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1.
Journal of Hepatology ; 77:S551, 2022.
Article in English | EMBASE | ID: covidwho-1996642

ABSTRACT

Background and aims: Hepatitis C virus (HCV) infection is a major global health problem in adults & children. The recent efficacy of Direct Acting Anti-viral therapy (DAA) has cure rates of 99% in adults and adolescents. These drugs were licensed for children 3–12 yrs during the recent coronavirus pandemic. To ensure equitable access, safe & convenient supply during lockdown, we established a virtual national treatment pathway for children with HCV in England & evaluated its feasibility, efficacy & treatment outcomes. Method: A paediatric Multidisciplinary Team Operational Delivery Network (pMDT ODN), supported by NHS England (NHSE), was established with relevant paediatric specialists to provide a single point of contact for referrals & information. Referral & treatment protocolswere agreed for HCV therapy approved byMHRA& EMA. On referral the pMDT ODN agreed the most appropriate DAA therapy based on clinical presentation & patient preferences, including ability to swallow tablets. Treatment was prescribed in association with the local paediatrician & pharmacist, without the need for children & families to travel to national centres. All children were eligible for NHS funded therapy;referral centres were approved by the pMDT ODN to dispense medication;funding was reimbursed via a national NHSE agreement. Demographic & clinical data, treatment outcomes & SVR 12 were collected. Feedback on feasibility & satisfaction on the pathway was sought from referrers. Results: In the first 6 months, 34 childrenwere referred;30- England;4-Wales;median (range) age 10 (3.9–14.5) yrs;15M;19F: Most were genotype type 1 (17) & 3 (12);2 (1);4 (4). Co-morbidities included: obesity (2);cardiac anomaly (1);Cystic Fibrosis (1);Juvenile Arthritis (1). No child had cirrhosis. DAA therapy prescribed: Harvoni (21);Epclusa (11);Maviret (2). 27/34 could swallow tablets;3/7 received training to swallowtablets;4/7 are awaiting release of granules.11/27 have completed treatment and cleared virus;of these 7/11 to date achieved SVR 12. 30 children requiring DAA granule formulation are awaiting referral and treatment. Referrers found the virtual process easy to access, valuing opportunity to discuss their patient’s therapy with the MDT & many found it educational. There were difficulties in providing the medication through the local pharmacy. However there are manufacturing delays in providing granule formulations because suppliers focused on treatments for COVID, leading to delays in referring and treating children unable to swallow tablets. Conclusion: The National HCV pMDT ODN delivers high quality treatment & equity of access for children & young people, 3–18 yrs with HCV in England, ensuring they receive care close to home with 100% cure rates.

3.
Journal of Retailing and Consumer Services ; 66:102897, 2022.
Article in English | ScienceDirect | ID: covidwho-1611888

ABSTRACT

This study uncovers the impact of combined dark triad personality traits, firm's power, and customer demographic characteristics. It uses a sample of 263 restaurant customers. The findings include customer configurations indicating misbehavior and non-misbehavior cases. From a theoretical perspective, the study questions the philosophy of customer sovereignty and applies asymmetric case-based modeling to identify configurations indicating misbehavior customers and non-misbehavior customers. Strategy implications: from a managerial perspective and to tackle misbehavior, firms should use coercive power (e.g., suing customers who misbehave), reward power (e.g., recognition and flattery when customers behave properly), and referent power (e.g., enforcing customers' affective attachment).

4.
Geographical Journal ; : 19, 2021.
Article in English | Web of Science | ID: covidwho-1550822

ABSTRACT

Much effort has been expended on measuring deprivation in neighbourhoods across the UK and elsewhere. However, there has been only a relatively limited concern with deprivation histories of areas. This paper takes as its focus Belfast in Northern Ireland and it capitalises on rich data sources on deprivation generally and unemployment specifically. The study makes use of data on multiple time points - the Census from 1971 to 2011, multiple deprivation measures for 2005, 2010, and 2017, and benefits claimant count data for 2020. The paper explores the changing geography of deprivation and unemployment, identifying areas with persistently high deprivation and unemployment across time and across measures. It is argued that trajectories are important, particularly in terms of targeting resources. The final section of the analysis uses claimant count data to assess changing unemployment rates following the outbreak of the COVID-19 pandemic and it shows that changes in these rates are strongly related to long-term deprivation and unemployment patterns.

5.
British Journal of Surgery ; 108(SUPPL 5):V11-V12, 2021.
Article in English | EMBASE | ID: covidwho-1408570

ABSTRACT

Introduction: During the COVID-19 pandemic, Major Trauma services were subject to significant challenges including reduced access to Computed Tomography (CT) scanning and restrictions on operative intervention due to limited intensive care beds. This study evaluated the pandemic's impact on access and timeliness of imaging and surgical intervention Method: This observational study compared 2 cohorts of patients admitted in a 10-week period during the COVID-19 pandemic and a similar time period in 2019. Variables included demographics, time to CT scan and to surgery and operative characteristics. Statistical comparisons were undertaken using Mann Whitney U, Fisher's exact and Chisquared tests Result: Of 642 patients, 405 were admitted in 2019 and 237 in 2020 representing a 41.5% absolute reduction in trauma admissions during the pandemic. There were no statistical differences (P=0.2585) between arrival to the Emergency Department and time to CT scan across both years (median 42 minutes) or between operative approach (P=0.728) and level of post-operative care (P=0.788). However, there were statistical differences in time to surgery (P=0.0193) and operative length (P=0.0141) with a 2-fold increase in overnight operating, 31.2% increase in patients operated on<24 hours from admission, and 42.9% reduction in surgery lasting >120 minutes during the COVID-19 pandemic Conclusion: Early robust restructuring of trauma services during the COVID-19 pandemic ensured timely access to appropriate imaging and surgery for major trauma injured patients. The higher rates of overnight surgery and shorter duration of procedure were likely explained by the increased onsite availability of suitably trained trauma surgical teams Take-home Message: COVID-19 had the potential to significantly impact Major Trauma services, however excellence in patient care was maintained by quick restructuring to staff, space and services Improvements to the Major Trauma pathway have become ingrained into daily practice and optimised for future outbreaks .

6.
Anaesthesia ; 76:102-102, 2021.
Article in English | Web of Science | ID: covidwho-1312123
7.
Langenbecks Arch Surg ; 406(7): 2469-2477, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1269148

ABSTRACT

PURPOSE: Globally planned surgical procedures have been deferred during the current COVID-19 pandemic. The study aimed to report the outcomes of planned urgent and cancer cases during the current pandemic using a multi-disciplinary prioritisation group. METHODS: A prospective cohort study of patients having urgent or cancer surgery at a NHS Trust from 1st March to 30th April 2020 who had been prioritised by a multi-disciplinary COVID Surgery group. Rates of post-operative PCR positive and suspected COVID-19 infections within 30 days, 30-day mortality and any death related to COVID-19 are reported. RESULTS: Overall 597 patients underwent surgery with a median age of 65 years (interquartile range (IQR) 54-74 years). Of these, 86.1% (514/597) had a current cancer diagnosis. During the period, 60.8% (363/597) of patients had surgery at the NHS Trust whilst 39.2% (234/597) had surgery at Independent Sector hospitals. The incidence of COVID-19 in the East Midlands was 193.7 per 100,000 population during the study period. In the 30 days following surgery, 1.3% (8/597) of patients tested positive for COVID-19 with all cases at the NHS site. Overall 30-day mortality was 0.7% (4/597). Following a PCR positive COVID-19 diagnosis, mortality was 25.0% (2/8). Including both PCR positive and suspected cases, 3.0% (18/597) developed COVID-19 infection with 1.3% at the independent site compared to 4.1% at the NHS Trust (p=0.047). CONCLUSIONS: Rates of COVID-19 infection in the post-operative period were low especially in the Independent Sector site. Mortality following a post-operative diagnosis of COVID-19 was high.


Subject(s)
COVID-19 , Pandemics , Aged , COVID-19 Testing , Humans , Middle Aged , Prospective Studies , SARS-CoV-2
8.
British Journal of Surgery ; 108(SUPPL 2):ii30, 2021.
Article in English | EMBASE | ID: covidwho-1254493

ABSTRACT

Introduction: Anecdotal evidence suggest a direct impact of the SARSCOV- 2-pandemic on presentation and severity of major trauma. Method: This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020 to 18/05/2020) to a historical cohort admitted during a similar time period in 2019 (11/03/2019 to 20/05/ 2019). Demographic differences, injury method and severity were compared using Fisher's and Chi-squared tests. Multivariable logistic regression examined the associated factors predicting 30-day mortality. Results: Of 642 patients, 405 and 237 were in the 2019 and 2020 cohorts respectively. 1.69%(4/237) of the 2020 cohort tested SARS-CoV-2 positive. There was a 41.5% decrease in trauma admissions in 2020. The 2020 cohort was older (median 46 vs.40 years), more comorbid and frailer (p<0.0015). There was a significant difference in injury method with a decrease in vehicle related trauma, but an increase in falls. There was a 2-fold increased risk ofmortality in the 2020 cohort that in adjustedmodels, was explained by higher injury severity and frailty. Positive SARS-CoV-2 status was not associated with increasedmortality onmultivariable analysis. Conclusions: Patients admitted during the SARS-CoV-2-pandemic were older, frailer, more co-morbid and had an increased risk of mortality.

9.
British Journal of Surgery ; 108:2, 2021.
Article in English | Web of Science | ID: covidwho-1254472
11.
Deviant Behavior ; : 1-15, 2020.
Article in English | Taylor & Francis | ID: covidwho-990251
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