ABSTRACT
As we navigate the first pandemic of our generation, we've been learning and adapting ourselves to this viral infection and its consequences. It's been more than two years since the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) pandemic, and the virus has crippled the healthcare services in almost all the countries of the world. The healthcare systems in various parts of the world are still in the phase of recovery from the effect of the pandemic, as each country is witnessing the emergence of various variants causing multiple waves of infection. As an important part of the health care system, blood banks were one of the affected services. Most of the blood centers in India reported a significant reduction in blood donation during the COVID-19 pandemic. As transfusion services constitute a crucial backbone for the management of transfusion-dependent patients with hemoglobinopathies, the substantial reduction in the timely blood supply drastically affected these patients. All major healthcare centers in India were designated as COVID-19 care centers, which left very few options for these patients to visit for their routine care. Every country managed this acute blood shortages and developed unique strategies to support patients requiring blood transfusion. This manuscript aims to provide a snapshot of the challenges faced by the blood banks and transfusion services in India in the care of patients with hemoglobinopathies, and the mitigation strategies that were adopted.Copyright © Annals of Blood. All rights reserved.
ABSTRACT
Proper management of Biomedical Waste (BMW) is an essential component of any sustainable healthcare sector. With the burst of COVID-19 pandemic when every hospital and treatment facility was overburdened patients, efficient handling of the huge amount of generated BMW became a task for the entire world. This review compares the BMW generated before and during the second wave of COVID-19, highlights the challenges in managing the exuberated amount of COVID-19 waste and sites recommendations to promote sustainable design thinking, in order to address this grave concern in the current setting of the Indian system. The study indicated that inappropriate management of waste and the lacunae in the entire chain from segregation to collection until its disposal has posed a serious threat to the wellbeing of healthcare workers, sanitation staff as well as the operators and housekeeping staff at the hospitals, isolation centers and Municipal Corporation. Many states had inadequate number of common BMW treatment facilities (CBMWTFs) leading to inefficient treatment of the excess waste. The behavioural and attitudinal barriers of neglect and ignorance of different stakeholders further aggravated the problem of BMW management to manifolds. To achieve better management we recommend spreading awareness regarding the kind and infectious nature of waste generated by COVID-19 patients and their caregivers, segregation and decontamination of such waste at source and increasing the capacity as well as number of CBMWTFs. Creative ways to recycle the waste must be devised so as to reduce the burden on disposal sites.
ABSTRACT
Introduction: To minimise footfall during COVID pandemic, breast care nurse (BCN) led triage of the referral letters was used in our department. Based on the referral history, the nurse would triage patients to be seen in the one-stop clinic, consultant telephone consultation or telephone BCN-led pain clinic. The study aimed to assess the effect of BCN-led triage on detection of cancer and number of patients seen in the clinic. Methods: A retrospective observational analysis was conducted for all referrals to one-stop clinic at breast unit in Broomfield Hospital from 1st-30th July 2020. Results: Of the total number of patients (n=225) triaged by the BCN, majority were females (M:F 2:223) having a mean age of 55.1 years (14-90). Most patients presented with a breast lump (152/225). 12% (n=27/225) of the patients were diagnosed with cancer. The average number of cancers identified per week were 4.4 (3-6) with the BCN identifying 67.5% (n=27/40) of them. The mean time to referral to initial decision was 2.6 days (0-14) with BCN-led triage compared to routine referral route (10.7 days [1-23]). 27 patients (12%) were triaged to telephone breast pain clinic. 1 patient re-attended the clinic after being discharged from pain clinic with persistent pain but not diagnosed with cancer. Conclusion: BCN-led triage had a higher rate of breast cancer detection and less time taken from referral to decision for breast patients. The BCN-led pain clinic reduced the number of patients seen in the one-stop clinic without missing any cancer diagnosis.
ABSTRACT
Introduction: During the COVID pandemic, all referrals to the breast unit were telephone triaged by the consultant surgeons prior to offering a clinical appointment at the one stop clinic to minimise footfall into the hospital and reduce social contact. The study aimed to assess the impact of telephone led consultations on the service delivery of one-stop clinic. Methods: A retrospective observational analysis of all referrals to the breast unit from 1st June 2020 to end of July 2020 at the Breast Unit, Broomfield Hospital, Chelmsford. All referrals to the breast unit from the community and other specialties were analysed. Results: A total of 399 patients were called by the consultants. 35.8% of the patients (M:F 25:118) were discharged following telephone consultation. The commonest presentation of the telephoned discharged patients was breast lump. The re-attendance rate following telephone discharge was 20.3% and the mean re-attender age was 34.9 years (17-65). The commonest presentation was lump and pain. None of the re-attenders were diagnosed with cancer and were discharged after clinic review. Following an initial telephone consult, patients were stratified by risk and 37 patients were deferred for a longer period of approximately 3 months to either a further telephone consult or a delayed one-stop. There was no re-attendance of these patients during the study period. There were 2 female cancers identified in the deferred patients. Conclusion: Consultant led telephone triage of one-stop clinic is safe and reduces number of patients seen in the clinic, however, the re-attendance rate is high.
ABSTRACT
RATIONALE Acute hypoxemic respiratory failure (AHRF) is the major complication of coronavirus disease 2019 (COVID-19), yet optimal respiratory support strategies are uncertain. We aimed to describe outcomes with highflow oxygen delivered through nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) in COVID-19 AHRF and identify individual factors associated with non-invasive respiratory support failure. METHODS We conducted a retrospective cohort study of hospitalized adults with COVID-19 within a large academic health system in New York City early in the pandemic to describe outcomes with HFNC and NIPPV. Patients were categorized into the HFNC cohort if they received HFNC but not NIPPV, whereas the NIPPV cohort included patients who received NIPPV with or without HFNC. We described rates of HFNC and NIPPV success, defined as live discharge without endotracheal intubation (ETI). Further, using Fine-Gray sub-distribution hazard models, we identified demographic and patient characteristics associated with HFNC and NIPPV failure, defined as the need for ETI and/or in-hospital mortality. RESULTS Of the 331 patients in the HFNC cohort, 154 (46.5%) patients were successfully discharged without requiring ETI. Of the 177 (53.5%) who experienced HFNC failure, 100 (56.5%) required ETI and 135 (76.3%) patients ultimately died. Among the 747 patients in the NIPPV cohort, 167 (22.4%) patients were successfully discharged without requiring ETI, and 8 (1.1%) were censored. Of the 572 (76.6%) patients who failed NIPPV, 338 (59.1%) required ETI and 497 (86.9%) ultimately died. In adjusted models, significantly increased risk of HFNC and NIPPV failure was observed among patients with co-morbid cardiovascular disease (sub-distribution hazard ratio (sHR) 1.82;95% confidence interval (CI), 1.17-2.83 and sHR 1.40;95% CI 1.06-1.84, respectively). Conversely, a higher oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) at HFNC and NIPPV initiation was associated with reduced risk of failure (sHR, 0.32;95% CI 0.19-0.54, and sHR 0.34;95% CI 0.21-0.55, respectively). CONCLUSIONS A subset of patients with COVID-19 AHRF was effectively managed with non-invasive respiratory modalities and achieved successful hospital discharge without requiring ETI. Notably, patients with co-morbid cardiovascular disease and more severe hypoxemia experienced lower success rates with both HFNC and NIPPV. Identification of specific patient factors may help inform more selective use of non-invasive respiratory strategies, and allow for a more personalized approach to the management of COVID-19 AHRF in pandemic settings.