ABSTRACT
Despite its potential utility for the outdoor recreation sector, there is no centralised surveillance system for recreational walking trails in Ireland and thus trail usage in Ireland during the COVID-19 pandemic is unknown. This paper aims to report trends in football count data on Irish trails during the COVID-19 period and to triangulate findings with openly available mobility data. This descriptive study analysed changes in footfall counts gathered from passive infrared sensors on 33 of Ireland's recreational walking trails between January 2019 and December 2020. The relationship between Google Community Mobility Report (GCMR) data and footfall counts was analysed to corroborate trends in footfall data. Total footfall increased by 6% between 2019 and 2020 on trails included in this analysis. Notably, mean trail usage was between 26% and 47% higher in October-December 2020 than during the same period in 2019. A strong correlation between GCMR data from 'parks' and footfall count data was found. The conclusions of this study are twofold. Firstly, the COVID-19 pandemic increased trail usage in Ireland, especially on trails closer to urban areas and there is potential for this to be a lasting legacy. Secondly, combining multiple data sources can provide trail managers with more detailed representations of trail usage and currently these are not harmonised. Future research should examine ways to encourage sustained recreational walking trail use in new users and implement novel ways to coordinate datasets across systems to monitor visitors on Irish recreational walking trails.
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Introduction: Prone positioning is commonly used when treating ventilated Covid-19 patients. Whilst there have been some reports of ICU proning-related injuries to the brachial plexus well before the pandemic (Goettler et al. 2002), it is usually a very uncommon complication. Despite guidance from the Faculty of Intensive Care Medicine on the care of the proned patient, cases of peripheral neuropathies following ICU admission have significantly increased during the Covid-19 pandemic at our centre (Miller et al. 2021). Nerve injury is associated with reduced quality of life, impaired activity participation and persistent pain (Bailey et al. 2009). Objectives: The aim of this quality improvement project was to identify the effect that new guideline development and related healthcare professional education had on the number and severity of peripheral neuropathies identified following Covid-19 ICU admission. Methods: Between March 2020 and May 2021, we collected clinical data from patients who sustained peripheral neuropathies during their inpatient stay for Covid-19. Data were collected via face-to-face patient assessments within acute nerve clinics or post-ICU rehabilitation wards. A grading system was used to categorise the peripheral nerve injuries into severe, intermediate and mild (Power et al. 2020). Electronic ICU clinical noting was examined to identify the frequency and duration of each proning episode for each patient who presented with nerve injury. Following the first surge in 2020 updated proning guidelines were developed with ICU team leaders and disseminated. This involved face-to-face education of frontline staff. Results: At our centre 93 patients survived Covid ICU between March -June 2020 (surge 1) and 21 of those sustained nerve injury (22.58%). 309 patients survived Covid ICU between September 2020 -May 2021 (surge 2) and 12 of those sustained nerve injury (3.88%). For patients who sustained nerve injury, the average number of prones changed between surges from 6 to 13. The average duration of each episode of proning changed from 17.8hrs to 18.6hrs. Despite the increase in prone frequency, nerve injury occurrence reduced (proportionate to the number of patients who survived Covid ICU) by 82%. 14/21 (66%) injuries acquired in the first surge were of high grade and 4/ 12 (33%) were of high grade during the second surge. Conclusion: Optimising positioning of the proned ventilated patient may reduce the incidence of nerve injury. However, we must also acknowledge that changes in medical management between surges (i.e. use of dexamethasone, remdesivir) may have contributed to this. Individuals still developed severe injury despite this change in practice. Further research looking into risk factors and further methods of optimising the prone positioning on ICU is warranted to reduce the occurrence of this potentially life-changing injury.
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Background COVID-19 has had a disproportionate impact on nursing home residents with significantly higher mortality rates compared to the general population. Less attention however has been paid to COVID- 19 induced morbidity in this cohort. Our study aims to examine how nursing home (NH) residents who survived a COVID-19 infection, have been affected in terms of their cognitive, mood and functional outcomes as compared to residents that did not contract the virus. Method We performed an observational retrospective cohort study of the records of 452 residents in NHs affected by COVID-19 in Ireland from February 2020 to February 2021. We extracted data from the scheduled monthly assessments of the Barthel Index (BI), the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS) performed on residents of these NHs. We compared data from residents who had contracted COVID-19 (cases) to those that had not (controls);at 6, 3 and 1 month prior to a positive COVID-19 PCR test, to ensure comparability of control group, and again at 1, 3 and 6 months after the infection using a Students-T test for normally distributed data. Results We noted a significant deterioration in MMSE, BI and GDS scores in residents who had contracted COVID-19 as outlined in the table. While there was recovery in BI and GDS in the months following the index infection, the MMSE score in COVID-19 affected residents remained significantly adversely affected at 6 months. Conclusion Our study demonstrates the significant impact of COVID-19 infection on the physical, functional, cognitive and mental health of nursing home residents. The patient cohort displayed significant resilience in recovering from the physical and psychological consequences of the disease. The failure of cognitive function to improve over the period of observation may represent the development of 'Long COVID' in these patients. The development of this condition in nursing home residents has been poorly studied, is likely under reported and requires further exploration.
ABSTRACT
Background: Immune checkpoint inhibitors targeting PD-1 and PD-L1 have significantly impacted treatment of Non-Small Cell Lung Cancer (NSCLC). KEYNOTE-189 demonstrated first-line pembrolizumab plus pemetrexed-platinum improves progressionfree survival (PFS) and overall survival (OS) in metastatic nonsquamous NSCLC, regardless of tumour PD-L1 expression [1]. Translating evidence from trials to real-world patient populations can be challenging as a significant proportion of patients in daily practice are often under-represented in randomised control trials due to strict inclusion and exclusion criteria. We aimed to compare real-world data with outcomes from KEYNOTE-189. Methods: We performed a retrospective analysis of 56 patients with metastatic nonsquamous NSCLC without targetable mutations, treated with first line pembrolizumab, pemetrexed and platinum. Data were collected from electronic records between October 2018 and January 2021 in 2 London cancer centres. Results: Our cohort comprised 56 patients with median age 61 years, 75% with smoking history, 59% male and 41% female. PD-L1 expression was <1% in 57% of patients. Median follow-up was 8.7 months. All patients received at least one cycle and 53% completed 4 cycles of chemoimmunotherapy. Treatment was stopped early or pemetrexed maintenance treatment was omitted due to COVID-19 in 4 patients (7%). Median PFS was 7.1 months (range 1.8 to 26.3) and median OS was 8.7 months (range 1.8 to 26.3). OS at 12 months was reached by 21 patients (38%). Adverse events were observed in 30 patients (54%), including grade 3-5 adverse events in 15 patients (27%). Conclusions: Median PFS was similar in our cohort compared to KEYNOTE-189, but not as substantial as that reported in their updated analysis. OS was lower in our cohort, however a significant proportion of our patients recently commenced treatment and had shorter duration follow-up. Safety outcomes were superior in our cohort compared to KEYNOTE-189. Disclosure: No significant relationships.
ABSTRACT
Background: In December 2019 a cluster of pneumonias, later identified as SARS-CoV-2 (CoV), were reported in China. The first case in Ireland was reported February 29th 2020. The first community acquired case in Ireland was reported March 5th. The World Health Organisation declared CoV a pandemic March 11th. Lockdown measures were implemented in Ireland March 27th. Cork University Hospital is a large acute hospital and a tertiary referral center for cancer care. We undertook an audit of unscheduled medical oncology admissions over a 3 month period with a view to assess the impact of CoV on the centre. Method(s): From 1st February to 30th April we audited unscheduled medical oncology admissions. Parameters included presenting time, location and complaint, CoV status and average length of hospital stay (aLOS). Data was organised into 3 phases: four week period prior to a confirmed case of CoV in Ireland (phase I), four week period from confirmed case to lockdown implementation (phase 2) and four week period during lockdown (phase 3). After the outbreak of CoV we developed a separate medical oncology assessment facility (AOS) with an admission pathway. A hospital CoV pathway (CoVp) for potential CoV cases was also implemented. Result(s): A total of 162 medical oncology patients had unscheduled admissions during this period. Over half (57%) were receiving anticancer systemic treatment. The most common presenting complaints were pain (21%), pyrexia (17%) and dyspnoea (14%). The underlying diagnosis was cancer-related in 51%, treatment-related toxicity in 10% and non-cancer related in 39%. One patient was CoV positive. Unscheduled hospital admissions, source of admission and aLOS are outlined in the Table. [Formula presented]. Conclusion(s): A reduction in aLOS and ED admissions was paralleled by increasing use of alternative pathways. Processes which facilitate urgent assessment of oncology patients in specialized units avoid ED attendance and accelerate discharge planning in the care of cancer patients in the face of a pandemic and beyond. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2020