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1.
Hong Kong Journal of Paediatrics ; 27(1):80, 2022.
Article in English | EMBASE | ID: covidwho-2003518

ABSTRACT

Introduction: Neuromuscular disorders (NMDs) are a group of diseases affecting the peripheral nervous system (1). Many NMDs cause disability or even premature death (2). We aim to design and establish a robust NMD patient registry in Hong Kong. Methods: By modelling international NMD patient registries, we designed patient-professional reported questionnaires to collect the demographic, clinical c haracteristics, genetic details, family history, investigation findings and specific treatment of NMD patients. Patients were recruited through Hong Kong West Cluster (DKCH, QMH) and Kowloon Central Cluster (HKCH). We also developed self-registration online platform. p<0.05 was considered statistically significant. Findings: Since June 2019, 125 NMD patients have been enrolled in the registry with 12 participants registered online. The registry recruited 13 types of NMDs, including spinal muscular atrophy (SMA) (n=31), Duchenne muscular dystrophy (DMD) (n=19) and congenital myopathy (n=18). The age range was 7 months to 63 years old. 65.6% of those enrolled were children (<18 years old). 63.2% were male. 64.8% of the patients had genetic diagnosis. The registry has contributed to two studies. The first one is a prospective study of clinical efficiency of Nusinersen in SMA patients (n=22). 14/16 SMA patients showed improvement in at least one of motor performance (CHOP intend/RULM/HINE/HFMSE) and health-related quality of life after 1st year of treatment. The second study is the reactogenicity and immunogenicity study of the COVID-19 vaccine in DMD patients (n=4). Data will be available in October. Conclusion: Hong Kong Patient registry has contributed to ongoing and new research study to optimise medical care.

2.
Bmj Open ; 12(6):8, 2022.
Article in English | Web of Science | ID: covidwho-1896056

ABSTRACT

Introduction Health systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during the first 6 months of the COVID-19 pandemic compared with prior to the pandemic. Methods We conducted a mixed study design in eight health facilities that are part of the Birhan field site in Amhara, Ethiopia and compared the trend of service utilisation in the first 6 months of COVID-19 with the corresponding time and data points of the preceding year. Result New family planning visits (43.2 to 28.5/month, p=0.014) and sick under 5 child visits (225.0 to 139.8/month, p=0.007) declined over the first 6 months of the pandemic compared with the same period in the preceding year. Antenatal (208.9 to 181.7/month, p=0.433) and postnatal care (26.6 to 19.8/month, p=0.155) visits, facility delivery rates (90.7 to 84.2/month, p=0.776), and family planning visits (313.3 to 273.4/month, p=0.415) declined, although this did not reach statistical significance. Routine immunisation visits (37.0 to 36.8/month, p=0.982) for children were maintained. Interviews with healthcare providers and clients highlighted several barriers to service utilisation during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilisation included communities' decreased fear of COVID-19 and awareness-raising activities. Conclusion We observed a decline in essential MNCH services particularly in sick children and new family planning visits. To improve the resiliency of fragile health systems, resources are needed to continuously monitor service utilisation and clients' evolving concerns during public health emergencies.

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Nephrology Dialysis Transplantation ; 36(SUPPL 1):i261, 2021.
Article in English | EMBASE | ID: covidwho-1402431

ABSTRACT

BACKGROUND AND AIMS: Renal involvement in COVID-19 under vigilant public health surveillance, including mass screening and early hospitalization is less wellcharacterized. We assessed renal involvement of COVID-19 patients in Hong Kong, including the association with risk factors, length of hospitalization, critical presentation and mortality. METHOD: Linked electronic records of all confirmed patients from 5 major designated hospitals were extracted. Primary outcome was the incidence of in-hospital AKI. Secondary outcomes were AKI-associated mortality, incident RRT, intensive care admission, prolonged hospitalization and disease course (defined as >90th percentile of hospitalization duration and duration from symptom onset to discharge, respectively), and change of eGFR. Patients were further stratified into being symptomatic or asymptomatic. RESULTS: Patients were characterized by young age (median:38.4, IQR:28.4-55.8 years old) and short time (Median:5, IQR:2-9 days) from symptom onset to admission. Among the 591 patients, 22 (3.72%) developed AKI and 4 (0.68%) required RRT. AKI increased the odds of prolonged hospitalization and disease course by 2.0 and 3.5 folds, respectively. Estimated GFR 24 weeks post-discharge reduced by 7.51 and 1.06 ml/min/ 1.73m2 versus baseline (at admission) in the AKI and non-AKI groups, respectively. The incidence of AKI was comparable between asymptomatic (4.8%) and symptomatic (3.7%) patients. CONCLUSION: The overall rate of AKI among COVID-19 patients in Hong Kong is low, which could be attributable to a vigilant screening program and early hospitalization. Among patients who developed in-hospital AKI, the duration of hospitalization is prolonged and kidney function impairment can persist for up to 6 months post-discharge. Mass surveillance for COVID-19 is warranted in identifying asymptomatic subjects for earlier AKI management.

7.
Investigative Ophthalmology and Visual Science ; 62(8), 2021.
Article in English | EMBASE | ID: covidwho-1378608

ABSTRACT

Purpose : COVID-19 continues to disrupt the delivery of ophthalmic care in the third wave of the pandemic. Increased rates of anxiety has been reported in patient cohorts as COVID-19 impacts patients' hospital perceptions and has upended the patient experience. We sought to assess the impacts of COVID-19 on glaucoma patient self-perceived outcomes and experiences as assessed by the POEM questionnaire. Methods : 126 consecutive patients attending a tertiary clinic over a 2-week period were surveyed with the Patient Reported Outcome and Experience measure (POEM). POEM is an 8-item questionnaire that addresses aspects of outcome (acceptability of treatment, fear of blindness, impact on daily life), and aspects of experience (safety, understanding, organization of care). The questionnaire was modified to determine if each item was more of a concern during the COVID pandemic. Assessments were performed in September 2020 and results were compared to pre-COVID survey results (n= 780). The questionnaires were conducted anonymously with no pairing to clinical data or demographics attempted. Results : Survey results showed that the items showing the biggest reduction in agreement pertained to the understanding of how glaucoma is treated and patients' perception of their treatment team. There was a a 10-15% decrease in agreement for Q2 (I understand how my eye problem is managed), Q4 (I think my glaucoma is not getting worse), Q7 (I feel safe under the care of my glaucoma team) and Q8 (My glaucoma care is well organized) compared to pre COVID-19 questionnaire findings. Patients identified Q6 (I'm not worried about losing vision from glaucoma), Q7 (I feel safe under the care of my glaucoma team) and Q8 (My glaucoma care is well organized) as the most common aspects of their glaucoma care that COVID has increased concern over with 28.8%, 32.1% and 40.2% giving 'yes' responses respectively. Conclusions : The COVID-19 pandemic has resulted in an increased uncertainty amongst patients about how their glaucoma is managed. Patients may not feel as safe about their glaucoma care and heightened anxiety about losing vision are issues which need to be addressed. Further studies investigating the patient experience and outcomes are required to fully elucidate the true psychological and physiological impacts of COVID-19.

8.
Alcoholism: Clinical and Experimental Research ; 45(SUPPL 1):28A, 2021.
Article in English | EMBASE | ID: covidwho-1314005

ABSTRACT

As a consequence of the global COVID-19 pandemic, a large number of research publications have appeared at a rapid pace, as well as a large number of withdrawal/retractions. Because of this rapid throughput, reproducibility and replicability in research become even more important. Many published scientific findings either have not been or cannot be reproduced or replicated. While some non-reproducible or non-replicable findings are the nature of the scientific process and its inherent uncertainty, others are usually due to the lack of transparency. These observations motivated the discussion of whether there is a “reproducibility and replicability crisis” and how to address it in many research areas, including psychology and medicine. In 2019, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a report titled “Reproducibility and Replicability in Science” and the American Statistical Association published a special issue on “Statistical Inference in the 21st Century: A World Beyond p < 0.05.” The objective of this presentation is to discuss how effective statistical practice under the open science environment may help the scientific community, including addiction researchers, to disseminate high-quality research findings. We will start by defining reproducibility and replicability, and describing how they relate to transparency and generalizability. Next, we will examine two key statistical concepts: uncertainty and variability, and highlight the differences between exploratory and confirmatory research. We will conclude the presentation with some possible solutions such as preregistration. References National Academies of Sciences, Engineering, and Medicine 2019. Reproducibility and Replicability in Science. Washington, D.C: The National Academies Press. https://doi.org/10.17226/25303.;2019 special issue on Statistical Inference in the 21st Century: A World Beyond p < 0.05. The American Statistician, 73(Supp 1) 1 - 401.

9.
Public Health Action ; 11(2): 41-49, 2021 Jun 21.
Article in English | MEDLINE | ID: covidwho-1278666

ABSTRACT

The COVID-19 pandemic and response measures, including lockdowns and the reorientation of health services, have disrupted essential health services for other diseases, including TB, HIV and malaria. For TB, reductions in case detection due to the COVID-19 pandemic are projected to result in increased TB transmission, morbidity and mortality. Active case-finding (ACF) for TB using community-based approaches is a potential strategy to offset reductions in TB detection by obviating the need for patients to seek care at a health facility. A number of approaches can be used to conduct TB ACF safely and screen designated target populations while managing the risks of SARS-CoV-2 transmission for staff, individuals and the community. We present a framework of options for and experience of adapting TB ACF services in response to the challenges of COVID-19 in our programme in Yogyakarta, Indonesia. Key changes have included revised prioritisation of target populations focusing on household contacts, reducing case-finding throughput, implementation of additional infection control measures and precautions, and integration of COVID-19 screening among those being screened for TB. Our approach could inform other programmes seeking to adapt TB ACF services to mitigate the negative impact of COVID-19 on TB case detection.


La pandémie de COVID-19 et les mesures de riposte incluant des confinements et une réorientation des services de santé ont perturbé les services de santé essentiels destinés aux autres maladies comme la TB, le VIH et le paludisme. En ce qui concerne la TB, les réductions de la détection des cas dues à la pandémie de COVID-19 devrait entraîner une augmentation de la transmission, morbidité et mortalité de la TB. La recherche active des cas (ACF) de TB grâce à des approches communautaires est une stratégie potentielle visant à compenser pour les réductions de détection de la TB en écartant le besoin pour les patients de solliciter des soins dans un structure de santé. Plusieurs approches peuvent être utilisées pour réaliser l'ACF TB de façon sûre et de dépister des populations cibles désignées tout en gérant les risques de transmission du SARS-CoV-2 pour le personnel, les individus et la communauté. Nous présentons un cadre d'options et d'expériences d'adaptation des services TB ACF en réponse aux défis du COVID-19 dans notre programme à Yogyakarta, Indonésie. Les changements majeurs ont inclus une révision des priorités des populations cibles focalisée sur les contacts domiciliaires ; une réduction de la cadence de la recherche de cas ; la mise en œuvre de mesures supplémentaires de lutte contre l'infection et de précautions ; et l'intégration du dépistage de COVID-19 parmi ceux dépistés pour la TB. Notre approche pourrait informer d'autres programmes voulant adapter les services TB ACF afin d'atténuer l'impact négatif du COVID-19 sur la détection des cas de TB.

11.
American Journal of Emergency Medicine ; 38(10):2011-2013, 2020.
Article in English | MEDLINE | ID: covidwho-1208524

ABSTRACT

The COVID19 crisis has provided a portal to revisit and understand qualities of screening tests and the importance of Bayes' theorem in understanding how to interpret results and implications of next actions.

12.
Ann R Coll Surg Engl ; 103(5): 337-344, 2021 May.
Article in English | MEDLINE | ID: covidwho-1133654

ABSTRACT

INTRODUCTION: The COVID-19 pandemic presented extraordinary challenges to the UK healthcare system. This study aimed to assess the impact of the COVID-19 lockdown on the epidemiology, treatment pathways and 30-day mortality rates of hip fractures. Outcomes of COVID-19 positive patients were compared against those who tested negative. METHODS: An observational, retrospective, multicentre study was conducted across six hospitals in the South East of England. Data were retrieved from the National Hip Fracture Database and electronic medical records. Data was collected for the strictest UK lockdown period (period B=23 March 2020-11 May 2020), and the corresponding period in 2019 (period A). RESULTS: A total of 386 patients were admitted during period A, whereas 381 were admitted during period B. Despite the suspension of the 'Best Practice Tariff' during period B, time to surgery, time to orthogeriatric assessment, and 30-day mortality were similar between period A and B. The length of inpatient stay was significantly shorter during period B (11.5 days vs 17.0 days, p<0.001). Comparison of COVID-19 positive and negative patients during period B demonstrated that a positive test was associated with a significantly higher rate of 30-day mortality (53.6% vs 6.7%), surgical delay >36h (46.4% vs 30.8%, p=0.049), and increased length of inpatient stay (15.8 vs 11.7 days, p=0.015). CONCLUSIONS: The COVID-19 lockdown did not alter the epidemiology of hip fractures. A substantially higher mortality rate was observed among patients with a COVID-19 positive test. These findings should be taken into consideration by the healthcare policymakers while formulating contingency plans for a potential 'second wave'.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Hip Fractures/epidemiology , Length of Stay/statistics & numerical data , Mortality , Public Policy , Time-to-Treatment/statistics & numerical data , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip , Bone Screws , COVID-19/complications , Cohort Studies , England/epidemiology , Female , Fracture Fixation, Internal , Fracture Fixation, Intramedullary , Hemiarthroplasty , Hip Fractures/complications , Hip Fractures/surgery , Humans , Male , Reoperation , SARS-CoV-2
13.
Int Orthop ; 44(12): 2819, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-792990

ABSTRACT

The published online version contains mistake, as the Fig. 1 legend should read "Kaplan-Meier survival curve for 30-day survival for 2020 cohort COVID-19 positive vs COVID-19 negative" whilst the Fig. 2 legend should read "Kaplan-Meier survival curve for 30-day survival 2020 COVID-19 negative group vs 2019 cohort".

14.
Int Orthop ; 45(1): 23-31, 2021 01.
Article in English | MEDLINE | ID: covidwho-734827

ABSTRACT

PURPOSE: Thirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients. METHODS: A multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019. RESULTS: Actual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57-5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification. CONCLUSION: COVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.


Subject(s)
COVID-19 , Hip Fractures/mortality , Aged, 80 and over , Elective Surgical Procedures , Female , Hip Fractures/surgery , Hospital Mortality , Humans , Male , Prospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , United Kingdom
15.
J Hosp Infect ; 106(2): 226-231, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-635357

ABSTRACT

BACKGROUND: In late 2019, a novel human coronavirus - severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) - emerged in Wuhan, China. This virus has caused a global pandemic involving more than 200 countries. SARS-CoV-2 is highly adapted to humans and readily transmits from person-to-person. AIM: To investigate the infectivity of SARS-CoV-2 under various environmental and pH conditions. The efficacies of various laboratory virus inactivation methods and home disinfectants against SARS-CoV-2 were investigated. METHODS: The residual virus in dried form or in solution was titrated on to Vero E6 cells on days 0, 1, 3, 5 and 7 after incubation at different temperatures. Viral viability was determined after treatment with various disinfectants and pH solutions at room temperature (20-25oC). FINDINGS: SARS-CoV-2 was able to retain viability for 3-5 days in dried form or 7 days in solution at room temperature. SARS-CoV-2 could be detected under a wide range of pH conditions from pH 4 to pH 11 for several days, and for 1-2 days in stool at room temperature but lost 5 logs of infectivity. A variety of commonly used disinfectants and laboratory inactivation procedures were found to reduce viral viability effectively. CONCLUSION: This study demonstrated the stability of SARS-CoV-2 on environmental surfaces, and raises the possibility of faecal-oral transmission. Commonly used fixatives, nucleic acid extraction methods and heat inactivation were found to reduce viral infectivity significantly, which could ensure hospital and laboratory safety during the SARS-CoV-2 pandemic.


Subject(s)
Betacoronavirus/growth & development , Betacoronavirus/pathogenicity , Coronavirus Infections/physiopathology , Microbial Viability , Pneumonia, Viral/physiopathology , Severe Acute Respiratory Syndrome/pathology , Virulence , Virus Inactivation , COVID-19 , China/epidemiology , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Severe Acute Respiratory Syndrome/epidemiology
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