ABSTRACT
Introduction People with Learning Disabilities are often invisible or deemed not being able to have sexual lives, however they are more likely to be exploited or abused, so being able to offer support and allow them to access good quality sexual and reproductive care was seen as important. Several clinicians felt poorly equipped to deal with this client group. Able to provide a welcoming space, looking at the specific support needed to allow this to work. Method The work was started by a MDT working party alongside, our partner the Family Planning Association (FPA) who had already supported another clinic, we were able to make use of their learning. Results Bespoke training was devised on three levels: introduction, specialist and Training the trainer which was of part of community involvement and networking opportunity. Building a library of recourses with visual aids to help illustrate common themes that might be presented in clinic. A booklet sent to new clients prior to attending, which outline what would be expected during consultations. Discussion Developing a welcoming space in a quiet community setting. We tabled a day where we would have one of the upskilled: clinician, health adviser with extended time slots. Building a rapport and trust over a few sessions might need to happen before any examination. We now have a code to be able to track the numbers. Covid as has made the provision moribund, we need to relaunch. CPD for new staff Annual training session for the Transition Team, working with young PWLD.
ABSTRACT
INTRODUCTION: Immunomodulation has been suggested as a treatment for COVID-19 to manage the hyperinflammatory state caused by cytokine release. Tocilizumab (TCZ) is an interleukin-6 (IL-6) monoclonal antibody approved for T-cell therapy induced cytokine release syndrome (CRS) and may provide benefit in COVID-19 patients with CRS. This study was conducted to assess clinical outcomes in patients with severe COVID-19 treated with TCZ. METHODS: Retrospective, single center, cohort study of adults with severe COVID-19 admitted to the intensive care unit who received TCZ between March 2020 to April 2020. All doses of TCZ were 400 mg given intravenously. A control group of severe COVID-19 patients who did not receive TCZ was randomly selected for comparison based upon similar baseline demographics (APACHE IV, SOFA score, age, gender, mechanical ventilation, multi-system organ failure (MSOF), and prone therapy). COVID-19 treatments received, temperature, inflammatory markers, mortality, diagnosis of superimposed infection and length of stay (LOS) was also collected. RESULTS: 25 patients who received TCZ and 17 patients who did not receive TCZ were included in the study. Baseline demographics were not significantly different between the TCZ vs. control group (APACHE IV = 53 vs. 55;SOFA score = 6.7 vs. 7.2). All patients were mechanically ventilated and 88% of patients in each group were diagnosed with MSOF. Maximum temperature and inflammatory markers were not significantly different (median IL-6 = 157.8 pg/mL vs. 131.5 pg/mL). There was no significant difference between the number of patients who received hydroxychloroquine, azithromycin, steroids, remdesivir, or convalescent plasma. 16 patients (64%) in the TCZ group received one dose and 9 (36%) received two doses. The mortality rate was not significantly different (8/25, 32% vs. 5/17, 29%;p = 0.86). The incidence of superimposed infection following TCZ administration was significantly higher compared to the incidence of superimposed infection at any time during admission for the control group (18/25, 72% vs. 7/17, 41%;p = 0.045). Mean LOS was 27 days vs. 19 days. CONCLUSIONS: There was no significant difference in mortality in COVID-19 patients who received TCZ. Our study suggests that patients who receive TCZ are at a significantly higher risk of infection.