of NHS care provided for adolescents and in particular about the responsiveness of services t...