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Canadian Liver Journal ; 2022.
Article in English | Web of Science | ID: covidwho-1938584


BACKGROUND: Prior studies have assessed risk factors and clinical outcomes in liver transplant (LT) recipients infected with COVID-19 globally;however, there is a paucity of Canadian data. Our multicentre study aims to examine the characteristics and clinical outcomes of LT patients with COVID-19 infection in Canada. METHODS: Adult LT recipients with reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19, from Canadian tertiary care centres between March 2020 and June 2021 were included. RESULTS: A total of 49 patients with a history of LT and COVID-19 infection were identified. Twenty nine patients (59%) were male, median time from LT was 66 months (IQR 1, 128), and median age was 59 years (IQR 52, 65). At COVID-19 diagnosis, the median alanine transaminase (ALT) was 37 U/L (IQR 21, 41), aspartate aminotransferase (AST) U/L was 34 (IQR 20, 37), alkaline phosphatase (ALP) U/L was 156 (IQR 88, 156), total bilirubin was 11 umol/L (IQR 7, 14), and international normalized ratio (INR) was 1.1 (IQR 1.0, 1.1). The majority of patients (86%) were on tacrolimus (monotherapy or combined with mycophenolate mofetil);median tacrolimus level at COVID-19 diagnosis was 5.3 ug/L (IQR 4.0, 8.1). Immunosuppression was modified in eight (16%) patients post-infection. Eighteen patients (37%) required hospitalization, and three (6%) required intensive care unit (ICU) admission and mechanical ventilation. Four patients (8%) died from complications related to COVID-19 infection. On univariate analysis, neither age, sex, comorbidities nor duration post-transplant were associated with risk of hospitalization or ICU admission. CONCLUSIONS: LT recipients with COVID-19 have high rates of hospitalization but fortunately have low rates of ICU admission and mortality in this national registry.

BMJ Open ; 11(7): e048395, 2021 07 26.
Article in English | MEDLINE | ID: covidwho-1327672


INTRODUCTION: One in three people aged 65 years and over fall each year. The health, economic and personal impact of falls will grow substantially in the coming years due to population ageing. Developing and implementing cost-effective strategies to prevent falls and mobility problems among older people is therefore an urgent public health challenge. StandingTall is a low-cost, unsupervised, home-based balance exercise programme delivered through a computer or tablet. StandingTall has a simple user-interface that incorporates physical and behavioural elements designed to promote compliance. A large randomised controlled trial in 503 community-dwelling older people has shown that StandingTall is safe, has high adherence rates and is effective in improving balance and reducing falls. The current project targets a major need for older people and will address the final steps needed to scale this innovative technology for widespread use by older people across Australia and internationally. METHODS AND ANALYSIS: This project will endeavour to recruit 300 participants across three sites in Australia and 100 participants in the UK. The aim of the study is to evaluate the implementation of StandingTall into the community and health service settings in Australia and the UK. The nested process evaluation will use both quantitative and qualitative methods to explore uptake and acceptability of the StandingTall programme and associated resources. The primary outcome is participant adherence to the StandingTall programme over 6 months. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the South East Sydney Local Health District Human Research Ethics Committee (HREC reference 18/288) in Australia and the North West- Greater Manchester South Research Ethics Committee (IRAS ID: 268954) in the UK. Dissemination will be via publications, conferences, newsletter articles, social media, talks to clinicians and consumers and meetings with health departments/managers. TRIAL REGISTRATION NUMBER: ACTRN12619001329156.

Exercise Therapy , Independent Living , Aged , Australia , Cost-Benefit Analysis , Humans , Randomized Controlled Trials as Topic
JAMA Ophthalmol ; 139(3): 344-347, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1030155


Importance: The coronavirus disease 2019 pandemic illustrates the increasingly important role of telemedicine as a method of clinician-patient interaction. However, electronic applications (apps) for the testing of ophthalmology vital signs, such as visual acuity, can be published and used without any verification of accuracy, validity, or reliability. Objective: To reassess the accuracy of visual acuity-testing apps and assess their viability for telehealth. Design, Setting, and Participants: The US Apple App Store was queried for apps for visual acuity testing. Anticipated optotype size for various visual acuity lines were calculated and compared against the actual measured optotype size on 4 different Apple hardware devices. No human participants were part of this study. Main Outcomes and Measures: Mean (SD) errors were calculated per device and across multiple devices. Results: On iPhones, 10 apps met inclusion criteria, with mean errors ranging from 0.2% to 109.9%. On the iPads, 9 apps met inclusion criteria, with mean errors ranging from 0.2% to 398.1%. Six apps met criteria and worked on both iPhone and iPad, with mean errors from 0.2% to 249.5%. Of the 6 apps that worked across devices, the top 3 most accurate apps were Visual Acuity Charts (mean [SD] error, 0.2% [0.0%]), Kay iSight Test Professional (mean [SD] error, 3.5% [0.7%]), and Smart Optometry (mean [SD] error, 15.9% [4.3%]). None of the apps tested were ideal for telemedicine, because some apps displayed accurate optotype size, while others displayed the same letters on separate devices; no apps exhibited both characteristics. Conclusions and Relevance: Both Visual Acuity Charts and Kay iSight Test Professional had low mean (SD) errors and functionality across all tested devices, but no apps were suitable for telemedicine. This suggests that new and/or improved visual acuity-testing apps are necessary for optimal telemedicine use.

Mobile Applications , Optometry/instrumentation , Smartphone , Telemedicine/instrumentation , Visual Acuity , COVID-19 , Humans , Predictive Value of Tests , Reproducibility of Results