ABSTRACT
The COVID-19 pandemic has had a global effect. The disproportionate impact on Indigenous peoples and racialized groups has brought ethical challenges to the forefront in research and clinical practice. In Canada, the Tri-Council Policy Statement (TCPS2), and specifically the principle of justice, emphasizes additional care for individuals "whose circumstances make them vulnerable", including Indigenous and racialized communities. In the absence of race-based data to measure and inform health research and clinical practice, we run the risk of causing more harm and contributing to ongoing injustices. However, without an accepted framework for collecting, maintaining, and reporting race-based data in Canada, more guidance is needed on how to do this well. Importantly, a framework for collecting race-based data should build on existing guidance from Indigenous and other structurally marginalized communities, the TCPS2, recommendations from the World Health Organization, and involve relevant stakeholders. In this paper, we describe historical examples of unethical studies on Indigenous and racialized groups, discuss the challenges and potential benefits of collecting race-based data, and conclude with objectives for a pan-Canadian framework to inform how race-based data is collected, stored, and accessed in health research.
ABSTRACT
Objective: To assess the outcomes of coronavirus disease-2019 patients with acute renal damage who received remdesivir against placebo at a private hospital in Karachi, Pakistan. Methodology: At the COVID-19 ICU of Hussain Lakhni Hospital, a cohort study was conducted from July 2021 to February 2022. Male and female study participants with COVID-19 and acute renal injury ranged in age from 40 to 80. Remdesivir-treated individuals with COVID-19 acute kidney injury were exposed, but placebo-treated patients with COVID-19 acute kidney injury were not exposed. In-hospital mortality, elevated serum creatinine levels, and prolonged hospital stays were the results. The data was analyzed using SPSS version 23. Result(s): Patients who took remdesivir had a lower mortality rate than those who were placebo (32.2% vs 67.8%, OR=0.38, 95 percent CI=0.27-0.52), with a p-value of 0.001. Remdesivir was also associated with a shorter hospital stay (4.2% versus 95.8%, OR=0.005, 95 percent CI=.003-0.009) with a p-value of 0.001). However, increased serum creatinine revealed statistically insignificant differences between groups. The odds of in-hospital mortality were 0.376 times lower (AOR=0.376, 95 percent CI=0.275-0.514, p=0.0001) and the odds of a prolonged hospital stay were 0.030 times lower (AOR=0.030, 95 percent CI=0.012-0.074, p=0.001) in the remdesivir group than in the placebo group after controlling for covariates. Practical implication: In literature Remdesvir was associated with acute kidney injury (rise in serum creatinine) and in many centres,it was not used in patients with acute kidney injury although it has very beneficial effect in patients of severe covid pneumonia,many centres were not using it in patients of acute renal failure. in our study, rise in serum creatinine was not significant in remdesvir group in patient with acute kidney injury,so remdesvir must not be withheld in this group of patients as it can decrease the severity of covid pneumonia and saves patients lives Conclusion(s): Remdesivir is an effective medicine in COVID-19 patients with acute renal damage in terms of in-hospital mortality and duration of stay. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
ABSTRACT
Purpose: The COVID-19 pandemic has fundamentally impacted upon the travel supply chain and influenced tourist behaviours. This is further evidenced in corporate and travel firm concerns surrounding future sales and profitability. Instilling confidence amongst tourists is therefore imperative to ensure consumers continue purchasing the holiday product. However, the management of an intangible and relatively unknown virus has compounded the already difficult management of the tourist experience. Design/Methodology/Approach: The chapter reviews the impact of COVID-19 in the context of the tourism supply chain and the safety and security measures implemented in destinations. The financial implications of safety and security measures are acknowledged with management challenges and solutions discussed. The chapter underpins its analysis with the use of regional, national and international examples. Findings: Contingency strategies ranging from quarantine to health and safety certification have been deployed by national governments and regional authorities. However, the complexity of the tourism product and the range of stakeholders involved in its make-up and distribution compounds the ability to ensure safety from the virus. Practical Implications: The review acknowledges limitations of health and safety measures in the field and forwards alternative suggestions that can be adopted by tourism destinations and enterprises. Originality/Value: The chapter is novel in that it reviews health and safety and financial security practices in the field as they relate to the COVID-19 pandemic. © 2021 Emerald Publishing Limited.
ABSTRACT
Aim: Remote consultations (RC) were implemented during the COVID-19 pandemic with the aim of preventing transmission of the virus. We conducted a survey to assess patients' and clinicians' satisfaction of RC. Method: Two online surveys were created for patient and clinician feedback, and each recorded a cohorts' opinions on various aspects of RC. The surveys were distributed to Urology, General and Vascular surgery departments at three NHS trusts. Patient feedback was collected over the phone, whilst clinicians completed the survey online. Results: Overall, responses from 99 patients and 22 clinicians were collected. 89.9% of patients were either 'satisfied or very satisfied' with RC, compared to 77.2% of clinicians who practiced RC. 93.9 % of patients felt they were able to discuss all their concerns during their RC. However, outside of the COVID-19 setting 50% of patients and 59.1% of clinicians would prefer face to face consultations. Both cohorts reported adherence to social distancing and convenience as key advantages of RC;furthermore 68.2% of clinicians thought RC were economically beneficial. 100% of clinicians felt the inability to examine patients was a disadvantage of RC and 33.8% of patients agreed with this. Conclusions: The majority of feedback from patients and clinicians was positive for RC. However, in future approximately 55% of both cohorts would prefer face to face consultations. Looking forward, we believe RC can form a part of routine practice in selected groups of patients, where it could potentially save time and money without compromising patient or clinician satisfaction.
ABSTRACT
INTRODUCTION: Tracheostomies are performed to facilitate weaning trauma patients from mechanical ventilation (MV). Our previous data demonstrated that nine days are required to liberate a patient from the ventilator following tracheostomy. We hypothesized that institution of a dedicated weaning protocol would decrease the number of days to liberate from the ventilator following tracheostomy. METHODS: We prospectively collected data from consecutive trauma patients ≥18 years of age who underwent a tracheostomy after implementation of a weaning protocol March 1, 2020 through May 30, 2020. We excluded patients with cervical spinal cord injuries and patients with COVID-19. We compared this to a pre-protocol cohort. The primary outcome was time from tracheostomy to liberation from MV, defined as ≥24 hours of continuous trach collar. RESULTS: There were 17 patients who met criteria in the weaning protocol group and 99 patients in the pre-protocol cohort. The protocol group was significantly older (59 yrs vs 45 yrs, p=0.002) and had a lower injury severity score (20 vs 32, p<0.001). There was no difference in sex, injury type, or days intubated prior to tracheostomy. The protocol group was weaned from MV after 5.2±6.2 days and the preprotocol group, 8.7±6.9 days (p=0.042). There was also a significant difference in the pneumonia rate with the protocol group having a higher incidence (p=0.044). There was no significant difference in ICU or hospital length of stay, or death between the two groups. CONCLUSIONS: Ventilator liberation occurred significantly faster in trauma patients after implementation of a dedicated weaning protocol despite having an older population and a higher incidence of pneumonia. As ventilator days usually drive ICU utilization, it remains unclear why earlier liberation did not decrease ICU length of stay and warrants further investigation.