ABSTRACT
Single use flexible bronchoscopes (SUFBs) have come to the forefront in the COVID-19 pandemic to minimise risk of infectious transmission as well as carry out bedside procedures for critically unwell patients. Multiple companies have released SUFBs with varying technical metrics. We hypothesised that clinician bronchoscope preference varies depending on physical characteristics and level of experience. 39 participants including physicians, surgeons and anaesthetists with a range of expertise from first time endoscopists to consultants took part in a trial of all available SUFBs (The Surgical Company (TSC) Broncoflex©, Boston Scientific©, Ambu©, Vathin©, Pentax© prototype scope). Likert scales were used to evaluate scope parameters including ergonomics, comfort and ease of procedures. Participant parameters were collected including height, gender and hand size. TSC Broncoflex © was the preferred scope overall with ratings of 82% for ergonomics and 83% for usage. Female participants preferred Pentax (p=0.04);male participants preferred TSC (p=0.04). Participants with small or medium glove size preferred Pentax (p=0.02) while those with large glove size ranked Vathin and TSC highest. Doctors with >10 years experience preferred Pentax (p=0.04). Gender, hand size and previous experience influenced scope preference. These factors should be considered in future scope development.
ABSTRACT
The development of single use flexible bronchoscopes (SUFB) has proceeded with pace over the last 2 years. Concerns regarding infection related to standard bronchoscopes with subsequent COVID-19 pandemic accelerated global uptake with multiple companies releasing SUFB. There has been no ex-vivo comparison of SUFBs to date. We obtained samples of all commercially available SUFBs (TSC© , Boston Scientific©, Ambu©, Vathin© and Pentax © prototype SUFB). We compared technical metrics using a custom-built bench toolkit engineered to allow standardisation. Angulation was analysed by a force meter to ascertain the effort needed to fully flex the scopes while empty and while accessed by both a forceps and cytology brush. The Ambu aScope 4 has the best performance in measured thumb force (Mean 4.15Nm/100 ). The Pentax EB15- S01 has the smallest outer diameter and the largest working channel but has the greatest loss in angulation when its working channel is occupied (-33 / -67 , -100 ). The Pentax EB15-S01 deviated the most from its reported specifications. The Vathin H-SteriScope provided the most angulation overall, including with its working channel in use (180 / 186 , 366 ). This research helps to inform the practical usability of each bronchoscope when deciding which SUFB is best for the physicians intended end use. Further research should look at perceived qualitative assessment of SUFB by clinicians.
ABSTRACT
Background: The COVID-19 pandemic has contributed to lower hospital admissions and higher mortalities associated with chronic conditions such as cancer and cardiovascular diseases. The Rapid Access Lung Clinic (RALC), established in 2009 for immediate assessment of individuals at risk of lung cancer, has experienced reduced functioning particularly during the pandemic peaks in Ireland. Therefore, we undertook a retrospective chart review of the 2019-2021 referrals and attendances at the Cork University Hospital (CUH) RALC to determine the impact of COVID-19 on this pathway. Methods: The medical charts of patients referred to CUH RALC from 03/2019 to 02/2020 (period I), and from 03/ 2020 to 02/2021 (period II), were reviewed after ethical approval was obtained. Clinicodemographic characteristics including age, sex, and hometown were extracted. Average time to acquire the first CT scan, consultation at RALC, and receiving a diagnosis of cancer were calculated using the date of referral and compared between periods I and II using the t-test. Frequency and the stages of cancer diagnosis in periods I and II were compared using a Chi-squared test. Progression-free and overall survivals were measured from diagnosis date until 09/2020 for period I and 09/2021 for period II. Results: Of the 1192 medical charts reviewed;687 patients in period I and 505 patients in period II were referred to RALC;indicating a 26.5% reduction in the number of referrals during the first year of the pandemic. Average monthly referrals (p = 0.008) and reviews (p = 0.017) were significantly lower in period II compared to period I and corresponded with the COVID-19 peaks in 04/2020 and 01/2021 in Ireland. However, no significant difference was seen in the length of time from referral to review at RALC (p = 0.11). There were 33% fewer post-referral CT scans performed (p = 0.032) and shorter wait times from referral to CT scan in period II (p = 0.001). The frequency of cancers detected did not differ between periods I and II. While there was no difference in the wait times from referral to diagnosis between periods, patients ultimately diagnosed with lung cancer in period II received surgery sooner than patients in period I (p = 0.024). Progression-free and overall survivals for patients diagnosed with lung cancer were comparable between periods I and II. Conclusions: Contrary to our hypothesis, we have shown that the COVID-19 pandemic had minimal impact on the performance of RALC. Shorter wait times for CT scan and surgery during the pandemic account for fewer hospital referrals and availability of CT scanner. Fewer referrals to RALC in period II may relate to the fewer patients attending their general practitioner (GP) and/or GPs raising the thresholds for referrals to RALC during the pandemic. Ultimately, a national evaluation will be required to fully determine the impact of this pandemic on lung cancer diagnosis, management, and outcomes in Ireland.
ABSTRACT
Introduction: Community pharmacy has played a frontline role during the COVID-19 pandemic (1,2). Governments and professional organisations in the United Kingdom and Republic of Ireland (RoI) have acknowledged the need to support and maximise community pharmacy to maintain delivery of patient care. However, the pandemic's impact on day-to-day changes to community pharmacy practice has not been comprehensively examined across the island of Ireland. Aim: To identify changes as communicated by policy and professional bodies to community pharmacy practice across the island of Ireland in preparation for and/or response to the COVID-19 pandemic, and to compare identified changes in Northern Ireland (NI) and RoI. Methods: Government, health service, regulatory and professional organisation websites in both NI and RoI were searched using relevant search terms (e.g. pharmacist, COVID- 19). Any document (e.g. official publications/reports, website pages, circulars) containing information relating to changes to community pharmacy-related infrastructure, funding/resourcing, legislation, guidelines or policies in preparation for, and/ or response to, COVID-19, published between 1st January and 31st October 2020 was included. Guidelines on clinical use of medicines were excluded as this was considered a separate topic. Initial screening of each website was undertaken by one reviewer. Brief details of potentially relevant documents were collated in a spreadsheet. Following removal of duplicates, full-texts of identified documents were assessed for inclusion by two reviewers independently, with discrepancies resolved through discussion. A content analysis was undertaken. Results: In total, 253 documents were identified. Following removal of duplicates and screening, 98 documents were included in the analysis. Most documents were published in the first three months of the pandemic (March-May 2020). A key theme related to medication prescribing and supply, with changes implemented to ensure continued access to medicines. In both NI and RoI, significant changes were made to emergency supply arrangements (e.g. increase in allowable duration of supply at the request of patients). In RoI, legislative changes were made to recognise Healthmail as the national electronic prescription transfer system and to temporarily extend prescription validity. In NI, many community pharmacy services (e.g. Minor Ailments Service, Medicines Use Review) were 'stood down' during initial months of the pandemic. Much of the communication in NI and RoI related to operational changes to ensure business continuity. In both jurisdictions a temporary register of pharmacists was introduced to allow previously registered pharmacists to contribute to the health service response. Additionally, in NI, General Dental Practitioners were redeployed to assist with community pharmacy response. Other areas of focus across both jurisdictions included infection control within a workplace setting, dealing with situations where staff were affected by COVID-19, and the use of personal protective equipment during pharmacy service provision. Conclusion: This study examined changes in community pharmacy practice across two jurisdictions during the COVID-19 pandemic. Whilst our searches were limited to publicly accessible documents only, the overlap in identified changes reflects the similarities in challenges faced by community pharmacists in adapting and responding to COVID-19. The cross-country comparison may help pharmacists and policy-makers to identify optimal approaches for responding to any future public health crises.
ABSTRACT
BACKGROUND: The first COVID-19-positive patient was identified in Ireland on 29 February 2020 (Department of Health, Government of Ireland; https://www.gov.ie/en/pressrelease/2f75fd-statement-from-the-national-public-healthemergency-team-sat-29-feb/). Healthcare worker (HCW) quarantining became a core intervention for those identified as 'close contacts' to reduce onward transmission within the workplace to patients and colleagues. Whether a quarantining strategy could be justified at a time when there was an increased demand for the services of HCWs remained unknown. AIMS: To establish whether quarantining staff away from a healthcare setting during a pandemic is justified. METHODS: This retrospective study examined close contacts of COVID-19-positive index cases (both residents and HCWs) in a community hospital over a 4-week period from 1 to 28 April 2020. Close contacts were identified in accordance with national guidelines. Zones of the hospital were examined to determine the number of COVID-positive index cases and their close contacts. A cumulative result for the hospital was recorded. RESULTS: While outcomes varied over time, per zone and per HCW category, the overall conversion rate from close contact to an index case was 30%. CONCLUSIONS: This study vindicates the policy of quarantining close contact HCWs from their workplaces as they pose a significant threat to both their patients and fellow workers.