Single centre experience of paediatric intestinal transplantation during the COVID-19 pandemic: Lessons from adapting to pandemic pressures

Introduction: The COVID-19 pandemic has created challenges for centres performing solid organ transplantation especially with the limited availability of donors, including restrictions related to lockdowns. We aimed to assess the impact of the measures and steps taken to mitigate these challenges in order to continue to deliver intestinal/multivisceral transplantation (I/MVTx). Methods: All I/MVTx between March 2020 to December 2020 were included in the study. Data were collated from a prospectively maintained departmental database and are presented descriptively. Results: All potential I/MVTx recipients were suspended at the start of the pandemic and were reactivated after an eight week period of risk assessment. A total of five transplants were performed during the study period. (Table-1) All recipients and donors were COVID tested just prior to surgery and managed through a COVID clean patient pathway as per NHSBT. Discussion: Pre-operative precautions (screening of donor history, additional endotracheal swabs and recipient swabs) were in place at the time of the procedures. Clinical urgency mandated conscious decisions such as liver reduction and staged abdominal closure in two patients with intractable GI bleeding. Intra-operative risk mitigation strategies included utilisation of standard PPE, minimal personnel in theatre and minimisation of surgical pauses. The prioritisation of the procedures to experienced donor and recipient surgeons allowed for short Cold ischemia times (some recipient operations were started prior to cross clamp at the donor site). No changes were made to immunosuppression protocols. Post-operative follow up was changed to minimize recipient visits to the hospital. There were no routine follow up endoscopies and stomal biopsies were reduced to once-a-week and when clinically indicated. No routine follow up face-to-face outpatient appointments were made. Instead, parents were educated and supported through a process of daily weight and stoma output monitoring and these were directly reported to the consultant through e-mail. Conclusion: Adaptation to different challenges during the pandemic permitted restitution of the intestinal transplant pathway without any deleterious effect on outcomes. Changes in post discharge practice introduced will continue and may improve the patient care pathway.

Management of ENT emergencies during the coronavirus disease 2019 pandemic.

BACKGROUND: Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre. METHODS: After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019. RESULTS: An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients. CONCLUSIONS: Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns.

An audit of the well-being of staff working in intellectual disability settings in Ireland during the COVID-19 pandemic

Purpose: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected millions of people worldwide. Individuals with intellectual disability are at a disproportionate risk of mortality, given the health inequalities they experience. This puts a significant burden of responsibility on staff who support these individuals. Consequently, this study aims to establish a baseline of the well-being of staff working in intellectual disability services in Ireland during the COVID-19 pandemic. Design/methodology/approach: An online survey was carried out using the Copenhagen Burnout Inventory, a brief measure of depression (Patient Health Questionnaire-9) and a brief measure of anxiety (General Anxiety Disorder-7). Findings: In total, 285 staff in the Republic of Ireland completed the survey. These staff reported moderate levels of personal and work-related burnout and mild levels of anxiety and depression. Higher mean scores were recorded across scales from staff who worked in independent living settings and from staff who supported individuals with challenging behaviour. Originality/value: This study, an audit, provides initial data on the well-being of staff working with individuals with intellectual disability in Ireland during the COVID-19 pandemic. It highlights that employers need to consider staff well-being, given the levels of personal and work-related burnout, and anxiety and depression that were found. This is particularly true for staff who work in independent living settings and with adults with challenging behaviour. Future research should focus on proactive strategies for improving staff well-being in the short term, given the current resurgence of COVID-19 in Ireland. © 2020, Emerald Publishing Limited.