ABSTRACT
Background. On March 11, 2020, the World Health Organization announced the status of a global pandemic for the 2019 coronavirus disease (COVID-19). Pregnant women are most vulnerable to being infected with COVID-19 and must take extra care of their health. The impact and risk of COVID-19 on pregnant and lactating women as well as on the fetus and baby are not yet known with certainty. However, due to changes in body shape and immune system, pregnant women are very susceptible to some res-piratory infections. Objective. The purpose of this study was to determine the effect of the COVID-19 pandemic on the quality of antenatal care (ANC) services in Probolinggo Regency. Methods. This analytic research has a cross-sectional design. The participants are 326 pregnant women in the third trimester. Sampling uses simple random sampling. The sample is some pregnant women in the third trimester, as many as 179 people. Chi- square is used for analysis. Results. According to the study's findings, as many as 170 respondents did not confirm that they had COVID-19 (95%). 153 respondents were provided with quality ANC services (85%). Conclusion. The results of the statistical test obtained a value of P=0.09;so there is an influence during the COVID-19 pandemic on the quality of ANC services. Efforts that can be made are health workers limit meetings with pregnant women without reducing the quality of ANC services.Copyright © the Author(s), 2023.
ABSTRACT
Introduction: The COVID-19 pandemic has required clinical teams to function with an unprecedented amount of uncertainty, balancing complex risks and benefits in a highly fluid environment. This is especially the case when considering the delivery of a pregnant woman critically unwell with COVID-19. This is one maternal critical care team's reflections on establishing best practice and a shared mental model when undertaking a Caesarean section in critically unwell patients with COVID-19. Objective(s): We describe our experience of balancing the risks and streamlining the process of this high-risk intervention. Method(s): We used our standard clinical governance forums across four specialties (Obstetrics, Intensive care, Anaesthetics and Neonatology) to identify key challenges and learning points. We developed a working group to combine our learning and develop a shared mental model across the involved teams. Result(s): 1. The decision to deliver must be multidisciplinary involving Obstetrics, Intensive care, Anaesthetics, Neonatology and the patient according to their capacity to participate. The existing structure of twice daily ITU ward rounds could be leveraged as a 'pause' moment to consider the need for imminent delivery and review the risk-benefit balance of continued enhanced pharmacological thromboprophylaxis. 2. We identified a range of scenarios that our teams might be exposed to: 3. Perimortem Caesarean section 4. Critically unwell - unsafe to move to theatre 5. Critically unwell - safe to move to theatre 6. Recreating an obstetric theatre in the ICU Advantages Avoids moving a critically unstable patient, although our experience is increasing moving patients for ECMO. Some forms of maximal non-invasive therapy such as High Flow Nasal Oxygen may require interruption to move to theatre with resultant risk of harm or be difficult to continue in transport mode through a bulky ICU ventilator e.g. CPAP Disadvantages Significant logistics and coordination burden: multiple items of specialist equipment needing to be brought to the ICU. Human factors burden: performing a caesarean section in an unfamiliar environment is a significant increase in cognitive load for participating teams. Environmental factors: ICU side rooms may offer limited space vs the need to control the space if performed on an open unit. Delivering a Neonate into a COVID bubble. Conclusion(s): Developing a shared mental model across the key teams involved in delivering an emergency caesarean section in this cohort of critically unwell patients has enabled our group to own a common understanding of the key decisions and risks involved. We recommend a patient centred MDT decision making model, with a structure for regular reassessment by senior members of the teams involved. In most circumstances the human factors and logistical burden of recreating an operating theatre in the ICU outweighs the risk of transport to theatre. Pre-defined checklists and action cards mitigate the cognitive and logistical burden when multiple teams do perform an operative delivery in ICU. Action cards highlight key aspects of routine obstetric care to be replicated in the ICU environment.
ABSTRACT
Introduction: Aberdeen Royal Infirmary is a low volume centre carrying out approximately 13 oesophagectomies per annum. Due to minimal exposure to post-operative oesophagectomy patients, staff had low perceived confidence in their management within the Intensive Care Unit (ICU). After an initial pause due to the COVID-19 pandemic, oesophagectomy service provision restarted in June 2020. Prior to this project, no standardised care pathway existed for post-operative oesophagectomy patients. A protocol driven management pathway was implemented within the ICU setting in October 2020. Objective(s): 1. Standardise the first 5 days of post-operative care for oesophagectamies 2. Improve 30 day mortality rate 3. Reduce opiate use on step down to High Dependency Unit (HDU) 4. Improve ICU Medical and Nursing staff perceived confidence in the management of oesophagectomy patients. Method(s): A multi-disciplinary approach was taken, with input from ICU, Surgical, Anaesthetic, Physiotherapy, Nursing, Pain and HDU teams. Standards of care for post-operative oesophagectomy patients were identified and a protocol was subsequently produced for use within ICU with reference to current Enhanced Recovery After Surgery (ERAS) guidelines.1 The protocol covered the first 5 days of post-operative care. It identified tasks to be completed each day and highlighted which staff group was responsible for performing each task. Additionally, an information sheet was distributed to Medical and Nursing ICU staff to educate them on oesophagectomy patients and recognition of potential complications that arise when caring for this patient group. Data on 30 day mortality and opiate use at step down to HDU was collected from electronic notes. This was collected retrospectively prior to implementation of the protocol from January 2019 - July 2020 and prospectively following its implementation, from October 2020 - December 2021. ICU staff perceived confidence in managing post-operative oesophagectomy patients was measured using a combined quiz and survey. It was completed by staff prior to introduction of the protocol. Following implementation of the protocol and distribution of the information sheet, the quiz and survey was repeated to evaluate improvement in staff confidence. Result(s): A total of 38 oesophagectomy cases were identified. 21 cases were reviewed prior to implementation of the protocol, with 1 mortality at 30 days. 17 cases were reviewed following implementation of the protocol, with 0 mortalities at 30 days. Qualitative scoring showed a 20% increase in staff confidence to manage this patient group. Review of drug prescription charts revealed a reduction in dose of modified release opiates at step down to HDU. Conclusion(s): Oesophagectomy is major surgery and causes significant staff anxiety in low volume centres. This protocol has successfully standardised care for this patient group and allowed continuation of this essential service provision during the COVID-19 pandemic. This protocol improved 30 day mortality, reduced opiate use at step down to HDU and improved ICU staff perceived confidence in caring for post-operative oseophagectomy patients.
ABSTRACT
Background: Tocilizumab, an interleukin-6 (IL-6) antagonist, is being evaluated for the management of covid-19 pneumonia. The objective of this study was to assess the effectiveness of Tocilizumab in severe covid-19 pneumonia. Method(s): This was a retrospective, observational, single centre study performed in 121 patients diagnosed with severe covid-19 pneumonia. 83 patients received standard of care treatment whereas 38 patients received tocilizumab along with standard of care. Tocilizumab was administered intravenously at 8mg/kg (upto a maximum of 800mg). The second dose of Tocilizumab was given 12 to 24 hours apart. The primary outcome measure was ICU related and hospital related mortality. The secondary outcome measures were change in clinical status of patients measured by WHO (World Health Organisation) 7 category ordinary scale, changes in interleukin-6 (IL-6) levels, secondary infections and duration of ICU stay. Result(s): Tocilizumab was administered between 3-27 days after the patient reported symptoms ( a median of 10.9 days ) and between the 1st to 3rd day of ICU admission (median of 2.1 days) . In Tocilizumab group, 16(42.1%) of 38 patients died in ICU whereas in standard of care group, 27(32.53%) of 83 patients died. The difference in clinical status assessed using WHO (World Health Organisation) 7 category ordinary scale at 28 days between Tocilizumab group and standard of care group was not statistically significant (odds ratio 1.35, 95% confidence interval 0.61 to 2.97, p = 0.44). Conclusion(s): Tocilizumab plus standard care was not superior to standard care alone in reducing mortality and improving clinical outcomes at day 28.Copyright © RJPT All right reserved.
ABSTRACT
Background: Risk perception and COVID‑19 anxiety in pregnant women restrict access to health services, cause pregnant women to resort to alternative channels such as the Internet, and affect prenatal care quality (PCQ) negatively. Purpose: The purpose of this study was to examine the effect of risk perception and COVID‑19 anxiety in pregnancy on decision‑making via the Internet (DMI) and PCQ with multivariate analysis. Materials and Methods: This cross‑sectional study was conducted with 406 pregnant women selected using the convenience sampling method in a training and research hospital, in Turkey. The data were collected using the information form, the perception of pregnancy risk questionnaire, the Coronavirus Anxiety Scale, the DMI Scale, and the PCQ Scale. The data obtained were subject to descriptive analysis and the multivariate analysis of variance. Results: Approximately 24.9% of the pregnant women were found to have a high perception of risk and 18% had symptoms of COVID‑19 anxiety. Pregnant women with high COVID‑19 anxiety and a higher perception of risk perceived the Internet as less influential for decision‑making (P < 0.05). Pregnant women with a high‑risk perception had lower PCQ (P < 0.05). Conclusion: The findings can be used to enhance mental health and resilience in pregnant women and to formulate appropriate intervention strategies. © 2023 Journal of Integrative Nursing ;Published by Wolters Kluwer ‑ Medknow.
ABSTRACT
Introduction: Spinal cord and dorsal root ganglion stimulation (SCS and DRG) are standard of care in chronic neuropathic pain. During the COVID-19 pandemic, it was critical to arrange postoperative care. Furthermore, the disparity between travel times and transportation options could influence the decision on seeking healthcare. Lacking financial resources could enhance this issue. Telehealth is usually restricted to video conferences, without interfering with implanted medical devices. Now, there exists a platform for remote programming of those devices. It is accessible via smartphones and allows direct contact between a patient and their doctor. Method(s): We initiated a pilot study for evaluating the performance of remote care in patients with SCS or DRG stimulation. We plan the enrollment of 20 patients, 10 each in the retrospective and the prospective group. Retrospective data has been collected from on-site programmed patients in our outpatient clinic in a large registry study. Prospective data is being collected under the new standard of care in the remotely programmed patients. We assess ten scores and categories to evaluate the status preoperatively, at implantation, and the postoperative course. The postoperative data are assessed in the context of video conferences for remote programming. 12 months after implantation, a final video conference is scheduled. In both groups, the same stimulation systems are used. Result(s): The study is ongoing. In the retrospective group (n=8), the mean duration of the programming appointment including waiting time was 43 minutes and the mean travel time 71 minutes (mean travel distance 106km with corresponding costs). So far, 5 patients have been enrolled for remote programming. Measured with the Telehealth Usability Questionnaire, their overall satisfaction with the system is high. In the Patient Global Impression of Change Scale 6 months after implantation, the retrospective group has a mean of 5 and the prospective group of 6 points. Considering the Visual Analog Scale, there was an improvement in both groups between the baseline and follow-up (in the retrospective group from mean 8 to 5 and in the prospective group from mean 8 to 2). Conclusion(s): The general convenience with the remote programming is high. Compared to the retrospective group, the patients do not experience a lack of efficacy of their stimulation. The use of remote programming offers various advantages, e.g., no travel times nor costs that allow simplified and more frequent programming. Especially in a pandemic or in case of travel limitations it is a very helpful tool. Disclosure: Mareike Mueller, MD: None, Andrea Dreyer: None, Phyllis McPhillips, RN: None, Guilherme Santos Piedade, MD: None, Sebastian Gillner, MD: ABBOTT: Consulting Fee:, Boston Scientific: Consulting Fee:, Philipp Slotty, MD: None, Jan Vesper, MD,PhD: Abbott: Consulting Fee:, Abbott: Fees for Non-CME/CE Services (e.g. advisor):, Medtronic: Fees for Non-CME/CE Services (e.g. advisor):, Boston Scientific: Consulting Fee:, Medtronic: Consulting Fee:, UniQure: Fees for Non-CME/CE Services (e.g. advisor):, ABBOTT: Consulting Fee:, Abbott: Speakers Bureau:, ABBOTT: Consulting Fee: Self, ABBOTT: Speakers Bureau: Self, ABBOTT: Contracted Research: Self, Boston Scientific: Consulting Fee: Self, Boston Scientific: Contracted Research: SelfCopyright © 2023
ABSTRACT
NHS England Genomics introduced whole genome sequencing (WGS) with standard-of- care (SoC) genetic testing for haemato-oncology patients who meet eligibility criteria, including patients with acute leukaemia across all ages, and exhausted SoC testing. Alongside, the role of germline mutations in haematological cancers is becoming increasingly recognised. DNA samples are required from the malignant cells (somatic sample) via a bone marrow aspirate, and from non-malignant cells (germline sample) for comparator analysis. Skin biopsy is considered the gold-standard tissue to provide a source of fibroblast DNA for germline analysis. Performing skin punch biopsies is not within the traditional skillset for haematology teams and upskilling is necessary to deliver WGS/germline testing safely, independently and sustainably. A teaching programme was designed and piloted by the dermatology and haematology teams in Sheffield and delivered throughout the NHS trusts in North East & Yorkshire Genomic Laboratory Hub. The training programme consisted of a 90-min session, slides, video and practical biopsy on pork belly or synthetic skin, designed to teach up to six students at one time. To disseminate best practice, the standard operating procedure and patient information used routinely in Sheffield were shared, to be adapted for local service delivery. From January 2021 to December 2022, 136 haematology staff from 11 hospitals, including 34 consultants, 41 registrars, 34 nurses and 8 physician associates, across the NEY GLH region completed the skin biopsy training programme. Feedback from the course was outstanding, with consistently high scores in all categories. Practical components of the course were especially valued;98.6% (71/72) trainees scored the practical element of the programme a top score of 5 out of 5, highlighting that despite the challenges of delivering face-to- face teaching due to COVID-19, teaching of practical skills was highly valued;training in this way could not have been replicated virtually. Costs of the programme have been approximately 16 000, including consultant input and teaching/educational materials. Recent support has been provided by a separately funded Genomic Nurse Practitioner (GNP), with succession planning for the GNP to take over leadership from the consultant dermatologist. Plans are in place to use the remaining budget to disseminate the programme nationally. Our training programme has shown that skin biopsy can be formally embedded into training for haematology consultants, trainees, nursing team, and physician associates. Delivery of training can be effective and affordable across regional GLHs with appropriate leadership and inter-speciality coordination, and ultimately sustainable with specialist nursing staff, including GNPs.
ABSTRACT
Background & Aim: The long-term effects of human mesenchymal stem cell (MSC) treatment on COVID-19 patients have not been fully characterized. The aim of this study was to evaluate the safety and efficacy of a MSC treatment administered to severe COVID-19 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial (NCT 04288102). Methods, Results & Conclusion(s): A total of 100 patients experiencing severe COVID-19 received either MSC treatment (n = 65, 4x107 cells per infusion) or a placebo (n = 35) combined with standard of care on days 0, 3, and 6. Patients were subsequently evaluated 18 and 24 months after treatment to evaluate the long-term safety and efficacy of the MSC treatment. The outcomes measured included: 6-minute walking distance (6-MWD), lung imaging, quality of life according to the Short Form 36 questionnaire, COVID-19-related symptoms, titers of SARS-CoV-2 neutralizing antibodies, MSC-related adverse events (AEs), and tumor markers. Two years after treatment, a marginally smaller proportion of patients had a 6-MWD below the lower limit of the normal range in the MSC group than in the placebo group (OR = 0.19, 95% CI: 0.04-0.80, Fisher's exact test, p = 0.015). On the SF-36 questionnaire, a marginally higher general health score was received by the MSC group at month 18 compared with the placebo group (50.00 vs. 35.00;95% CI: 0.00-20.00, Wilcoxon rank sum test, p = 0.016). In contrast, there were no differences in the total severity score of lung imaging or the titer of neutralizing antibodies between the two groups. Meanwhile, there were no MSC-related AEs reported at the 18- or 24-month follow-ups. The serum levels of most of the tumor markers examined remained within normal ranges and were similar between the MSC and placebo groups. Long-term safety was observed for the COVID-19 patients who received MSC treatment. Yet few sustained efficacy of MSC treatment was observed at the end of the 2-year follow-up period. Funding(s): The National Key Research and Development Program of China (2022YFA1105604, 2020YFC0860900), the specific research fund of The Innovation Platform for Academicians of Hainan Province (YSPTZX202216) and the Fund of National Clinical Center for Infectious Diseases, PLA General Hospital (NCRCID202105,413FZT6). [Figure presented]Copyright © 2023 International Society for Cell & Gene Therapy
ABSTRACT
Introduction: Most modern healthcare systems are striving to improve patient outcomes in an evidence-based manner. Increasingly, performance metrics are seen as key tools for accurately measuring and improving patient outcomes and healthcare value.1 However, in order to achieve better outcomes, process measures need to be identified. Process measures are evidence-based, best practices metrics that can be measured and thus, used to identify if outcomes are being met. Good process measures can improve patient outcomes by reducing the amount of variation in care delivery. During the Covid-19 pandemic, vast quantities of data were generated while managing ARDS (Acute Respiratory Distress Syndrome) on the ICU. Furthermore, there was as a concomitant evolution of treatment strategies, which made it exceedingly difficult to identify processes that were actually improving patient outcomes. Objective(s): The aim of our quality improvement project was to promote standardised high quality care for intubated Covid-19 patients by identifying potential quality indicators and trends in their management. It is our intention to expand on this work to report metrics on all severe acute respiratory failure patients. Method(s): 15 process metrics surrounding the early care of intubated of Covid-19 patients were selected via a consultant led review process and a literature review in an effort to identify markers of quality surrounding intubation on our ITU. The variables selected included: - P/F ratio 24 hours pre-intubation, CPAP (continuous positive airway pressure) duration prior to intubation, Recording intubation location, Enhanced thromboprophylaxis prescribed, Permissive hypercapnia, Driving pressure documented, prone position and paralysis initiated if P/F ratio was less than 20 kPa, Echo post intubation. Result(s): Data surrounding the intubation of Covid-19 patients was collected over an 11 week period between September and November 2021. The data was collected in a standardised fashion from patient notes and nursing notes, then stored in an excel file. Our data showed more than half the patients admitted were either intubated on the ward or immediately following arrival onto our ICU, possible indicating a delay in admitting Covid-19 patients. Our data also demonstrated heterogeneity of duration in CPAP prior to intubation which may also indicate delayed intubation for these patients.2 Conclusion(s): Our data demonstrated a reasonable degree of heterogeneity in our approach to the early care of intubated Covid-19 Patients. Areas of concern highlighted were the number of patients intubated on the ward or immediately upon arrival to ITU, rather than admitting prior to deterioration (most likely due to bed pressure) and variation in post intubation respiratory sampling between invasive and non-invasive broncheoalveolar lavage. Ongoing PDSA (plan-do-study-act) cycling are in progress to refine the data collection processes and reporting for all severe acute respiratory failure patients.
ABSTRACT
Background/Objectives: COVID-19 still represents a lifethreatening disease in individuals with a specific genetic background. We successfully applied a new Machine Learning method on WES data to extract a set of coding variants relevant for COVID- 19 severity. We aim to identify personalized add-on therapy. Method(s): A subset of identified variants, "actionable" by repurposed drugs, were functionally tested by in vitro and in vivo experiments. Result(s): Males with either rare loss of function variants in the TLR7 gene or L412F polymorphism in the TLR3 gene benefit from IFN-gamma, which is specifically defective in activated PBMCs, restoring innate immunity. Females heterozygous for rare variants in the ADAMTS13 gene and males with D603N homozygous polymorphism in the SELP gene benefit from Caplacizumab, which reduces vWF aggregation and thrombus formation. Males with either the low-frequency gain of function variant T201M in CYP19A1 gene or with poly-Q repeats >=23 in the AR gene benefit from Letrozole, an aromatase inhibitor, which restores normal testosterone levels, reducing inflammation and which rescues male golden hamsters from severe COVID-19. Conclusion(s): By adding these commonly used drugs to standard of care of selected patients, the rate of intubation is expected to decrease consistently, especially in patients with high penetrance rare genetic markers, mitigating the effect of the pandemic with a significant impact on the healthcare system.
ABSTRACT
Background: Work stress among healthcare staff has been identified as an extensive problem already before the pandemic. To be able to treat the surge of COVID-19 patients in need of intensive care COVID-19 ICUs were swiftly set up and staffed. The aim of this study was to investigate what staff perceived as most stressful. Material(s) and Method(s): During spring 2020 up to 270 COVID-19 patients were simultaneously treated in ICU's in the greater Stockholm and Sormland regions, upholding 100 ICU beds pre-pandemic.1 Staff reactions to work in a COVID-19 ICU was collected in a survey. Nine causes for stress were scored on a five graded likert like scale from does not agree to fully agrees. 612 nurses and physicians, both regular ICU staff and newcomers, working in ICU's in 2 larger and 3 smaller hospitals responded, (response rate approx. 35%). Data was analyzed using structural equation modeling to calculate loading of each factor. Result(s): The highest scoring cause of stress was "making a mistake". "Getting infected" got the lowest score among the 9 predefined causes. Conclusion(s): Clinicians working in COVID-19 ICUs were generally confident not to get infected at work. Commitment to maintain patient safety and frustration not to live up to standards of care in this strained situation was reflected in "making a mistake" and "relatives cannot visit" scoring as the number one and three out of the nine causes of stress. Increased knowledge about work-related stressors is crucial, in order to prevent detrimental impacts of such stressors.
ABSTRACT
Education and training is one of the pillars of clinical governance that helps to maintain and improve the quality of patient care within the NHS. The impact of COVID-19 has disrupted the delivery of governance sessions. Original large departmental face-to-face sessions have changed because of social distancing, staff sickness or staff having to isolate. Furthermore, part-time staff often miss clinical governance sessions and do not have the opportunity to maintain training compared to full time staff. The need to deliver education and training is still crucial for staff development and optimising patient care and safety. This poster explores how flipped learning combined with blended learning that is used within academic institutions can also be used to deliver clinical governance within the ultrasound department. Considering the IMPALA framework and its components, the following format is an alternative provision that could be used to deliver governance: online presentation including a video/audio clip;selfdirected study/activity;face to face or online session. The format would ideally suit new guidelines being introduced into a department, for example the applying O-RADS to images. Similarly, the format would suit education and training in case studies, protocols and even departmental quizzes or discussion forums. Including video/audio allows staff to feel in touch and be included with their peers despite circumstances potentially not allowing all to be present. Pillars of governance are crucial to deliver optimal patient care. The education component is also very important to ultrasound practitioners. CPD is continuous and staff should be provided with equal opportunities despite working patterns or absence. Alternative methods to deliver governance sessions should be used as well as the traditional departmental/face to face session. The given format allows the ultrasound department to give education and training to all staff maintaining staff CPD and optimal patient care.
ABSTRACT
Introduction: The importance of psychological safety, staff morale, culture and civility (PSMCC) has been highlighted by multiple recent maternity investigations as key to the provision of safe, high quality maternity care [1]. These factors are also crucial for staff retention and recruitment. Concomitantly, the NHS Staff Survey indicates an almost universal decline in staff motivation and engagement since COVID;a trend also noted in our institution [2]. Regular, authentic, individual and group positive feedback could improve PSMCC by creating a culture of kindness and appreciation, reinforcing positive behaviour and improving teamwork. At UHP, an established 'Learning for Excellence (LfE)' positive feedback system is in place, facilitating provision of volitional, authentic feedback to individuals and enabling organisational learning about what works. The aim of this project was to assess the impact of a shift to a more positive, appreciative narrative in maternity using intensive positive feedback from patients and staff. Method(s): A literature review to derive validated questions for incorporation into a questionnaire to assess baseline levels of PSMCC and perceptions of positive feedback receipt. QI methodology and stakeholder focus groups aided the development of the interventions. Once established, the impact of these positive interventions on PSCMM will be assessed. Result(s): There were 103 responses to the baseline questionnaire. 24% staff felt their actions at work were never positively acknowledged;45% felt undervalued. 63% felt they do not receive enough positive feedback, whilst 93% believed that receiving more positive feedback would improve staff morale, wellbeing, culture and care. Discussion(s): Based on these findings, interventions to provide regular, authentic, positive feedback across our maternity unit have been created. These include: 1)motivational board sharing positive feedback stories from patients and staff obtained via LfE, showcasing the kind, compassionate and high quality care delivered;2) Weekly email shots of LfE stories focussing on specific positive behaviours such as teamwork and patient centred care;3) A white board for staff and patients to share positive messages ad hoc;4)Promotion of the LfE initiative to patients thus increasing positive feedback to staff. The impact of these interventions will be assessed shortly and presented in full.Copyright © 2023 Elsevier Ltd
ABSTRACT
Introduction: Over 200,000 patients survive an intensive care admission each year in the United Kingdom (UK). For patients, survival is frequently beset by a range of chronic disabilities. Approximately 50% must navigate an often complex convalescence, while suffering serious and persistent symptoms of post-traumatic stress disorder (PTSD), anxiety and/or depression.1 Eye-movement desensitisation and reprocessing (EMDR) is a trauma-focussed psychological therapy, recommended for treating PTSD by the International Society for Traumatic Stress Studies2 and NICE.3 However, EMDR has never been systematically investigated for patient benefit following intensive care admission. Objective(s): CovEMERALD4 evaluated the feasibility of delivering a randomised controlled trial (RCT), testing the effect of EMDR on the psychological health of intensive care survivors, following COVID-19 related critical illness. We also provide preliminary evidence of the effect on clinically relevant outcomes. Findings will inform the design of a subsequent fully-powered RCT. Method(s): This feasibility RCT was conducted at a single-centre, teaching hospital in the UK (University Hospital Southampton). Patients were eligible if they were admitted to intensive care for over 24-hours with confirmed COVID-19, were above 18 years of age, were recruited within 3-months of hospital discharge, and had no cognitive impairment or pre-existing psychotic diagnosis. Participants were randomised (1:1) to receive either up to 8 sessions of remotely-delivered EMDR (Recent traumatic events protocol) or standard care alone as the control group (CG). Psychometric evaluation was undertaken at Baseline and 6-months after hospital discharge. Result(s): Seventy-five consecutive patients were screened at hospital discharge, from October 2020 to April 2021. 51 eligible patients approached. 26 (51%) provided consent. Reasons for declining participation were;no psychological distress (n=16), no internet access (n=7) and being physically unready (n=2). Demographic variables were balanced between groups. Of the 13 patients randomised to EMDR, one withdrew prior to intervention: the remaining attended all sessions recommended by the psychological therapists (mean of 3-4 sessions per patient), giving an overall adherence of 93%. One patient from each group declined the 6-month follow-up evaluation, so trial completion was possible in 23 of 26 (88%) participants. No reasons for trial withdrawal were given. There were no attributable adverse events. Mean change in PTSD score (PTSD Checklist-Civilian) from Baseline to 6-months, was -8 (SD=10.49) in the EMDR group vs. +0.75 (SD=15.17) in CG (p=0.126). Mean change in anxiety (Hospital Anxiety and Depression Scale-Anxiety) was -0.45 (SD=2.3) following EMDR vs. -0.83 (SD=4.0) in the CG (p=0.787), and median change in depression (HADS-D) was -2(IQR:-3.0,1.0) following EMDR vs. +1(IQR-1.5,2.0) in the CG (p=0.263). Figure 1. Box-plot of change in PTSD symptoms (PCL-C) from baseline to 6-months post-hospital discharge for control group and EMDR intervention group. Conclusion(s): EMDR can improve psychological recovery following an intensive care admission for COVID-19, and appeared feasible and safe. Although not powered to determine clinical effectiveness, this single-centre feasibility study returned a positive signal, in reducing PTSD and depressive symptoms. A full results manuscript will be submitted prior to congress. CovEMERALD has supported a successful NIHR doctoral fellowship application, during which protocol refinements will be tested, within existing, and recommended rehabilitation pathways. Trial activity and progression will be consistent with the Medical Research Council framework for developing and evaluating complex healthcare interventions.5.
ABSTRACT
Background & Aim: Immunocompromised patients are susceptible to high-risk opportunistic infections and malignant diseases. If available, most antiviral and antifungal drugs are quite toxic, relatively ineffective, and induce resistance in the long term. Methods, Results & Conclusion(s): We have previously demonstrated the safety of adoptive cell therapy for COVID-19 patients with CD45RA negative cells containing SARS-CoV-2-specific T cells from a donor, chosen based on HLA compatibility and cellular response to SARS-CoV-2 peptide pools. After finishing a Phase 2 randomized multicenter clinical trial (RELEASE, NCT04578210), we concluded that the infusion is safe, effective, accelerates lymphocyte recovery and shows hallmarks of an immune response. To use adoptive cell therapy to treat COVID-19 it would be necessary to develop a biobank of living drugs. For that, we examined the immune evolution performing a longitudinal analysis from previously SARS-CoV-2 infected and infection- naive individuals covering 21 months from infection. Cellular responses were maintained over time while humoral responses increased after vaccination but were gradually lost. Therefore, the best donors would be recovered individuals and two months after vaccination. We also evaluated the effect of dexamethasone (current standard of care treatment for COVID-19 and other infections involving lymphopenia) and Interleukin-15 (cytokine involved in T-cell maintenance and survival) on CD45RA negative. Dexamethasone did not alter cell functionality, proliferation or phenotype at a clinical-practice concentration, while interleukin-15 increased the memory T-cell and T-regulatory cell activation state, and interferon gamma release. Furthermore, we applied the adoptive passive transfer of CD45RA negative cells containing pathogen-specific memory T-cells to other infectious diseases characterized by sustained lymphopenia. We infused six immunocompromised patients with Cytomegalovirus, BK virus, Aspergillus, and Epstein-Barr virus lymphoproliferative disease. Patients experienced pathogen clearance, resolution of symptoms and lymphocyte increase. Transient microchimerism was detected in three patients. The use of CD45RA negative cells containing specific memory T cells of a third-party donor for treating severe pathogenic diseases in immunocompromised patients is feasible, safe, and effective, and has an advantage over other cell therapies such as lower costs and a less complex regulatory environment.Copyright © 2023 International Society for Cell & Gene Therapy
ABSTRACT
The covid-19 outbreak prompted many health care providers to use video consultation for the first time. While it is particularly useful in times of pandemic, a number of patients wish to continue using video consultation as it allows easy access to their physician. However, many physicians may be uncomfortable communicating with new technologies and without performing a traditional physical examination. Training in communication and virtual physical examination in telemedicine appears to be necessary, making it possible to make videoconsultation sustainable into daily practice while guaranteeing quality of care.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.
ABSTRACT
Intro: Ritonavir-boosted nirmatrelvir has shown efficacy in reducing the rate of hospitalisation and 28-day mortality among unvaccinated populations with COVID-19. The role of Ritonavir-boosted nirmatrelvir among high risk hospitalised COVID-19 patients remained uncertain. Our study aimed to assess the efficacy of Ritonavir-boosted nirmatrelvir in reducing disease progression among high-risk hospitalised COVID-19 patients. Method(s): This is a retrospective case-control study (ratio 1:1) among hospitalised COVID-19 patients with mild-moderate severity, within 5 days of illness, and had at least one risk factor for severe disease. Treatment group (case) received Nirmatrelvir and Ritonavir twice daily for 5 days. Historical controls before the introduction of Ritonavir-boosted nirmatrelvir were obtained in the same hospital. Both groups received standard of care. The primary outcome was rate of clinical progression from non-hypoxia to hypoxia. Finding(s): 200 patients from January to July 2022 were included in the analysis, where 108 (54%) were male, mean age of 63.7 (SD 17.1), 95% completed primary COVID-19 vaccination and 91 (45.5%) had evidence of pneumonia (moderate severity). Most common comorbids were hypertension(65%), diabetes mellitus(40%) and overweight(36%). Clinical progression to hypoxia was significantly lower in the treatment group (4%) compared to the control group (18%) (OR=0.190, 95% CI: 0.0618 - 0.583). Comparing case to control, the rates of ICU admission were 1% vs 3%, mechanical ventilation 0% vs 2% and inpatient mortality 2% vs 2%. 97% patients completed Ritonavir-boosted nirmatrelvir in the treatment group. Conclusion(s): Among high-risk hospitalised COVID-19 patients who received ritonavir-boosted nirmatrevir, they were 81% less likely to experience desaturation. Ritonavir-boosted Nirmatrelvir remains beneficial among highly vaccinated populations during the Omicron wave in COVID-19 pandemic.Copyright © 2023
ABSTRACT
Intro: Dysregulated inflammation plays a key role in the development of severe SARS-CoV-2 infection. One of the key cellular signaling pathway involved in the inflammatory response is JAK/STAT signaling. Among the hospitalized Covid patients with hypoxia to reduce the progression to ARDS, immunomodulators have a definite role. Baricitinib is an oral selective Janus kinase 1/2 inhibitor with anti-inflammatory properties. This study evaluates the efficacy and all-cause mortality among moderate to severe Covid patients who received Baricitinib. Method(s): A retrospective case-control study was carried out among moderate to severe Covid patients who had received Baricitinib. COVID severity matched group from the same time period was selected as the control. We evaluated the efficacy (based on WHO-ordinal scale) and difference in all-cause mortality among case and control groups. Baseline characteristics and outcome variables were retrospectively captured from the hospital health information system. Finding(s): During our study period, 2547 active Covid patients have admitted, out of which 105 patients received Baricitinib. Based on the retrospective analysis 75 patients were selected as the case group and 75 covidpositive patients of similar age and sex were identified by a simple random selection technique to serve as a control group. The age group of the baricitinib group 60.82 (+/- 13) and the Control group 62.34 (+/-13). Among the participants, 62.66% were severe (58% Baricitinib group & 66% control), 36% were with moderate severity (40% Baricitinib group & 33.33% control). The all-cause mortality of cohort was 43% (n=64), 36% (n=27) of cases as compared to 49.3% (n=37) of control group, (P Value= 0.06). Improvement in WOS score by at least 1-point cases 47% and 37.3 % in controls, (P Value= 0.09). Conclusion(s): Baricitinib when combined with standard of care, among hospitalized patients with moderate to severe Covid infection, showed a trend towards clinical improvement and decreased all-cause mortality.Copyright © 2023