ABSTRACT
Background/Purpose: Cleft Surgery in our centre is delivered by a single specialist surgeon in a regional Burns and Plastic service. We see 35-45 cleft-affected births per annum and, prior to the COVID-19 pandemic, ran 6 theatre lists per month, conducting 170-180 cleft procedures annually. The pandemic severely hindered elective operating in even tertiary centres, due to the redeployment of theatre staff and resources to manage the emergency care load. Cleft surgery was suspended entirely during the first wave (March-June 2020), before efforts in collaboration with the RCPCH (UK) to conserve the cleft pathway restored it as a priority. Primary palatine reconstruction is recommended at 6-9 months of age to optimise velopharyngeal function and speech proficiency by 5 years (Slater et al 2019). Our service was restarted at 1-2 ad hoc lists a month, which was both insufficient to manage ongoing demands and deal with rising outstanding cases. We faced a major challenge in safely distributing scarce surgical time and capacity across the entire cleft surgical burden. Therefore, we aim to examine our response to these limitations in the face of rising cases and time pressures, illustrating our methods in prioritising cleft procedures. Methods/Description: We reviewed the current literature to determine which of the main cleft procedures were most time critical, and compiled a cleft priority document with a broad evidence basis. Babies with palate involvement were top priority, in light of the strong evidence advocating primary palate repair by 13 months of age (CRANE 2020), after which there is a risk of speech delay (Shaffer et al 2020). Primary lip +/- alveolar involvement were prioritised lower and performed later (∼1 year), as cosmesis during infancy was deemed less detrimental, although there remained the psychological impact on the parent (Grollemund et al 2020). Secondary speech surgery was next, the lack of which can inhibit education and require intensive speech therapy to support patients (Baillie and Sell 2020). This was followed by alveolar bone grafting, ideally performed prior to canine eruption at ∼8-9 years to limit further dental reconstructions (Vandersluis et al 2020). As per national consensus, all adult cleft surgery was suspended to accommodate higher priorities. Focusing on early palate repair helped restart the cleft pathway and prevent functional delay as well as further interventions and schoolage support. However, late lip repair saw a rise in complications - two cases of dehiscence were associated with self-inflicted toddler trauma. This is in addition to the psychosocial implications of cosmesis, including early maternal interactions (Montirosso et al 2011), stigmatisation by peers (Bous et al 2021), and parental anxiety (Bous et al 2020). We recommend isolated lip reconstructions are also undertaken within 9 months. Long-term physical and psychosocial impacts of delay in surgery should guide resource allocation in the event of future operating limitations.
ABSTRACT
COVID-19 has changed how healthcare will deliver services. Faced with a shortage of medical staff and appropriate infrastructure, health services face an enormous challenge in managing COVID-19 patients while continuing to care for patients with other pathologies. The development of robust health information systems and digital health solutions is essential in the provision of healthcare services across Ireland now and in the future (1). The purpose of this report is to collate information from articles, government publications and grey literature in order to assess the impact of digital health on transforming healthcare services during COVID-19 internationally and to compare these interventions to the Irish digital health experience. A comprehensive search was undertaken using PubMed and Google Scholar (2019-present). The review covers three countries;Ireland, Scotland and Denmark. These countries were chosen as they have a similar population and demographics to Ireland. Health services and government agencies implemented digital health solutions in order to allow both routine care to continue and COVID-19 testing, tracing and treatment to be optimised. Digital health solutions include;electronic prescribing, electronic referrals, electronic health records, individual health identifiers, telemedicine and mobile applications. These innovations strengthened the Irish, Danish and Scottish response to the COVID-19 pandemic. This study highlights the importance of robust digital health systems during a time of emergency. The COVID-19 pandemic acted as a catalyst for the rapid introduction of digital health solutions in Ireland. The high uptake of these technologies shows the appetite for such digital technologies in health systems across the globe.
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Background/AimsRheumatology departments were required to switch rapidly from faceto-face (F2F) to remote consultations during the COVID-19 pandemicin the UK. We conducted a patient satisfaction survey on the switch toinform future service development.MethodsAll patients [new (NP), follow-up (FU)] were identified between 1st to5th June 2020. Patients who attended or did not attend (DNA) a prebooked F2F consultation or cancelled were excluded. Of theremainder, half the patients was surveyed by phone using astandardised questionnaire and the other half was posted the samequestionnaire. Both groups were offered the opportunity to completethe survey online. Patients were surveyed on the organisation andcontent of the consultation, whether they were offered a subsequentF2F appointment and future consultation preference.Results233 consultations were scheduled during the study period. After 53exclusions (34 pre-booked F2F, 16 DNA, 3 cancellations), 180 eligibleconsultations were surveyed (85 via mailshot, 95 by telephone). 75/180patients (42%) responded within 1 month of the telephone consultation(20 NP, 47 FU, 8 missing).The organisation of the switch was positively perceived (Table).Patients were highly satisfied with 4 of the 5 consultation domains butwere undecided whether a physical assessment would have changedthe outcome of the consultation (Table).After the initial phone consultation, 7 of 20 NP and 19 of 47 FU werenot offered subsequent F2F appointments at the clinicians' discretion.Of those not offered subsequent F2F appointments, proportionallymore NP (3/7, 43%) would have liked one, compared to FU (5/19, 26%). Reasons included communication difficulties and a desire for adefinitive diagnosis. 48/75 (64%) would be happy for future routine FUto be conducted by phone ''most of the time" or "always'';citingpatient convenience and disease stability. Caveats were if physicalexamination was required or if more serious issues (as perceived bythe patient) needed F2F discussion.ConclusionPatients were generally satisfied with telephone consultations andmost were happy to be reviewed again this way. NPs should beoffered F2F appointments for first visits to maximise patient satisfaction and time efficiency.
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We contribute to the growing evidence of the positive effect of use of online peer feedback tools on students' teamwork skills development. We do so by exploring individual and contextual factors underlying satisfaction with using a peer feedback system alongside team projects. Employing path analytical framework and bootstrap methods, we analysed data from an international sample of 100 project teams in management studies. Drawing on procedural justice theory, we theorised and found support that students' uncertainty avoidance orientation and virtuality in collaboration were positively related to their satisfaction with use of a peer feedback system. Such satisfaction in turn allowed them to be more effective team members. Our findings provide evidence for higher education institutions and instructors considering the adoption of online peer feedback systems alongside teamwork in their curricula. Specifically, peer feedback appears to be effective in the development of teamwork skills and students appreciate the opportunity to provide feedback to their peers in a structured and dedicated environment. Our findings are timely and of important practical significance as educational institutions increasingly rely on the use of computer-mediated technology during the COVID-19 pandemic.
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Introduction and Objectives Descriptions of clinical characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19), their clinical course and short-term in- A nd outpatient outcomes in deprived urban populations in the United Kingdom is still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequalae of patients admitted to two large District General Hospitals across a large East London NHS Trust during the first wave of the pandemic. Methods A retrospective analysis was carried out on a cohort of 1,946 patients admitted to two hospital sites during the first UK wave of the pandemic, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three Respiratory Units in the trust. Results Overall survival and rates of transfer to critical care are comparable to data from other urban centers. Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 67% of survivors, with 42% of patients unable to return to work due to ongoing symptoms. At 12-week follow up, 5 patients out of 109 followed up required treatment for pneumonitis with 2 requiring re-admission. Associated complications such as MI, PE and CVA were seen in less than 2% overall postdischarge. Conclusions Whilst clinical features, course of illness and inhospital outcomes are broadly in line with published literature, our initial follow up data suggest there are ongoing sequalae of COVID-19 including, persistent symptoms and radiological abnormalities. These data highlight the ongoing need for localized pathways to provide physical, emotional and psychological support these patients. There are also potential economic ramifications from these patients' delayed return to work. Further data, including longer term follow up data, are necessary to improve our understanding of this novel pathogen and associated disease.
ABSTRACT
Introduction and ObjectivesDescriptions of clinical characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19), their clinical course and short-term in- and outpatient outcomes in deprived urban populations in the United Kingdom is still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequalae of patients admitted to two large District General Hospitals across a large East London NHS Trust during the first wave of the pandemic.MethodsA retrospective analysis was carried out on a cohort of 1,946 patients admitted to two hospital sites during the first UK wave of the pandemic, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three Respiratory Units in the trust.ResultsOverall survival and rates of transfer to critical care are comparable to data from other urban centers. Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 67% of survivors, with 42% of patients unable to return to work due to ongoing symptoms. At 12-week follow up, 5 patients out of 109 followed up required treatment for pneumonitis with 2 requiring re-admission. Associated complications such as MI, PE and CVA were seen in less than 2% overall post-discharge.ConclusionsWhilst clinical features, course of illness and in-hospital outcomes are broadly in line with published literature, our initial follow up data suggest there are ongoing sequalae of COVID-19 including, persistent symptoms and radiological abnormalities. These data highlight the ongoing need for localized pathways to provide physical, emotional and psychological support these patients. There are also potential economic ramifications from these patients’ delayed return to work. Further data, including longer term follow up data, are necessary to improve our understanding of this novel pathogen and associated disease.
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We offer preliminary evidence drawing on a novel dataset of corporate bonds issued in the European energy sector since January 2020 in combination with the European Central Bank's (ECB) purchases under the Pandemic Emergency Purchase Programme (PEPP) in response to COVID-19. We show that the likelihood of a European energy company bond to be bought as part of the ECB's programme increases with the greenhouse gas (GHG) intensity of the bond issuing firm. We also find weaker evidence that the ECB's PEPP portfolio during the pandemic is likely to become tilted towards companies with anti-climate lobbying activities and companies with less transparent GHG emissions disclosure. Our findings imply that, at later stages of the COVID-19 recovery, an in-depth analysis may be necessary to understand if, and if yes why, the ECB fuelled the climate crisis.
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BACKGROUND: Surgeons need guidance regarding appropriate personal protective equipment (PPE) during the COVID-19 pandemic based on scientific evidence rather than availability. The aim of this article is to inform surgeons of appropriate PPE requirements, and to discuss usage, availability, rationing and future solutions. METHODS: A systematic review was undertaken in accordance with PRISMA guidelines using MEDLINE, Embase and WHO COVID-19 databases. Newspaper and internet article sources were identified using Nexis. The search was complemented by bibliographic secondary linkage. The findings were analysed alongside guidelines from the WHO, Public Health England, the Royal College of Surgeons and specialty associations. RESULTS: Of a total 1329 articles identified, 95 studies met the inclusion criteria. Recommendations made by the WHO regarding the use of PPE in the COVID-19 pandemic have evolved alongside emerging evidence. Medical resources including PPE have been rapidly overwhelmed. There has been a global effort to overcome this by combining the most effective use of existing PPE with innovative strategies to produce more. Practical advice on all aspects of PPE is detailed in this systematic review. CONCLUSION: Although there is a need to balance limited supplies with staff and patient safety, this should not leave surgeons treating patients with inadequate PPE.