ABSTRACT
The year 2020 will be remembered a battle for existence of mankind against a super spreading virus Covid-19. While health-workers fought from the front, power industry stood like backbone to ensure proper support to handle the crisis. The covid-19 brought lots of changes in people's sociocultural, economic, day to day life. The fear of the pandemic along with its counter measure pushed many people to work from home. On the other hand, health care industry faced an unprecedented demand of oxygen, medicine, transportation, PPE, life support system etc. In this paper it has been shown that how the pandemic affected the different regions of Indian power industry by changing energy and power demand, load pattern, generation resource sharing and creating transients. Also, it describes how Indian Power Industry stood tall by successfully handling all these unprecedented situations. © 2021 IEEE.
ABSTRACT
Background/AimsThere is evidence for non-pharmacological interventions to supportpatients to self-manage fatigue, however implementation in clinicalpractice is a challenge. LIFT (Lessening the Impact of Fatigue ininflammatory rheumatic diseases: a randomised Trial) is a multi-centrethree-arm randomised trial using a remotely delivered cognitivebehavioural approach (CBA) or personalized exercise programme(PEP) interventions, in addition to usual care, compared to normal carealone. Interventions were delivered to patients by rheumatology healthprofessionals using a manual, after training. The aim of this nestedqualitative evaluation was to understand their perspectives ofdelivering the interventions. MethodsA subgroup of rheumatology healthcare professionals who haddelivered the CBA and PEP interventions took part in semi-structuredtelephone interviews to explore their experiences of training anddelivery, the challenges and benefits of learning new skills, and thebarriers and facilitators to supporting patients remotely (mainly bytelephone) using the LIFT manual.ResultsA total of 17 rheumatology healthcare professionals (13 women, 4 men)from the CBA (n = 9) and PEP (n = 8) arms contributed. SB conducted aninductive thematic analysis of the data set. ED, CA, AW and KL revieweda sub-set of transcripts. Five main themes were identified: The benefitsof informative, structured training: Rheumatology healthcare professionals reflected how training, including role-play, helped them topractice their skills, even though this could feel uncomfortable. Thoseallocated shorter four-hour training sessions would have liked more timeto practice. Many felt anxious before meeting patients for the first timebut liked the manual to refer to.Getting into the swing of it: Practice gave rheumatology healthcareprofessionals the confidence to tailor content to individual patients'requirements. Clinical supervision in the PEP and CBA arm supportedrheumatology healthcare professionals to query their own practice, gain valuable feedback, and request assistance where needed.Benefits of telephone delivery: The initial face-to-face session enabledrheumatology healthcare professionals to build rapport with patients.Thereafter, patients seemed engaged and valued the opportunity toaddress their fatigue and challenge their own beliefs via the telephone.Some patients not ready to change: Rheumatology healthcareprofessionals struggled to work collaboratively with a minority ofpatients who were not willing to make changes, lacked motivation tocomplete tasks or stopped engaging with the intervention.LIFT developing clinical skills: Rheumatology healthcare professionalswere confident that they were doing the 'right thing' for patients withfatigue and gained professional satisfaction seeing patients' fatigueimprove. Many felt that the skills they acquired and their experiencesof remote delivery were helping them to respond to the current COVID-19 related changes in service provision.ConclusionFindings support the value of skills training for rheumatology healthprofessionals to deliver fatigue management interventions remotely.These insights can inform service provision and clinical practice.
ABSTRACT
Background/AimsLeflunomide, a conventional disease modifying drug (csDMARD), isused in a variety of autoimmune rheumatic diseases (ARD) due to itsimmunomodulating, immunosuppressive and antiproliferative properties. This agent does however confer a greater infection risk and, dueto its long half-life, drug washout procedures are often advised in thecontext of serious infections. Interestingly, Leflunomide is currentlybeing tested as a potential therapy for COVID-19 in the generalpopulation. It is unknown whether leflunomide therapy is associatedwith a poor or favourable outcome among ARD patients infected withCOVID-19.MethodsA Scottish-wide registry was rapidly developed in March 2020. Clinicalcharacteristics and outcomes of infected cases were collated acrossall Scottish health boards. Eligible patients included any adultleflunomide treated ARD patients with a confirmed (clinically or PCR)diagnosis of COVID-19.ResultsOf the 69 cases included in the registry, n = 4 were treated withleflunomide (75% female;mean age 61, SD 4.2). N = 2 were treatedwith combination baricitinib or hydroxychloroquine respectively, whilstn = 1 received recent corticosteroid therapy (intramuscular Kenalog).Comorbidities observed in this sub-cohort include diabetes mellitusn = 3, hypertension n = 2, cardiovascular disease n = 1, lung diseasen = 1 and latent TB n = 1. At presentation, all patients (n = 4)experienced the established COVID-19 related symptom triad ofdyspnoea, cough and fever and promptly developed acute respiratorysyndrome. Diarrhoea was also recorded in n = 2 and constitutionalupset n = 3. All patients suffered a serious COVID-19 disease outcome(defined as a requirement of invasive or non-invasive ventilation (n = 4)and/ or death (n = 2).ConclusionPreliminary data from this Scotland-wide registry has identified only asmall number of leflunomide treated ARD patients infected withCOVID-19. However, it is concerning that all cases experienced aserious outcome. Given the relatively infrequent prescription of thisdrug, combining similar national registry data is necessary to ensurethis observation is not spurious. If confirmed, leflunomide washoutprocedures should be encouraged among such patients when theyfirst present with COVID-19.
ABSTRACT
Background/AimsThe novel infectious disease COVID-19 is associated with a widespectrum of clinical severity amongst the general population. Patientswith autoimmune rheumatic diseases (ARD) are more likely toexperience serious COVID-19 related events, although risk factorsfor such outcomes have yet to be established. In particular, the riskprofiles of specific ARD therapies are unknown.MethodsA Scottish wide registry was rapidly developed in March 2020. Clinicalcharacteristics and outcomes of infected cases were collated acrossall Scottish health boards, leveraging the Scottish Systemic VasculitisNetwork and Scottish Society for Rheumatology. Eligible patientsincluded any adult ARD patients with a confirmed (clinically or PCR)diagnosis of COVID-19. Simple descriptive statistics were employed toevaluate associations between ARD therapies and a serious COVID-19disease outcome, as defined by a requirement of invasive or noninvasive ventilation, and/or death.ResultsA total of 69 patients (59% female;mean age 65.6, SD15.5) wererecruited to the registry , 92% of which required hospitalisation. Caseswere most commonly diagnosed with rheumatoid arthritis (n = 32, 46.4%) followed by spondyloarthritis (n = 19, 27.5%) and systemicvasculitis (n = 9, 13.0%). Anti-TNF therapy (n = 8, 11.6%) andmethotrexate (n = 31, 44.9%) were the commonest biologic andconventional disease modifying drug (bDMARD and csDMARD) usedrespectively. N = 20 (29%) received background corticosteroid therapy (15.9% prednisolone >5mg, 13% prednisolone 5mg). A severeoutcome was observed in n = 25(31.9%);n = 11 required assistedventilation and n = 19 died. With the exception of Leflunomide, conventional and biologic DMARDs did not appear to confer ahigher risk for severe outcome (table 1). Of note, anti-TNF therapywas associated with a non-serious outcome (p = 0.04) and prednisolone>5mg with a serious outcome (p = 0.08). ConclusionPreliminary data from this Scotland-wide ARD COVID-19 registryevidences variation in the impact of standard ARD therapies on theseverity of COVID-19 outcome. In general, background csDMARD andbDMARD use does not appear to be a risk factor for severe outcomes.However, anti-TNF therapy may confer a favourable outcome, whileleflunomide and corticosteroids may have the opposite effect.Rheumatologists should be aware of these possible risk factors andcontinue to contribute to registries to help establish whether theseputative signals are clinically relevant.