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1.
Surg Open Sci ; 10: 168-173, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2061888

ABSTRACT

Background: The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods: A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results: Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39-70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P < .001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non-Protected Elective Surgical Unit (0.42% vs 3.2% P < .001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19-positive patients. COVID-19 infection, age > 70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion: This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.

2.
Investigative Ophthalmology and Visual Science ; 63(7):2659, 2022.
Article in English | EMBASE | ID: covidwho-2057987

ABSTRACT

Purpose : Charles Bonnet syndrome (CBS) is characterised by visual hallucinations secondary to sight loss. Aside from sight loss, other risk factors associated with CBS include social isolation, loneliness, and post-traumatic stress. The health and lifestyle circumstances of visually impaired military veterans place this profile at an increased risk of developing CBS. The purpose of this study was to estimate the prevalence of CBS through an analysis of health records for members of a UK sight loss charity (Blind Veterans UK) and report experiences of CBS during the COVID-19 pandemic. Methods : A retrospective analysis and screening/filtering of military veterans' electronic membership records at Blind Veterans UK. Text analysis was used to identify CBS cases. A cross sectional survey of individuals with active CBS was used to measures patientreported features of hallucinatory experiences during the COVID-19 pandemic and perceived episode triggers. Results : Analysis was conducted on 4109 members of Blind Veterans UK. Following screening and exclusion of members with non-sight loss related hallucination risk factors (e.g., Alzheimer's disease), 532 members were identified as CBS cases, representing 12.9% (95% CI: 11.1%-14.7%) of the cohort. Forty-five individuals with CBS completed the survey. Loneliness during the pandemic was associated with changes in the nature of visual hallucinations (p=0.04). Individuals experiencing greater loneliness were, on average, older than those with no changes to their feelings of loneliness (p=0.03). Despite experiencing greater feelings of loneliness (67%), most individuals had not accessed support services. Conclusions : The relative high prevalence of CBS among visually impaired military veterans indicates that this cohort may be at greater risk of the condition. Approximately half of survey respondents experienced exacerbation of visual hallucinations during the COVID-19 pandemic, which may partly be explained by loneliness and/or environmental triggers.

3.
Surgery open science ; 2022.
Article in English | EuropePMC | ID: covidwho-2046206

ABSTRACT

Background The COVID-19 pandemic has caused unprecedented healthcare challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units (PESU) were developed to mitigate against infection related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of PESUs can result in significant reduction in risk. Methods A retrospective observational study of consecutive patients from 18 specialties, undergoing elective or emergency surgery under general, spinal or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day post-operative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and PESU transmission rates. Results Between 15th March 2020 and 14th March 2021, 9,925 patients underwent surgery, 6,464 (65.1%) elective, 5,116 (51.5%) female and median age 57 (39–70). 69.5% of all procedures were performed in PESUs. Overall, 30-day post-operative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective p < 0.001). PESU post-operative transmission was significantly lower than non-PESU (0.42% vs 3.2% p < 0.001), with an adjusted likely in-hospital PESU transmission of 0.04%. The 30-day all-cause mortality was 1.7%, and 14.6% in COVID-19 positive patients. COVID-19 infection, age > 70, male gender, ASA > 2 and emergency surgery were all independently associated with mortality. Conclusion This study has demonstrated that PESUs can facilitate high volume elective surgical services throughout peaks of the COVID-19 pandemic whilst minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.

4.
International Journal of Mental Health Nursing ; 31:25-25, 2022.
Article in English | Web of Science | ID: covidwho-2030750
6.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009632

ABSTRACT

Background: Immunotherapy is becoming a common therapy in cancer patients. Cancer patients on systemic therapy are a vulnerable population, making them highly susceptible to illness from any infection. The purpose of this study was to collect and analyze data reported by patients regarding the side effects of COVID-19 vaccines (Pfizer-BioNTech and Moderna) in cancer patients with solid tumors receiving immunotherapy. Due to the lack of studies and inclusion of cancer patients in the clinical trials for the vaccine, it is pivotal to investigate of the effects of the SARS-2-CoV vaccine on patients receiving immunotherapy to begin to bridge the current gap in knowledge. Methods: We performed a twophased retrospective analysis of adult patients (age ≥18 years) who received either Moderna or Pfizer-BioNTech COVID-19 vaccinations and were currently on immunotherapy (December 15th, 2020, through July 31st, 2021). Phase 1 included a tertiary health system (n = 15,910) in Northeast Georgia. Phase 2 involved cross-tabulation with the VAERS CDC database to compare results at a national level (n = 374,667). The primary endpoints were severity of side effects, timing of side effects and the relationship between the vaccines. The method to evaluate outcome was the Pearson-Chi-Squared test. Results: Results showed that patients on immunotherapy were more likely to have at least one side effect in the tertiary health system (OR 6.727 [95% CI, 2.748 -16.465] compared to least two side effects in the national dataset (X2 = 7.032, p < 0.05). This difference was driven by the Moderna vaccine recipients, demonstrating a higher likelihood of experiencing two or more side effects (X2 = 6.159, p < 0.05). Those receiving the Pfizer-BioNTech vaccine did not demonstrate statistically significant side effects. The most common reaction noted was weakness in both datasets, which was more likely to occur after the Moderna vaccine. Gender analysis showed no difference in side effects in those receiving immunotherapy. In terms of timing of side effects, patients on immunotherapy (M = 10.66, SD = 25.1) had a delayed side effect onset of 10 days vs. four days. (M = 4.72, SD = 15.5, p < 0.05). Conclusions: Both local and national datasets demonstrate cancer patients receiving immunotherapy compared to those that were on immunotherapy, were more likely to experience mild vaccine side effects, specifically weakness being the most common. There was no statistically significant increase in more serious adverse reactions. Additionally, side effect onset was delayed in patients on immunotherapy. These findings provide a foundation for understanding mRNA vaccines in patients on immunotherapy, with future research needs involving larger sample sizes.

7.
BMJ Open ; 12(9), 2022.
Article in English | PMC | ID: covidwho-2009221

ABSTRACT

Objectives: Across diverse ethnic groups in the UK, explore attitudes and intentions towards COVID-19 vaccination and sources of COVID-19 information. Design: Remote qualitative interviews and focus groups (FGs) conducted June–October 2020 before UK COVID-19 vaccine approval. Data were transcribed and analysed through inductive thematic analysis and mapped to the Theoretical Domains Framework. Setting: England and Wales. Participants: 100 participants from 19 self-identified ethnic groups. Results: Mistrust and doubt were reported across ethnic groups. Many participants shared concerns about perceived lack of information about COVID-19 vaccine safety and efficacy. There were differences within each ethnic group, with factors such as occupation and perceived health status influencing intention to accept a vaccine once made available. Across ethnic groups, participants believed that public contact occupations, older adults and vulnerable groups should be prioritised for vaccination. Perceived risk, social influences, occupation, age, comorbidities and engagement with healthcare influenced participants’ intentions to accept vaccination once available. All Jewish FG participants intended to accept, while all Traveller FG participants indicated they probably would not.Facilitators to COVID-19 vaccine uptake across ethnic groups included: desire to return to normality and protect health and well-being;perceived higher risk of infection;evidence of vaccine safety and efficacy;vaccine availability and accessibility.COVID-19 information sources were influenced by social factors and included: friends and family;media and news outlets;research literature;and culture and religion. Participants across most different ethnic groups were concerned about misinformation or had negative attitudes towards the media. Conclusions: During vaccination rollout, including boosters, commissioners and providers should provide accurate information, authentic community outreach and use appropriate channels to disseminate information and counter misinformation. Adopting a context-specific approach to vaccine resources, interventions and policies and empowering communities has potential to increase trust in the programme.

8.
Clinical Nutrition ESPEN ; 48:481-482, 2022.
Article in English | EMBASE | ID: covidwho-2003942

ABSTRACT

Background: In the UK, 38% of people residing in care homes are estimated to be at high risk of malnutrition1 and it is known now that nutritional status can further be negatively affected by COVID-19 not only directly through medical complications but also social factors such as social isolation, staffing issues, increased anxiety and low mood2. Our aim is to evaluate the clinical and cost effectiveness of direct dietetic input (Rapid Access Dietetic Service) to care homes during the COVID-19 pandemic. Methods: During the first wave of the Covid-19 pandemic, a rapid access service to support care homes was set up, accepting referrals directly from the care home staff and offering a remote dietetic assessment within 1 week of referral. Patients at high risk of malnutrition / on ONS were followed up as part of a 12-week care pathway. The 12-week pathway consisted of initial and last telephone/video consultation by the dietitian and monthly telephone follow ups in between by the dietetic assistant. Care home staff were provided remote training on ‘Food First’ malnutrition management and ONS prescribing. Outcomes audited were MUST, clinical outcomes (number of falls, pressure sores, chest and UTI infections, hospital admissions, A&E attendance in the last 3 months) pre and after 12-week pathway. Cost benefit analyses were performed on both clinical outcomes and ONS changes. Service evaluation was done by requesting GP / care staff and community dietitians’ feedback. Results: 54 patients were referred by the care homes staff/GP, 24 of those because of medium/high risk of malnutrition, 30 referred for ONS review. Out of the patients who were medium/high risk (n = 24) and were onboarded onto the 12-week care pathway, the number of patients with MUST of 0 (low risk) increased 8-fold, patients with MUST of 1 (medium risk) increased 2.3 times and patients with MUST of 2 or above (high risk) declined by half after the 12-week care pathway. Cost benefit analysis on clinical outcomes showed combined estimated cost savings of £26,061 (Table 1). Out of the patients on ONS, 11 prescriptions were changed, 5 were stopped, 13 were continued resulting in a total ONS annualised savings of £12,753 / £425 per patient. The service was evaluated by the community dietitians, care staff and GPs and positive feedback was provided. [Formula presented] Discussion: Despite being an existing service, significant adaptations were made in order to continue providing care throughout the COVID-19 pandemic. All interactions and engagement with GPs and care home staff were conducted remotely in place of the usual in-person service. Despite this change, marked improvements in patient malnutrition status were seen during the 12-week care pathway. Cost benefit analysis show a combined annualised cost saving of £38,814 during the 6-month intervention from the ONS changes and clinical outcomes. This equates to an annualised cost saving of £77,628 and £718.7 per person referred. The service was highly valued by the care home staff, GPs and community dietitians as evidenced by the positive feedback received. Limitations include other possible factors may have influenced the results e.g. medications/other HCP involvement. Annualized savings for ONS changes and clinical outcomes were estimated based on savings achieved in the 6 months over the service was running. The cost of dietitian was not included as a pre-existing service was altered during the pandemic months prioritizing care homes. Conclusion: The new rapid access service for care homes resulted in residents being seen quickly and appropriately treated for malnutrition where identified. The service also resulted in significant cost savings for ONS prescriptions and avoidance of healthcare costs associated with malnutrition. Continuation of this new service model should be considered to reduce the incidence of malnutrition and effectively manage those identified as malnourished. References 1. Nutrition Screening Survey in care Homes in the UK: A report based on the amalgamated data from the four Nutrition Screening Week surveys undertaken by BAPEN in 2007, 2008, 2010 and 2011 C A Russell and M Elia on behalf of BAPEN and collaborators 2. Azzolino D, Saporiti E, Proietti M, Cesari M. Nutritional considerations in frail older patients with COVID-19. The journal of nutrition, health & aging. 2020 Jul;24:696-8. 3. National Schedule of Reference Costs 2017/2018 4. Dealey C, Posnett J, Walker A. The cost of pressure ulcers in the United Kingdom. J Wound Care. 2012 Jun;21(6):261-2, 264, 266. 5. British National Formulary – National Institute for Health and Care Excellence -

9.
Journal of Cystic Fibrosis ; 21:S129-S130, 2022.
Article in English | EMBASE | ID: covidwho-1996790

ABSTRACT

Background: Highly effective modulator therapy (HEMT) is now available for ∼90% of adults with CF with Kaftrio® licenced for use in the UK from August 2020. Despite continuation of routine CF treatments in randomised controlled trials, real-world evidence suggests a reduction in prescribed inhaled medication for people with CF on HEMT.1 Alongside the introduction of Kaftrio®, additional factors have impacted upon our inhaled medication prescribing practice including the COVID-19 pandemic and the introduction of CFHealthHub, which allows us to monitor nebulised treatment adherence. Objective: To examine how and to what extent our inhaled medication prescribing practice has changed over the past 5 years. Method: A retrospective audit of our prescribed inhaled medication databases from 2016, 2019 and 2021. Results: See table 1. Table 1. Number of CF patients prescribed inhaled mucolytics and long term inhaled therapy for Pa. (Table Presented) Conclusion: Despite an increasing rate of Pa infection,we have observed an overall reduction in prescribing of inhaled antibiotics and mucolytics. HEMTs, particularly Kaftrio®, have improved the health of our patients and, despite our caution, many have requested a reduction of inhaled therapy in line with their improved well-being. Assessment of adherence via CFHealthHub has often led to rationalisation of inhaled treatments in order to support improved adherence. During the COVID-19 pandemic, drug response assessments, the gateway to accessing a change in inhaled medication, have frequently been delayed as we have had to redesign our service in response to changing circumstances.

10.
Journal of Clinical Lipidology ; 16(3):e36, 2022.
Article in English | EMBASE | ID: covidwho-1996300

ABSTRACT

Lead Author's Financial Disclosures: Nothing to disclose. Study Funding: None. Background/Synopsis: Telehealth services have been implemented in many chronic conditions with the expectation to improve care for patients and has expanded greatly due to the COVID pandemic. Little is known about the impact that telehealth on the practice of lipidology. Objective/Purpose: To determine the current utilization of telehealth for lipid management and explore barriers and enablers to telehealth's future impact on the practice of lipidology. Methods: The PubMed database was searched from inception to June 25, 2021, to identify all relevant articles published utilizing telehealth for lipid management. This search returned 376 articles when using the following key words: "lipids or cholesterol" and "telehealth". Articles were included at screening if they mentioned telehealth and lipids. The definition of telehealth was refined during full-text screening as a synchronous visit between a patient and a clinician that replaced an in-office appointment. All other types of telehealth were excluded including those that only implemented mobile health technologies, remote monitoring, or call backs for return of laboratory results. Additionally, articles had to measure lipid levels. Article findings were synthesized into one of the following categories: 1) barriers to implementing and delivery of telemedicine visits, 2) facilitators to implementing and delivery of telemedicine visits, 3) clinician perspectives on telemedicine, or 4) mention future utility of telemedicine. Results: Of the 376 articles found, 128 s were included, and 79 articles were included after full text screening. The main reason for exclusion were not meeting the definition for telemedicine. Of the 81 articles, 18 were reviews, 31 were randomized clinical trials, 15 were pre-post evaluations, and 15 were categorized as other study designs. About half of the articles reported telehealth services for individuals with diabetes. Barriers reported include lack of evidence that supports telemedicine's impact or sustainability, technology cost, high appointment cancelation rates, and lack of reimbursement for clinicians. Enablers reported positive to no-negative impact on health outcomes, cost savings for health systems, and easier implementation of multidisciplinary approaches to care. Clinicians had mixed feelings on their ability to deliver clinical care, but report improved patient satisfaction. Future use of telemedicine included mentions of the need for new reimbursement structures, technology literacy programs, and revisions to current clinician licensing laws. Conclusions: Telemedicine use to provide care for individuals with lipid conditions has expanded during the COVID pandemic, but more research is needed to determine whether it is a sustainable model for lipid management.

11.
Heart Lung and Circulation ; 31:S167, 2022.
Article in English | EMBASE | ID: covidwho-1977298

ABSTRACT

Background: It is historically difficult to recruit trained cardiac sonographers within New Zealand (NZ) and internationally. In NZ, the Northern Region DHBs have significant and on-going workforce shortages. Auckland metro DHBs have consistently used vacant qualified FTE to employ trainees and support them to obtain cardiac sonographer qualifications. The first few months of training require intensive one-on-one supervision. This reduces throughput as the supervisor is removed from the workforce. We sought to investigate how a combined approach to training, in the initial 6 weeks, would impact on trainees, trainers, and departments in terms of throughput. Method: Auckland Metro DHBs worked together, with NRA support, to plan and prepare a 6-week introduction program for trainees. Each DHB took responsibility for preparing and providing teaching materials for a 2-week block and planned to undertake the hands-on training for that period. They recruited and started 1 trainee each, concurrently. Results: COVID lockdown prevented trainees leaving their home DHB. They attended presentations by Zoom and provided constructive and generally positive feedback. The time commitment for each DHB and impact on throughput was reduced. Relationships between the DHBs and the trainees was enhanced. Conclusion: It is workable and advantageous for regional DHBs to work collaboratively when recruiting and training cardiac sonographers. This leads to economical use of time and resource, develops collegial relationships, and support networks for the trainees. With new technology, the reach of the teaching sessions could be expanded to include participants outside the region.

12.
African Arts ; 55(2):1-+, 2022.
Article in English | Web of Science | ID: covidwho-1854564
13.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-336645

ABSTRACT

Viruses are microscopic pathogens capable of causing disease and are responsible for a range of human mortality and morbidity worldwide. They can be rendered harmless or destroyed with a range of antiviral chemical compounds. Cucurbit[n]urils (CB[n]s) are a macrocycle chemical compound existing as a range of homologues;due to their structure they can bind to biological materials, acting as supramolecular “hosts” to “guests”, such as amino acids. Due to the increasing need for a non-toxic antiviral compound, we investigated whether cucurbit[n]urils could act in an antiviral manner. We have found that certain cucurbit[n]uril homologues do indeed have an antiviral effect against a range of viruses, including RSV and SARS-CoV-2. In particular, we demonstrate that CB[7] is the active homologue of CB[n] mixtures, having an antiviral effect against enveloped and non-enveloped species. High levels of efficacy were observed with five-minute contact times across different viruses. We also demonstrate that CB[7] acts with an extracellular virucidal mode of action via host-guest supramolecular interactions between viral surface proteins and the CB[n] cavity, rather than via cell internalisation or a virustatic mechanism. This finding demonstrates that CB[7] acts as a supramolecular virucidal antiviral (a mechanism distinct from other current extracellular antivirals) demonstrating the potential of supramolecular interactions for future antiviral disinfectants.

14.
Journal of Heart and Lung Transplantation ; 41(4):S539-S539, 2022.
Article in English | Web of Science | ID: covidwho-1848796
15.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-335852

ABSTRACT

Viruses are microscopic pathogens capable of causing disease and are responsible for a range of human mortality and morbidity worldwide. They can be rendered harmless or destroyed with a range of antiviral chemical compounds. Cucurbit[n]urils (CB[n]s) are a macrocycle chemical compound existing as a range of homologues;due to their structure they can bind to biological materials, acting as supramolecular “hosts” to “guests”, such as amino acids. Due to the increasing need for a non-toxic antiviral compound, we investigated whether cucurbit[n]urils could act in an antiviral manner. We have found that certain cucurbit[n]uril homologues do indeed have an antiviral effect against a range of viruses, including RSV and SARS-CoV-2. In particular, we demonstrate that CB[7] is the active homologue of CB[n] mixtures, having an antiviral effect against enveloped and non-enveloped species. High levels of efficacy were observed with five-minute contact times across different viruses. We also demonstrate that CB[7] acts with an extracellular virucidal mode of action via host-guest supramolecular interactions between viral surface proteins and the CB[n] cavity, rather than via cell internalisation or a virustatic mechanism. This finding demonstrates that CB[7] acts as a supramolecular virucidal antiviral (a mechanism distinct from other current extracellular antivirals) demonstrating the potential of supramolecular interactions for future antiviral disinfectants.

17.
British Journal of Surgery ; 109(SUPPL 1):i8, 2022.
Article in English | EMBASE | ID: covidwho-1769192

ABSTRACT

Aim: The COVID-19 pandemic has caused unprecedented healthcare challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self contained Protected Elective Surgical Units (PESU) were developed to mitigate against infection related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of PESUs can result in significant reduction in risk. Method: A retrospective observational study of consecutive patients from 18 specialties, undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and PESU transmission rates. Results: Between 15th March 2020 and 14th March 2021, 9,925 patients underwent surgery, 6,464 (65.1%) elective, 5,116 (51.5%) female and median age 57 (39-70). 69.5% of all procedures were performed in PESUs. Overall, 30-day post-operative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective p<0.001). PESU post-operative transmission was significantly lower than non-PESU (0.42% vs 3.2% p<0.001), with an adjusted likely in-hospital PESU transmission of 0.04%. The 30-day all-cause mortality was 1.7%, and 14.6% in COVID-19 positive patients. COVID-19 infection, age >70, male gender, ASA >2 and emergency surgery were all independently associated with mortality. Conclusions: This study has demonstrated the value of PESUs in minimising COVID-19 viral transmission and associated mortality with additional relevance to protected elective services going forward (possibilities of reduced cancellations due to bed shortages and transmission of other nosocomial infections).

19.
Clinical nutrition ESPEN ; 48:481-482, 2022.
Article in English | EuropePMC | ID: covidwho-1755596
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