Updated results from MOMENTUM: Momelotinib vs. Danazol in JAK inhibitor-experienced, symptomatic, and anaemic myelofibrosis patients

The phase 3 MOMENTUM study (NCT04173494) of the ACVR1/JAK1/JAK2 inhibitor momelotinib (MMB) vs. danazol (DAN) in patients with myelofibrosis (MF) previously treated with a JAK inhibitor (JAKi) met the primary endpoint and all key secondary endpoints at week 24 (W24). We provide updated results from week 48 assessments. Eligible patients had primary or post-ET/ PV MF;DIPSS high, Int-2, or Int-1 risk;Total Symptom Score (TSS) >=10;haemoglobin (Hb) <10 g/dL;platelets >=25 x 109/L;prior JAKi for >=90 days (>=28 days if red blood cell [RBC] transfusions >=4 units in 8 weeks or grade 3/4 thrombocytopenia/anaemia/ hematoma);and palpable spleen >=5 cm. Randomisation was 2:1 to MMB 200 mg/day or DAN 600 mg/day for 24 weeks, followed by open-label (OL) MMB. Week 48 endpoints included durations of response (TSS, transfusion independence [TI], splenic) and overall and leukaemia-free survival (OS, LFS). As of 17 May 2022, 93/130 (72%) MMB -> MMB and 41/65 (63%) DAN -> MMB patients received OL MMB;mean MMB durations were 48 weeks and 24 weeks, respectively. Analyses for W24 responders showed the following: of TSS responders, 31/32 (97%) MMB -> MMB and 6/6 DAN -> MMB patients had TSS < baseline;of TI responders, 36/40 (90%) and 10/13 (77%) had no RBC transfusions or Hb <8 g/dL;and of spleen responders, all patients had splenic volume < baseline. In the OL phase, the most common grade >=3 treatment-emergent adverse events (TEAEs) were thrombocytopenia (MMB -> MMB, 9%;DAN -> MMB, 15%) and anaemia (MMB -> MMB, 9%;DAN -> MMB, 2%). Grade >=3 infections occurred in 19% of MMB -> MMB and 10% of DAN -> MMB patients, including grade >=3 (nonfatal) COVID-19. Peripheral neuropathy (PN) occurred in 2% of patients in each arm, and none discontinued MMB due to PN. TEAEs led to MMB discontinuation in 18% (MMB -> MMB) vs. 10% (DAN -> MMB). A trend towards improved OS up to W24 was previously observed with MMB vs. DAN (hazard ratio [HR], 0.506;p = 0.0719);after all patients crossed over to OL MMB, OS and LFS curves for both arms converged (HR, 0.945, 95% CI, 0.528-1.693;HR, 0.830, 95% CI, 0.473-1.4555). Sixty of 81 (74%) MMB -> MMB and 29 of 43 (67%) DAN -> MMB patients with baseline platelets <=150 x 109/L entered the OL phase. Efficacy and safety results in thrombocytopenic subgroups in the OL period were consistent with the intent-to- treat (ITT) population. OL MMB maintained symptom, TI, and spleen responses with continued good survival and safety in the ITT and low platelet populations. MMB may address an unmet need in anaemic patients with MF.

Global Supply Chains in a Glocal World: The Impact of Covid-19 and Digitalisation

Growing global trade flows and integration has led to continuous and accelerating changes to our global supply chains over the past decades. Recent macroeconomic events, new technological developments, and most notably Covid-19, are envisioned to push global supply chains in further transforming and adapting. How will companies look into issues of resilience, security, and digitalisation in their supply chains and operations? Global Supply Chains in a Glocal World aims to answer these mission-critical questions via a series of articles contributed by academics and senior management covering different industry sectors such as healthcare, food, e-commerce, textiles, mobility, and FMCG, as well as geographical, risk management, and technological perspectives. Proffering varied views of what has happened during the Covid years and what it means for the future, this book provides academics and practitioners a valuable resource when they navigate their next steps in an increasingly turbulent world. © 2023 by World Scientific Publishing Co. Pte. Ltd.

Regional Health Care Programme Partnering General Practitioners to Reduce Low Acuity Attendance at the Emergency Department: GPFirst

Study Objectives: To evaluate the impact of a general practitioner (GP) programme on low-acuity patient load (patient acuity scale P3 or P4) presenting at a participating emergency department (ED) of a regional public hospital in Singapore. Secondly, to analyse the appropriateness of participating GPs' referrals to ED based on programme criteria. Study Design/Methods: This is a descriptive observational study of a regionally implemented, government funded programme called GPFirst, from 2014 to 2019 (pre-COVID). In this programme, a patient attended to at a GPFirst clinic and subsequently referred to ED, will qualify for an ED attendance fee discount. Data are retrospectively collected from referral letters of GPs participating in the programme and the hospital's electronic health record system. Results/Findings: During the study period, 207 GPs were progressively enrolled. The annual number of low acuity attendances reduced from 62,213 in 2013 (pre-GPFirst) to 53,480 in 2019 even though the annual number of ED attendances increased gradually from 138,784 in 2014 to 141,072 in year 2019. Moreover, the annual proportion of low-acuity, self-referred cases decreased from 63.4% (39,425) in 2013 to 57.1% (30,528) in year 2019. The annual percentage of GPFirst referrals to the ED which meet referral appropriateness criteria increased from 94.5% (FY2014) to 97.6% (FY2019) and 98.0% (FY2020). Overall, the roll out of GPFirst appears to coincide with a reduction in low acuity patient load without compromising the appropriateness of GP referrals to the ED. Conclusion(s): A multi-faceted regional programme which included campaigned public education, regular GP continuous education, a supportive administrative team and financial incentive for patients, is able to reduce low acuity attendances. An ecosystem emerges which contributes to GPFirst's success. Further research is needed to evaluate safety and the effects of scaling this programme to a national level. No, authors do not have interests to disclose Copyright © 2022

An Investigation of the Experiences of Physiotherapists During the Aotearoa New Zealand COVID-19 Pandemic 2020

Mental distress associated with the COVID-19 pandemic is recognised among frontline health professionals. Experiences of physiotherapists in New Zealand during the initial outbreak in early 2020 were explored in an online survey made available to members of the professional association in February 2021. Respondents (n = 326) included physiotherapists from both the public and private sectors. Mental distress was a key factor across all workplaces: 48% (n = 132) experienced stress and 44% (n = 120) felt anxious and overwhelmed. Furthermore, despite being “essential workers”, 55% (n = 11) of physiotherapists working in acute hospitals were excluded from collaborations due to misconceptions about their roles by other health professionals or poor communication. Respondents from acute hospital settings encountered a lack of training (30%;n = 10) and those from both acute, non-acute/community settings experienced inadequate access to personal protective equipment (44%;n = 19). Study outcomes suggest more work needs to be done at the managerial level to understand and support the contribution physiotherapists make as key members of the interprofessional team and to support physiotherapists’ wellbeing across all workplaces. © 2022, Physiotherapy New Zealand. All rights reserved.

COVID-19: four paediatric cases in Malaysia. (Coronavirus (COVID-19) collection.)

Objective: This is a brief report of 4 paediatric cases of COVID-19 infection in Malaysia Background: COVID-19, a coronavirus, first detected in Wuhan, China has now spread rapidly to over 60 countries and territories around the world, infecting more than 85000 individuals. As the case count amongst children is low, there is need to report COVID-19 in children to better understand the virus and the disease. Cases: In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy. Discussion: There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children.

COVID-19: Four Paediatric Cases in Malaysia.

OBJECTIVE: This is a brief report of 4 paediatric cases of COVID-19 infection in Malaysia BACKGROUND: COVID-19, a coronavirus, first detected in Wuhan, China has now spread rapidly to over 60 countries and territories around the world, infecting more than 85000 individuals. As the case count amongst children is low, there is need to report COVID-19 in children to better understand the virus and the disease. CASES: In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy. DISCUSSION: There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children.

How should front-line general practitioners use personal protective equipment (PPE)?

The COVID-19 outbreak continues to evolve with the number of cases increasing in Malaysia, placing a significant burden on general practitioners (GPs) to assess and manage suspected cases. GPs must be well equipped with knowledge to set up their clinics, use Personal Protective Equipment (PPE) appropriately, adopt standard protocols on triaging and referrals, as well as educate patients about PPE. The correct use of PPE will help GPs balance between personal safety and appropriate levels of public concern.