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2.
Surgical Practice ; 26(Supplement 1):23, 2022.
Article in English | EMBASE | ID: covidwho-2078282

ABSTRACT

Aim: Head and neck cancer surgeries often result in defects requiring reconstruction. When compared to free flaps, local flaps are associated with shorter operation time, which is preferred in patients with comorbidities and during COVID pandemic with local attrition of anesthetists. Submental flap has a theoretical risk of compromising oncological outcome in level I neck dissection. Alternatively, infrahyoid flap harvest is confined to the central compartment, which is a rare region for lymph node spread. To our knowledge, infrahyoid flap reconstruction has not been reported in Hong Kong. This study aims to evaluate the surgical outcome in patients underwent infrahyoid flap reconstruction at our unit. Method(s): 6 patients (median age 67) who had received infrahyoid flap reconstruction from May2018 to May2022 were retrieved. The primary lesion sites included tongue (4 patients), concomitant retromolar and buccal mucosa (1 patient) and submandibular region (1 patient). The blood supply, dimension of flap skin paddle, flap survival and complications were evaluated. Result(s): The dimension of flap skin paddle was 25 cm2 (range 20- 28). Blood supply was all via superior thyroid vessels. 100% flap survival was achieved in 5 out of 6 patients. Only one patient developed superficial skin necrosis which was treated conservatively. One patient had mild dehiscence of donor site. One patient suffered from disease recurrence and succumbed one year after operation. The other patients are alive up to today. Conclusion(s): In our experience, pedicled infrahyoid flap is a safe and reliable procedure for reconstruction of medium-sized defects after head and neck cancer surgeries.

3.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P127-P128, 2022.
Article in English | EMBASE | ID: covidwho-2064495

ABSTRACT

Introduction: Pediatric epistaxis is highly prevalent, yet patient characteristics, frequency of office cauterizations, and outcomes have been minimally described. This study examined the epidemiology and prevalence of epistaxis and potential impact by COVID-19. Method(s): A retrospective summary was performed on all patients (0-18 years) seen/treated for epistaxis by pediatric otolaryngologists within a single health care system across northeast and southeast United States between January 1, 2013, and October 31, 2021. Demographics, geographics, medical history, and office and operating room cauterization were reviewed. Data were analyzed using chi2 and logistic regression. Result(s): Of 9770 unique patients, with 26,699 epistaxis encounters, 62% were male. Median age at first encounter was 8.5 years;50% of patients were White. Encounters were most frequent during the fall (September-November) and least frequent during winter (December-February) with no significant differences. The incidence of epistaxis has significantly increased since the onset of the COVID-19 pandemic (P<.001). Overall, 27% received a procedural intervention, 54% required more than a single visit. Logistic regression revealed age, ethnicity, and geographical region as independent predictors of receiving a procedure on the first encounter, with a model receiver-operating characteristic (ROC) curve with area=0.75 (95% CI, 0.73-0.76). Similarly, procedural intervention, history of allergies, and nasal steroid use were independent predictors of recurrent visits, with a model ROC curve with area=0.79 (95% CI, 0.78-0.80). Conclusion(s): The incidence of pediatric epistaxis is not significantly correlated with seasonality. However, there has been a significant increase in epistaxis encounters during the COVID-19 pandemic. Recurrent visits for pediatric epistaxis were significantly predicted by procedural intervention, allergies, and nasal steroid use.

4.
British Journal of Surgery ; 109:vi39, 2022.
Article in English | EMBASE | ID: covidwho-2042542

ABSTRACT

Aim: We conducted a trainee survey at the first peak of the pandemic to investigate the impact of COVID-19 on the North of Scotland (NoS) and East of Scotland (EoS) orthopaedic trainees. Method: An online survey was distributed to all NoS and EoS orthopaedic trainees. All data collection was anonymous. Results: Across both Scottish deaneries, 28 trainees had responded: 39% from EoS and 61% from NoS. Trainees at all stages of training responded to the survey, with the most responses received from specialist trainees in third year of training (ST3) (25%). In response to the pandemic, 18% of trainees had been redeployed and they were from NoS. Since the reconfiguration of service, 18% of trainees had done >20 operations in a month and they were senior trainees. If COVID-19 outbreak is likely going to reduce operating opportunities for a long period, only 36% of trainees would be open to the idea of making standard surgical specialty training longer whereas 57% of trainees would be open to longer working hours to achieve certification in Trauma and Orthopaedic surgery within 96 months. Conclusion: The outbreak of COVID-19 has impacted both deaneries orthopaedic training and urgent restoration of surgical training is essential for individual trainees. Changes in working practices necessitated by COVID-19 have known to impact theatre efficiency. Actions should be taken to improve the theatre efficiency while prioritizing training opportunities.

5.
British Journal of Surgery ; 109:vi39, 2022.
Article in English | EMBASE | ID: covidwho-2042541

ABSTRACT

Aim: To determine the orthopaedic trauma theatre efficiency in two large major trauma centres (MTCs) in Scotland before and after the outbreak of Coronavirus disease (COVID-19) pandemic. Method: All trauma patients presented to the North and East of Scotland's MTCs prior to the outbreak of COVID-19 (7th May to 7th June 2019), during the first peak of COVID-19 (7th May to 7th June 2020), after Aerosol Generating Procedures updates (7th November to 7th December 2020) and the 'new normal' (7th May to 7th June 2021) were retrospectively reviewed. Training opportunities and theatre time were compared. The Kruskall-Wallis test was used. Results: There were no significant differences in the length of hospital stay (p=0.117, 0.065) and time from injuries and surgery within groups in both MTCs (p=0.508, 0.384). The pandemic has negatively affected the anaesthetic and surgical preparation time, time between end of procedure and send for next case, and turnover time, with more profound effect on the North of Scotland's MTC. The trainee's involvement as main surgeon had decreased with the outbreak of the pandemic, with the junior trainees being affected most severely in North of Scotland. The time taken for patient to arrive to theatre after sending and total downtime were twice as long in the North of Scotland. Conclusion: The COVID-19 pandemic has negatively impacted the orthopaedic trauma theatre efficiency and training opportunities. Actions should be taken to improve the turnover time to maximise theatre efficiency while prioritizing training opportunities.

6.
Trials ; 23(1), 2022.
Article in English | EuropePMC | ID: covidwho-2034045

ABSTRACT

Introduction At present, vaccines form the only mode of prophylaxis against COVID-19. The time needed to achieve mass global vaccination and the emergence of new variants warrants continued research into other COVID-19 prevention strategies. The severity of COVID-19 infection is thought to be associated with the initial viral load, and for infection to occur, viruses including SARS-CoV-2 must first penetrate the respiratory mucus and attach to the host cell surface receptors. Carrageenan, a sulphated polysaccharide extracted from red edible seaweed, has shown efficacy against a wide range of viruses in clinical trials through the prevention of viral entry into respiratory host cells. Carrageenan has also demonstrated in vitro activity against SARS-CoV-2. Methods and analysis A single-centre, randomised, double-blinded, placebo-controlled phase III trial was designed. Participants randomised in a 1:1 allocation to either the treatment arm, verum Coldamaris plus (1.2 mg iota-carrageenan (Carragelose®), 0.4 mg kappa-carrageenan, 0.5% sodium chloride and purified water), or placebo arm, Coldamaris sine (0.5% sodium chloride) spray applied daily to their nose and throat for 8 weeks, while completing a daily symptom tracker questionnaire for a total of 10 weeks. Primary outcome Acquisition of COVID-19 infection as confirmed by a positive PCR swab taken at symptom onset or seroconversion during the study. Secondary outcomes include symptom type, severity and duration, subsequent familial/household COVID-19 infection and infection with non-COVID-19 upper respiratory tract infections. A within-trial economic evaluation will be undertaken, with effects expressed as quality-adjusted life years. Discussion This is a single-centre, phase III, double-blind, randomised placebo-controlled clinical trial to assess whether carrageenan nasal and throat spray reduces the risk of development and severity of COVID-19. If proven effective, the self-administered prophylactic spray would have wider utility for key workers and the general population. Trial registration NCT04590365;ClinicalTrials.gov NCT04590365. Registered on 19 October 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06685-z.

7.
25th International Conference on Miniaturized Systems for Chemistry and Life Sciences, MicroTAS 2021 ; : 151-152, 2021.
Article in English | Scopus | ID: covidwho-2012630

ABSTRACT

We present a nucleic acid-based point-of-care diagnostic for the detection of the SARS-CoV-2 from saliva using an additively manufactured microfluidic cartridge. The assay uses reverse transcriptase loop-mediated isothermal amplification (RT-LAMP) to detect the presence of SARS-CoV-2 RNA on-cartridge in a point-of-care optical detection system based on a smartphone. We show positive results within the 10-30 minutes range and integrated biological controls on the cartridge. We demonstrate the microfluidic diagnostic with human patient samples, with results that are consistent with the off-cartridge validation. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

8.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927826

ABSTRACT

Introduction: Encephalopathy in a transplant recipient is a challenging clinical presentation that requires a broad differential (both infectious and noninfectious) and consideration of exposures. West Nile Virus (WNV) encephalitis is a rare etiology of encephalopathy in a transplant recipient with controversial management. Case: A man in his seventies presented due to encephalopathy in September 2021. Medical history was significant for deceased donor kidney transplant in September 2020 and myasthenia gravis. Immunosuppression consisted of tacrolimus, mycophenolic acid, and prednisone 10 mg daily. He was on fluconazole for coccidioidomycosis prophylaxis. Symptoms consisted of worsening weakness over five days and headaches for two days. On admission, he was febrile to 38.1° C and had altered mental status. He was started on empiric meningitis treatment with ampicillin, vancomycin, cefepime, and acyclovir, and was given doxycycline for atypical coverage. He developed worsening encephalopathy and was intubated for airway protection. CSF profile revealed 255/mm3 WBC (77% neutrophils, 20% lymphocytes, 3% monocytes), 45/mm3 RBC, 61 glucose mg/dL (serum 126 mg/dL), and 96.1 mg/dL protein. Exposure history was significant for visiting family in central Arizona several weeks prior to presentation where he was exposed to mosquitos and two cats. He ate at a fast-food restaurant two days prior to presentation. He received three doses of COVID-19 vaccine. He was born and raised in Arizona and has remote travel to Mexico. Extensive studies (considering the risk factors above) identified the etiology of his encephalopathy as WNV encephalitis with positive serum PCR, elevated serum and CSF IgM with normal IgG. Unfortunately, the patient expired despite aggressive therapy. Discussion: This case represents three interesting challenges that we feel will be of interest to the conference attendees. The first is encephalopathy in a transplant recipient within one year of transplant requires a broad differential including donor-derived infections, opportunistic organisms that can cause meningoencephalitis, as well as knowledge of local and seasonal pathogens on the rise. With the monsoon season in 2021, Arizona rose to become one of the top ten states in the country with WNV cases. The second is management of a critically ill patient with meningitis and myasthenia gravis, since multiple agents for empiric therapy have been associated with worsening of or precipitating myasthenic crisis. Finally, supportive care is the mainstay of the management of WNV encephalitis and IVIG and adjustments in immunosuppression is controversial.

9.
Journal of Mens Health ; 18(4):7, 2022.
Article in English | Web of Science | ID: covidwho-1887428

ABSTRACT

Background: Quarantine, social distancing, and restricted movement and social interaction due to the eoronavinis disease (COVID-19) have been reported reduce physical activity across several countries. However, few studies have evaluated the changes in physical activity patterns before and after COVID-19 among people with disabilities. Therefore, this study aimed to evaluate how physical activity participation has changed during COVID-19 among people with disabilities in South Korea. Methods: This study was conducted among 3871 persons with disabilities, aged 10-69 years, who participated in the 2020 Sports Survey for the Disabled conducted by the Korean Ministry of Culture, Sports and Tourism in March 2020. This survey collected data regarding participants' demographic characteristics (age, gender, etc.) and disability along with the type of physical activity (intensity, frequency, time, etc.), method (facilities, home training, classes/lectures, club), and type (swimming, resistance training, walking and jogging, etc.) of participation in physical activity before and after COVID-19. A chi-squared frequency test was performed to confirm the difference in the ratio of participation frequency, time, intensity, and method and type of physical activity before and after COVID-19. Results: After the COVID-19 outbreak, the frequency, duration, and intensity of physical activity of people with disabilities were reduced compared to before the COVID-19 pandemic. Additionally, in terms of physical activity participation method, attendance of classes, lectures, and clubs decreased, while physical activity at home increased. In participation types of physical activity, participation in walking and jogging, gymnastics, mountain climbing, and cycling increased, whereas swimming, weight training, and other activities decreased. Conclusion: Public health guidelines and social distancing due to COVID-19 have reduced the frequency, duration, and intensity of physical activity, while changing the types and methods of participation in physical activity for people with disabilities. Therefore, public health support to promote adherence to physical activity should be needed.

10.
IEEE Region 10 Conference (TENCON) ; : 429-434, 2021.
Article in English | English Web of Science | ID: covidwho-1883150

ABSTRACT

COVID-19, particularly vaccines, have caused an 'infodemic' online;a rapid and vast spread of unreliable information. While vaccines can minimize the detrimental effects of COVID-19, misinformation, fearmongering, and 'anti-vax' movements have fostered opposition which is especially prevalent on Twitter. Understanding public emotions related to vaccines is an important, yet inconsistent, area of research. To resolve some of the inconsistencies in the field, we develop and apply two integrated emotion detection models to a longitudinal sample of COVID-19 vaccine related tweets (n = 823,748). Contrary to prior research, which concluded that positive emotions are the most dominant emotion (e.g., trust and happiness), the balanced emotion model (consisting of eight emotions) shows that fear (41%) is the most dominant emotion. The extended emotion model (consisting of sixteen emotions) shows various negative emotions such as panic (27%), fear (22%), and shame (37%) as the dominant emotions in the tweet hashtag groups such as COVID-19, Vaccine, and Anti-vaxxers.

11.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880574
12.
Diabetic Medicine ; 39(SUPPL 1):108-109, 2022.
Article in English | EMBASE | ID: covidwho-1868616

ABSTRACT

Aims: At a North London hospital which lacked remote blood glucose monitoring, we sought to introduce a system that automatically alerted the Diabetes Team of inpatients with deranged blood glucose (BG) measurements. We hypothesised that this would streamline the team's workflow, and improve glycaemic control in inpatients. Methods: We developed a feature that used data from recently deployed e-vitals software to generate daily reports containing lists of inpatients who had experienced hypo-or substantial hyper-glycaemia ( < 4 or >20mmol/L) within the previous 24h. These reports were automatically sent each morning to the Diabetes Team. Results: Feedback from specialist nurses suggested improvement in the efficiency of their patient identification workflow, which previously had principally involved taking phone referrals and manually searching ward lists. Initial post-intervention data did not suggest improvement in hospital-wide deranged BG rates, however this was confounded by a sharp rise in covid-19 admissions shortly after deployment, with the majority receiving corticosteroids. After several months of use, the feature unexpectedly failed for approximately six weeks, during which time on average significantly more daily hypoglycaemic episodes occurred vs the preceding six-week period (two-sided rank sum, p < 0.001), with rates returning to baseline after it was reintroduced. Conclusions: Our intervention aided staff workflows and possibly improved inpatient glycaemic control, although worsening glycaemic control outcomes upon intervention withdrawal cannot reliably be extrapolated to infer overall benefit of the feature vs pre-intervention standard-of- care. Financial barriers often preclude deployment of gold-standard digital systems in healthcare;innovative exploitation of data generated by more affordable systems can improve productivity and patient care without additional cost.

13.
Endocrine Practice ; 27(6):S105-S106, 2021.
Article in English | EMBASE | ID: covidwho-1859544

ABSTRACT

Introduction: Hypercalcemia is a common clinical diagnosis. Hyperparathyroidism is one of the most common etiologies. Rarely hypercalcemia is associated with intense inflammation secondary to IL-6 production. Herein we present an interesting case of hypercalcemia associated with COVID-19. Case Description: 36-year-old woman with history of Cirrhosis secondary to hepatitis C and alcohol abuse initially admitted for COVID/ARDS and cryptococcemia without CNS involvement. She was initially treated with amphotericin B and continued on fluconazole. Patient was re-admitted after 2 weeks with abdominal pain, constipation and hypercalcemia (Ca 14.2 mg/dl (normal range 8.7-10.1mg/dl). Her ionized calcium was 1.78 mmol/L (normal range 1.12-1.32 mmol/L). Serum phosphorus was 2.5 mg/dl (normal range 2.5-4.5mg/dl). Intact PTH level was 6.7 pg/ml (normal range 6-48pg/ml). Vitamin D 25-OH level was 26.8 ng/ml (sufficient range 32-100 ng/ml);Vitamin D 1,25-OH level was 7.4 pg/ml (normal 19.9-79.3pg/ml). PTH-rp was unmeasurable (< 2pmol/l). CRP was elevated at 31.7mg/L (normal range 0.2-8 mg/L). She was not on calcium, Vitamin D supplementation or thiazide diuretics. Her renal functions were normal. She was given Intravenous fluids & Intravenous pamidronate. Steroids were not used due to an ongoing fungal infection. It was proposed that the patient had Interleukin-induced hypercalcemia secondary to COVID-19 infection. Her serum calcium normalized with improvement in clinical status Discussion: Recent literature suggests COVID-19 is associated with inflammatory response with cytokines & interleukins production. IL-6 production is significantly upregulated especially in severe cases of COVID-19 known as “Cytokine storm”. IL-6 is produced by bronchial epithelial cells. High levels of IL-6 are associated with worse outcomes and much more severe disease. IL-6 in turn causes osteoclast activation, bone resorption & hypercalcemia. In our patient other potential causes of hypercalcemia were ruled out. The proposed mechanism of her hypercalcemia is an intense inflammatory response associated with COVID-19 infection. Conclusion: We present a rare sequelae of COVID-19 infection which presents a teaching point for clinicians to consider while managing such novel disease

14.
Team Performance Management ; : 16, 2022.
Article in English | Web of Science | ID: covidwho-1853405

ABSTRACT

Purpose Organizations worldwide use virtual teams to cope with the COVID-19 pandemic and capitalize on distributed members' unique expertise to accomplish essential tasks. A critical reason that inhibits virtual team members from leveraging each other's knowledge is a lack of psychological safety. Specifically, individuals are unwilling to speak out for fear of negative repercussions, such as embarrassment to one's image and rejection from others in their teams. The purpose of this study is to advance the importance of distinct awareness (task knowledge and presence) enabled by information technologies in developing the psychological safety of men and women in virtual teams. Design/methodology/approach This study tested the hypotheses using a survey study of 94 participants from 19 graduate student virtual teams. Findings This study found that task knowledge awareness predicted psychological safety for men, whereas it was presence awareness for women. By demonstrating the role of awareness in promoting psychological safety for men and women in virtual teams, this study also sheds light on reducing online gender inequitable issues. Practical implications First, organizational managers need to incorporate gender when deciding the awareness type to promote psychological safety in virtual teams. For men, it is task knowledge awareness, whereas for women, it is presence awareness. Second, as there is a wide range of information technologies (ITs) available, managers need to identify if the provided ITs enable virtual team members to develop the specific type of knowledge awareness critical for psychological safety development. Third, managers can incorporate rewards and apply interventions at regular temporal periods to encourage team members to increase their online presence as well as question and share task-related content. Originality/value It is imperative to identify ways to encourage men and women working in virtual teams to speak up so that the expertise held by the members can be better leveraged. This study represents an important step in this direction.

15.
Cardiology in the Young ; 32(SUPPL 1):S16, 2022.
Article in English | EMBASE | ID: covidwho-1852341

ABSTRACT

Introduction: COVID-19 prevent expectant parents of babies with congenital heart disease (CHD) from visiting cardiac surgical units prior to the birth of their baby who may be separated early for treatment. Pre-recorded video-clips or telephony consultation are generic and cannot deliver individual needs, especially in complex care pathways. We demonstrate our pilot experience using HoloLens 2 (Microsoft, Washington, USA) to deliver bespoke one-to-one virtual tour of the hospital and acute cardiac service environment. Methods: Families with antenatal diagnosis of significant CHD were offered the virtual tour in their third trimester. Parents and Fetal Nurse Specialists communicate via Microsoft Teams (Microsoft 365, Washington, USA) on portable electronic devices. HoloLens was deployed by the Nurse Specialists to provide oneto- one audio-visual experience, with opportunity to interact and raise questions. All parents participated remotely from the hospital site. The first 5 sets of parents had company of a second Nurse Specialist during the tour, in case of adverse psychological reaction. Due to zero negative event, the presence of the 2nd Nurse was optional subsequently. All were asked to complete a questionnaire. Results: Over the 3-month period, 25 sets of parents participated in the quality improvement survey. Respond rate was 96%. 85% said the virtual visit met or exceeded their expectations for preparedness, 80% said they liked that it allows them to 'visit' the hospital without physical attendance and associated costs of childcare/leave from work/travel time, 80% said it is a great use of technology, 70% liked that they were able to interact with the nurse specialist during the visit, 80% would recommend a virtual visit to other families and only 10% said they would have preferred to visit the hospital in person. Conclusions: The innovative use of HoloLens in cardiac fetal services is proven useful for the family, enabling preparedness for the arrival and early separation of their babies. Its deployment met the needs to continue high quality service in critical time. Whilst not intended to replace physical consultation;however, this technology proves to be an effective option for parents once the pandemic has passed.

16.
Learning Organization ; : 20, 2022.
Article in English | Web of Science | ID: covidwho-1799379

ABSTRACT

Purpose This study investigates the processes that the US universities and colleges used to learn during the COVID-19 pandemic and the factors that facilitated and impeded their learning processes. Design/methodology/approach To address this study's research questions, this study used a crisis communication and learning lens to interview crisis response team members from 30 US higher education institutions in May 2020 (the first pandemic semester). In October 2020 (the second pandemic semester), this study conducted follow-up interviews with 25 of the original interviewees. Overall, this study conducted 55 interviews. Findings Learning during the COVID-19 pandemic is facilitated by a recognition of a serious deficiency in the current system and impeded by the need to act quickly. The findings demonstrate the process by which decisions, actions and strategies emerged during crises. Originality/value This investigation illustrates how crises can prompt organizational learning while demonstrating the critical role of internal and external resources in the learning process.

17.
Journal of Health and Social Sciences ; 6(4):556-565, 2021.
Article in English | Scopus | ID: covidwho-1789780

ABSTRACT

Introduction: The role of social responsibility has been used to underpin the implementation of rapidly changing non-pharmaceutical interventions (NPIs) to slow COVID-19 community transmission. Methods: To explore public awareness of COVID-19 and social responsibility in a pandemic, we conducted eight mobile app-based online focus group discussions (FGDs) with participants in Singapore between 28 March and 13 April 2020. Results: Findings from our online FGDs indicate that social responsibility, especially during the early stages of COVID-19, was influenced by external factors such as appropriate legislation and allowances in existing societal culture, as well as action-based factors including mask wearing and safe distancing. Both were further mitigated by individual factors that mediated an individual’s capacity and capability to comply with rapidly changing legislation during a pandemic. Conclusion: While similar NPIs have been imposed globally, considerable between-country differences remain in health outcomes and adherence rates, displaying the complex nature of social responsibility. Evol-ving the role of social responsibility should be accompanied by expanding social norms and less reliance on punitive approaches. Copyright © 2021 Jane Lim et al. Edizioni FS Publishers.

18.
Open Forum Infectious Diseases ; 8(SUPPL 1):S139, 2021.
Article in English | EMBASE | ID: covidwho-1746748

ABSTRACT

Background. In early months of COVID-19 pandemic, SGH recorded a year-on-year increase in antibiotic (ABx) use for community acquired acute respiratory infection (CA ARI) from Feb-Apr 2019 (48.7 defined daily doses (DDD)/100 bed-days) to 2020 (50.8 DDD/100 bed-days). To address concerns of misuse, the antibiotic stewardship unit (ASU) expanded prospective audit feedback (PAF) to CA ARI patients admitted to ARI wards, with low procalcitonin (PCT). PAF was conducted on day 2-3 of ABx, on weekdays. Doctors received feedback to stop/ modify when ABx was deemed inappropriate. Here, we describe the impact of ASU's adaptive approach to curb rising ABx use in patients admitted for ARI during COVID-19 pandemic. Methods. A Pre- & Post-intervention study was conducted. All patients started on ABx (ceftriaxone/co-amoxiclav/piptazo/carbapenems/levofloxacin) for CA ARI & PCT < 0.5μg/L were analysed. Those who died ≤48h of admission;admitted to intensive care;required ABx escalation;>1 infective sites;complex lung infection were excluded. Primary objective was to compare the proportion of ABx stopped ≤4 days (time to final infection diagnosis) Pre (22/3-18/4/20) & Post (21/4-13/7/20). Results. 184 (Pre) & 528 (Post) ABx courses were analysed. ASU audited 51 (Pre) & 380 (Post) courses with the rest discontinued/discharged before review. Patients were largely similar in both periods;a third had low likelihood of bacterial infection (C reactive protein < 30mg/L). In Post, 73 feedback was given to stop ABx (often because symptoms suggested viral/fluid overload) & 18 to switch to oral ABx. 82 (90%) feedback was accepted. No ABx was restarted ≤48h or deaths ≤30 days due to ARI. 1 patient had C. difficile diarrhoea a day after ABx cessation as per ASU feedback. Proportion of all ABx stopped ≤4 days was higher in Post than Pre [27/184 (15%) vs 152/528 (29%), p< 0.01]. Median duration of therapy of IV ABx was reduced (6.5 vs 3 days, p< 0.01), with corresponding shorter median length of stay (10.5 vs 6 days, p< 0.01). Conclusion. PAF directly and indirectly reduced ABx duration in patients treated for CA ARI as prescribers become more conscious about stopping ABx when investigations show low likelihood of bacterial infection. ASU must remain agile during pandemics to detect emerging problems and adapt processes to counter early.

19.
Pediatric Infection and Vaccine ; 28(3):173-180, 2021.
Article in English | Scopus | ID: covidwho-1744576

ABSTRACT

After initial reports of multisystem inflammatory syndrome in children (MIS-C) in April 2020 in Europe, this disease has been known to occur in children with recent history of coronavirus disease 2019 (COVID-19) and most cases have been reported in Europe and the Unites States of America. We report a case of a 14-year-old girl who was diagnosed with MIS-C with acute myocarditis and successfully treated with intravenous immunoglobulin (IVIG), methylprednisolone, and anakinra. At initial presentation, she had persistent high fever, generalized rash, generalized swelling, abdominal pain, and low blood pressure. She showed a remarkably elevated level of inflammation and cardiac enzyme markers and had a previous history of COVID-19 5 weeks before the initial presentation. After extensive work up, other infectious and non-infectious causes were excluded. She was diagnosed with MIS-C and initially treated with IVIG and high-dose methylprednisolone;however, despite treatment, her heart function deteriorated and coronary artery dilatation progressed. Therefore, anakinra, an interleukin-1 receptor antagonist, was administered on hospital day 6, after which her cardiac function exhibited improvement. She was discharged on hospital day 19 without any symptoms, and follow-up echocardiography after 1 month revealed fully recovered heart function with normal coronary arteries. © 2021 The Korean Society of Pediatric Infectious Diseases.

20.
Safety and Health at Work ; 13:S213-S214, 2022.
Article in English | EMBASE | ID: covidwho-1677142

ABSTRACT

Introduction: We aim to explore the association between seasonal influenza vaccine behavior (from 2018 Southern Hemisphere to 2020/2021 Northern Hemisphere influenza seasons) and COVID-19 vaccine uptake among healthcare workers. Material and Methods: This study used electronic vaccination records of staff who have worked in a tertiary hospital for at least 3 years. Multivariable logistic regression was used to predict early adopters of COVID-19 vaccine (receive the vaccine within the first month of vaccine roll-out). We used Cox proportional hazards models to estimate hazard ratios (HRs) for the probability of COVID-19 vaccine uptake at 260 days (from 30 Dec 2020 to 15 Sept 2021). Results: Of the 6121 staff, 81% were females, 39% were nurses, 84% had at least three past influenza vaccines and 12% had one to two past influenza vaccines. The COVID-19 vaccine uptake was 96%. Staff who had >=3 influenza vaccines (OR 3.3, 95%CI 2.6-4.1) and staff who had 1-2 influenza vaccines (OR 1.4, 95%CI 1.1-1.9), had higher odds of COVID-19 vaccine uptake in the first month of vaccine roll-out compared to those who did not receive any, after adjustment for age, gender, years working in hospital and healthcare groups. At 260 days, HRs for COVID-19 vaccine uptake among staff who received >=3 past doses of influenza vaccines and staff who received 1-2 doses of influenza vaccines, compared to those without, were 2.0 (95%CI 1.7-2.3) and 1.3 (95%CI 1.1-1.5) respectively. Conclusion: Seasonal influenza vaccine uptake is a strong predictor of COVID-19 vaccine adoption and should be promoted even when there is no epidemic.

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