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1.
Eye (Lond) ; 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2096681

ABSTRACT

BACKGROUND: The COVID-19 pandemic has impacted negatively on many areas of biomedical research and there is concern that academic recovery will take several years. This survey aimed to define the impact of the COVID-19 pandemic on UK ophthalmologists' research activities and understand the implications for recovery. METHODS: An online survey comprising multiple choice and free-text questions was designed, piloted and then distributed to Royal College of Ophthalmologists (RCOphth) members in January 2021. Respondent characteristics, research expectations and experiences through the pandemic were captured. Descriptive and comparative statistics were applied to quantitative data alongside content analysis of qualitative data. RESULTS: In total, 148 respondents (3.7% of RCOphth membership) comprised 46 trainees (31.1%), 97 consultants (65.5%) and 5 SAS doctors (3.4%); 54 had clinical-academic roles (36.5%) and 65/94 (69.1%) ophthalmologists with fully clinical posts identified as research-active. Of 114 research-active respondents, 104 (91.2%) reported an impact on their research from COVID-19; negative impacts included loss of research time (n = 69), research delays (n = 96) and funding shortfalls (n = 63). Content analysis identified five common themes; type of research activity, clinical demands, institutional challenges, COVID-19 alignment and work-life balance. CONCLUSIONS: UK ophthalmology research has been adversely impacted by the pandemic. A substantial proportion of UK ophthalmologists are research active, but 20.4% of those surveyed felt that the pandemic had made research less attractive. Strategic steps must be taken to nurture UK ophthalmologists' engagement with research, especially for those who currently do no research, if the profession is to align itself with the Government vision of 'Research for All'.

2.
Vox Sanguinis ; 117(SUPPL 1):269-270, 2022.
Article in English | EMBASE | ID: covidwho-1916289

ABSTRACT

Background: The Coronavirus Disease 2019 (COVID-19) pandemic was first detected in Wuhan, China. It is caused by a novel coronavirus known as Severe Acute Respiratory Distress Syndrome Coronavirus-2 (SARS-Cov-2). The pandemic presents a challenge to the healthcare system worldwide due to widespread infection and limited definitive therapeutic options available. The previous research suggested that convalescent plasma (CP) may be effective against infection. Aims: To investigate the effect of CP transfusion in the clinical outcome of severe COVID-19 patients. Methods: A cross-sectional study was conducted among severe COVID-19 adult patients admitted to six public hospitals across Malaysia from 1st August 2020 to 28th February 2021. A total of 53 patients received CP transfusion along with the standard care (intervention group) and another 53 patients received standard care only (control group) were recruited. An age, gender and comorbidity between the two groups were manually matched approximately at a 1:1 ratio. Each patient (intervention group) received at least a unit (approximately 250 ml) ABO-compatible CP over 1 or 2 h infusion. Another unit of CP was transfused after 24 h in 18 patients (34.0%) after being assessed by a treating physician. The convalescent plasma was collected from an individual who was recovered from COVID-19 infection, negative for COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) and fulfilled the eligibility criteria for blood donation according to the national guideline. The anti-COVID-19 antibody was tested before the donation. However, the anti-COVID-19 neutralizing antibody (nAb) titre was not determined. The median interval between CP transfusion and severe COVID-19 staging was 2 days. The data were analysed using International Business Machines Corporation (IBM) Statistical Package for the Social Science (SPSS) Statistics Version 26 IBM, New York, USA. Results: The demographics of selected patients were male (60.4%), Malay race (83.0%), and has one or more comorbidity (74.5%). The commonest comorbidities were hypertension (47.2%), followed by diabetes mellitus (44.3%), dyslipidaemia (16.0%), and cardiovascular disease (16.0%). The commonest symptoms upon admission were cough (63.2%), followed by fever (60.4%), and shortness of breath (17.0%). The patients in the intervention group received a shorter duration of oxygen supplementation (median: 12 vs. 14 days, p = 0.030) and a shorter duration of mechanical ventilation (median: 6 vs. 10 days, p = 0.048). The difference in the mechanical ventilation rate, length of intensive care unit (ICU) stay, length of hospital stay, and mortality rate across both groups was not statistically significant (p = 0.492, 0.793, 0.614 and 0.374). The prevalence of adverse transfusion reactions was 5.7%. Summary/Conclusions: CP transfusion is safe and seems to be effective in the treatment of severe COVID-19 patients. However, a randomized-controlled trial with a larger sample size is necessary at the national level to ascertain the benefits of CP transfusion among severe COVID-19 patients.

3.
Journal of Long-Term Care ; 2022:22-39, 2022.
Article in English | Scopus | ID: covidwho-1876506

ABSTRACT

Context: The precarious work arrangements experienced by many long-term care workers have led to the creation of a “shared” workforce across residential, home, and community aging care sectors. This shared workforce was identified as a contributor to the spread of COVID-19 early in the pandemic. Objective: This analysis sought to review policy measures targeting the long-term care workforce across seven high income jurisdictions during the first year of the COVID-19 pandemic. The focus was on financial supports introduced to recognize long-term care workers for the increased risks they faced, including both (1) health risks posed by direct care provision during the pandemic and (2) economic risks associated with restrictions to multi-site work. Method: Environmental scan of publicly available policy documents and government news releases published between March 1, 2020 and March 31, 2021, across seven high income jurisdictions. Findings: While there was limited use of financial measures in the United States to compensate long-term care workers for the increased health risks they faced, these measures were widely used across Canada, as well as in Wales, Scotland, and Australia. Moreover, there was a corresponding use of financial measures to protect workers from income loss in parts of Canada, Australia and the UK. Limitations: Our analysis did not include additional policy measures such as sick pay or recruitment incentives. We also relied primarily on publicly available policy documentation. In some cases, documents had been archived or revised, making it difficult to ascertain and clarify original information and amendments. Implications: While these financial measures are temporary, they brought to light long-standing issues related to the supply of and support for workers providing care to older adults in long-term care homes. © 2022 The Author(s).

4.
Journal of Clinical Oncology ; 40(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1700453

ABSTRACT

Background: During the COVID19 pandemic, many centres in the UK, shifted towards utilising hypofractionated radiotherapy (RT) to pancreas. We aim to report the UK experience hypofractionated (3-5 fractions) RT to the pancreas from 7 centres in the UK. Rates of toxicity, progression, death and potential prognostic factors were assessed. Univariate and multivariate Cox proportional hazards analyses were performed. Results: 92 patients from 7 centres were included in the analysis (median age 71 (range 49-88). 90% had performance status of 0-1. 66% had locally advanced disease. 53% had RT delivered over 3- 5 fractions (n = 49, median: 30Gy/5f, range:30- 40Gy in 3-5f). The rest had 15-fraction RT with or without concurrent chemotherapy (n = 43, median: 45Gy/15f, range: 36-45Gy/15f). Induction chemotherapy (CT) was used in 64% (FOLFIRINIOX -42/59). Median follow-up was 13 months from first treatment (induction CT or RT). Median overall survival (OS) among all patient was 17 months, (95% CI-14.5-19.5 months). On multivariable analysis, induction CT was the only predictor of improved PFS (median survival (MS) 12 vs 5 months;hazard ratio [HR] 0.23;95% confidence interval [CI]: 0.12-0.44, p < 0.001) and OS (MS 24 vs 11 months;HR 0.15;95% CI: 0.07 - 0.34, p < 0.001). There were no deaths. 4 patients had grade 3+ toxicities (transaminitis, cholecystitis and gall bladder perforation, small bowel obstruction and diarrhoea) -all had concurrent CT. Conclusions: Our survival outcome appears to be comparable with published data from CT + concurrent chemoradiotherapy. Induction CT appears to improve outcome. Careful selection of patients can help maximise advantage in this patient population.

7.
Med J Malaysia ; 76(5):653-657, 2021.
Article in English | PubMed | ID: covidwho-1399968

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic posed a significant and urgent threat to global health and economy. Currently, there is no effective treatment known to alter the course of COVID-19. Convalescent plasma (CP) has been used previously to treat several types of infections during pandemics. The aim of our study is to evaluate the efficacy of CP in the treatment of severe COVID-19 infections at Hospital Sultanah Bahiyah, Kedah, Malaysia. MATERIALS AND METHODS: A retrospective cross-sectional study of all severe COVID-19 patients who received CP treatment from 1st August 2020 until 31st December 2020 was conducted. Clinical outcomes were compared before and after CP transfusion. RESULTS: Thirty-four patients were enrolled and received CP transfusion during the study period. The most common presenting complaints were fever (64.7%) and cough (58.8%). Fourteen patients showed improvement in oxygen support after CP transfusion. Several laboratory parameters also improved such as increased lymphocyte count (1.48 vs 1.98, p=0.008) and decreased C-reactive protein levels (28.1 vs 10.6, p=0.004), and these were statistically significant. Median time from symptoms onset to CP transfusion was 6 days (range 1-11) while median time from PCR diagnosis to CP transfusion was 5 days (range 1-11). One patient developed urticaria after CP transfusion and no severe adverse events were observed. Two of our patients passed away due to secondary causes. CONCLUSION: This study showed CP treatment was well tolerated and could potentially prevent progression of COVID-19 to a severe disease if administered early during the viraemic phase. Further evaluation with randomized control trial should be conducted to help ascertain the optimal dose and effectiveness of CP treatment, in correlation with the IgG titer of the donated CP.

8.
Med J Malaysia ; 76(2):254-257, 2021.
Article in English | PubMed | ID: covidwho-1141048

ABSTRACT

We describe here the first laparotomy involving a COVID-19 patient in Malaysia. A 60-year-old man screened positive for SARS-CoV-2 in March 2020 and developed acute abdomen in the ward in Hospital Sultanah Bahiyah, Kedah. He underwent laparotomy and cholecystectomy for gangrenous cholecystitis. All personnel adhered to infectious control precautions, donning full personal protective equipment (PPE) throughout the surgery. Post-operatively, due to raised septic parameters, he was carefully diagnosed with and treated empirically for superimposed bacterial sepsis instead of cytokine release syndrome, with confirmed blood culture of Klebsiella pneumoniae. Patient was discharged well later. None of the staff involved in his care developed COVID-19 infection.

9.
Br J Community Nurs ; 25(10): 480-488, 2020 Oct 02.
Article in English | MEDLINE | ID: covidwho-841751

ABSTRACT

People with chronic pain faced potential treatment disruption during the COVID-19 pandemic in Singapore, as the focus of healthcare shifted. A model of rapid integration of a pain centre with community healthcare teams was implemented to care for vulnerable older patients with chronic pain and multiple comorbidities. Telemedicine and home visits by community nurses were used, with risk-mitigation measures, ensuring comprehensive assessment and treatment compliance. Medications from pain physicians were delivered at home through a hospital pharmacy. A secure national electronic health records system used by all teams ensured seamless access and documentation. Potential emergency department visits, admissions and delayed discharges were thus avoided. Integration of community teams with chronic pain management services can be recommended to ensure pandemic preparedness.


Subject(s)
Chronic Pain/therapy , Community Health Nursing , Coronavirus Infections , House Calls , Pain Clinics , Pain Management , Pandemics , Pneumonia, Viral , Telemedicine , Betacoronavirus , COVID-19 , Cooperative Behavior , Delivery of Health Care , Female , Humans , Male , Middle Aged , Patient Care Team , Referral and Consultation , SARS-CoV-2 , Singapore , Workflow
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