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The COVID-19 pandemic has altered people's lifestyles around the world. Prevention of recurrent episodes of the disease and mitigation of its consequences are especially associated with effective post-COVID-19 rehabilitation in patients. The aim of the study was to evaluate the effects of the drug Likopid (glucosaminylmuramyl dipeptide, GMDP) for post-COVID-19 rehabilitation in patients. Material and methods. Patients who recovered from mild to moderate COVID-19 (n=60, mean age 54+/- 11.7 years) were randomized into the observation group (n=30, 15 men and 15 women) who received 2 courses of Licopid (1 mg twice a day) and the comparison group (n=30, 15 men and 15 women). Analysis of the phenotypic and functional characteristics of the innate immune cellular factors was carried out before the start of immunomodulatory therapy, immediately after the end of the course, and also after 6 months observations. In order to assess the quality of life of all patients, we used the SF-36 Health Status Survey and the Hospital Anxiety and Depression Scale questionnaires. Results. During assessing the effect of immunomodulatory therapy on the parameters of innate immunity of patients at the stage of rehabilitation after COVID-19, an increase in the protective cytolytic activity of CD16+ and CD8+Gr+ cells, as well as a persistent increase in TLR2, TLR4 and TLR9 expression was found, which indicates the antigen recognition recovery and presentation at the level of the monocytic link of the immune system. The use of GMDP as an immunomodulatory agent resulted in an 8-fold reduction in the frequency and severity of respiratory infections due to an increase in the total monocyte count. As a result of assessing patients' quality of life against the background of the therapy, a positive dynamic in role functioning was revealed in patients. In the general assessment of their health status, an increase in physical and mental well-being was noted during 6 months of observation. The comparison group showed no improvement in the psychoemotional state. Discussion. The study demonstrated the effectiveness of GMDP immunomodulatory therapy in correcting immunological parameters for post-COVID-19 rehabilitation in patients. The data obtained are consistent with the previously discovered ability of GMDP to restore impaired functions of phagocytic cells and induce the expression of their surface activation markers, which in turn contributes to an adequate response to pathogens. Conclusion. The study revealed that the correction of immunological parameters with the use of GMDP in COVID-19 convalescents contributed not only to a decrease in the frequency and severity of respiratory infections, but also to an improvement in the psycho-emotional state of patients, and a decrease in anxiety and depression.Copyright © Eco-Vector, 2023. All rights reserved.
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The presence of stridor in children signifies a partial obstruction in the upper airways, the cause of which may range from mild to life-threatening depending on aetiology. The most common causes of stridor in this population are laryngotracheobronchitis (viral croup) and foreign body aspiration. This article gives an overview of the signs, symptoms and potential causes of stridor and the signs and symptoms of, and diagnostic criteria for, viral croup. The author also discusses evidence-based assessment criteria and treatments and criteria for admission or discharge. A case study is used for illustration.
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Prospective research in Artificial Intelligence (AI) in various domains has changed engineering around the world. It is difficult to build clinical decision models due to lack of large datasets. Knowledge engineering with AI techniques provides a solution to health services by improvising the safety and quality at low cost. Combining the power of machine learning and deep learning offers a strong base for clinical decision support system. With increasing number of patients worldwide, there is a severe setback in healthcare system to fight against control of COVID-19, a pandemic and a threat to lives of human beings. The whole world is looking for a novel technology to fight against this pandemic. This research focuses on use of various AI technologies to analyze and predict COVID-19 patients by collecting real-time data from various age groups, gender, and health conditions. Hence, in this chapter, in application of AI concepts to predict the future health predictions of COVID- 19-recovered patients, use of data science to obtain statistics of COVID-19, and to provide a personalized care for each and every COVID-19 patient, knowledge engineering concepts are applied. Also, this chapter focuses on possible health issues met by COVID-19-improved patients. By collecting real-time data through social media, in person and surveys, data is analyzed and implemented to predict future health issues that may be confronted by the COVID-19-recovered patients. Existing machine learning and statistical analysis methods are applied to predict future health problems that a COVID-19 patient. Results obtained are promising with real-time statistics of COVID-19-recovered patients. © 2022 Scrivener Publishing LLC.
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Background: The need for cardiac intensive care unit (ICU) beds remains high in order to monitor and treat emergency patients with severe cardiovascular diseases, particularly during the COVID-19 pandemic. Therefore, timely discharge strategies from the cardiac ICU to peripheral wards are crucial to meet the increasing demand for cardiac ICU beds. Early patient transfer from ICU to the peripheral ward may result in worsening of the patient's clinical condition and outcome with readmission to the ICU, while late transfer may require prolonged expert care and generate unwanted costs. Purpose(s): To investigate whether unplanned readmission of cardiac patients to the cardiac ICU within 72 hours after the index ICU stay is associated with increased mortality risk (primary outcome) and prolonged total hospital length of stay (LOS) (secondary outcome), as well as to identify predictors of ICU readmission in cardiac patients. Method(s): Adult patients who were admitted to the cardiac ICU due to a primary cardiac admission diagnosis at a tertiary care center between 2003 and 2021 were included. Outcomes were analysed with multivariable regression models adjusted for 26 a priori defined variables on patient demographics, underlying comorbidity levels, ICU procedures and administered ICU drugs. Result(s): 30,942 cardiac patients were included, out of whom 1,499 patients (4.84%) were readmitted to the cardiac ICU within 72 hours. 1,023 (68.2%) of readmitted patients were male. Compared to non-readmitted patients, readmitted patients were older, had more underlying comorbidities (Charlson Index), had more severe disease courses (SOFA score, TISS, APACHE II score and SAPS), as well as required more frequently vasopressor therapy, renal replacement therapy and coronary angiographies (Table 1). Readmission to the cardiac ICU was associated with higher in-hospital mortality risk (Odds Ratio 7.52, 95% Confidence Interval (CI) 4.15-12.27, P<0.001) and prolonged hospital LOS (Incidence Rate Ratio 1.56, 95% CI 1.15-1.58, P<0.001). Patients who were readmitted to the ICU had been discharged 18% earlier during the index ICU stay compared to non-readmitted patients (P<0.001). Of note, readmitted and nonreadmitted patients had similar vital parameters at time of ICU discharge after their index ICU stay. During the index ICU stay, non-readmitted patients were prescribed more beta blockers (65.3% vs. 45.8%), ACE inhibitors (37.0% vs. 27.2%) and blood transfusions (10.7% vs. 7.7%). Conclusion(s): Early readmission to the cardiac ICU was associated with increased in-hospital mortality and prolonged hospitalisation. Readmitted patients had been discharged earlier from their index ICU stay and required more comprehensive critical care. ICU discharge strategies should optimally be based on objective patient assessments to facilitate patient safety and shorten hospital length of stay. Artificial intelligence-based algorithms may support clinicians with safe ICU discharge. (Table Presented).
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Introduction: Parallel with the emerging results of the FAST-Forward (FF) trial, we implemented ultrahypofractionated radiation therapy (RT) for early-stage breast cancer in our clinic at the beginning of the COVID-19 pandemic [Brunt 2020]. This scheme of 26 Gy in 5 consecutive fractions, was given to all breast cancer patients referred for postoperative RT of the breast only. Uniquely, in view of the pandemic, we also gave a single ultrahypofractionated sequential tumourbed boost of 6 Gy, if indicated according to our local protocol. The aim of this prospective study was to assess 2-year late normal tissue effects in this cohort of breast cancer patients. Method(s): Data was recorded in a prospective database. Early results were published before [Machiels 2020]. A sequential boost of 6 Gy in 1 fraction was delivered to all patients <70 y. Late normal tissue effects were patient-assessed using EORTC QLQ-BR23 breast cancer module, body image scale questionnaire and the FF protocol-specific questions relating to changes to the affected breast (breast appearance, size, induration, and skin appearance) 24 months after treatment. Patient assessments used a four-point scale (i.e., not at all, a little, quite a bit, very much). We performed this 24-month assessment using tele-medicine follow-up as we did during the pandemic. Descriptive statistical analysis of late normal tissue effects was performed;differences were assessed using Pearson chi-square test and p-values <0.05 were considered significant. Result(s): All 68 patients from our earlier cohort were contacted 2 years after completion of RT, of which all but two were available. Forty-two patients received a boost and 24 did not. Median follow-up was 24 months (range;22- 27). Prevalence of the most-reported mild late normal tissue effects was 53% for mild increase in induration, 50% for mild appearance changes and 48% for mild sensitivity (Table 1). Most-reported moderate normal tissue effects was 13% for sensitivity. The only reported marked effects was 3% change in breast appearance. No significant differences between patients receiving a boost and no boost were seen. Conclusion(s): Our findings are similar to the late normal tissue effects reported in the FF trial and endorse the use of ultrahypofractionated RT for early-stage breast cancer. An ultrahypofractionated tumourbed boost did not result in increased late normal tissue effects, which is being further investigated in a randomised trial. No conflict of interest.Copyright © 2022 Elsevier Ltd. All rights reserved
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To investigate occupational therapists' experiences with home assessments and modifications in VHA, while comparing virtual to in-person home visits. A preliminary qualitative study using semi-structured individual interviews. Department of Veterans Affairs (VA) Home Based Primary Care (HBPC). Purposefully selected occupational therapists implementing home assessments and modifications for rural Veterans (N=3). Not applicable. Semi-structured individual interview via Microsoft Teams. Home visits to conduct home assessments and modifications for rural Veterans were standards of care delivery. However, travel restrictions and social distance during the COVID-19 pandemic required a shift toward virtual care. Our preliminary results show that the VA Video Connect (VVC) application allows occupational therapists to provide instant feedback and training to Veterans when new equipment is installed in the Veteran's home, without the need to drive long-distance. However, the VVC does not allow occupational therapists to measure physical features of the home, such as door threshold height and hallway width. Participants also reported difficulty evaluating Veterans' functioning, such as balance, strength, and gait pattern. Thus, the VVC improves access to the services but requires additional assistance from caregivers compared to in-home assessments. Initial home assessments are recommended to be conducted during home visits, but follow-up visits can be conducted via telehealth depending on Veterans' and caregivers' ability to utilize telehealth devices and perform self-assessments. The study team has no conflicts of interest to report.
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The COVID-19 pandemic is a major health threat and its global spread has led governments worldwide to take a series of public health and social measures and restrictions, aiming to reduce its transmission. As COVID-19 outbreak continues, there is a crucial need for further analysis and evaluation of the main features that seem to affect the clinical status of a patient infected by SARS-CoV-2. In this context, the present paper introduces a Covid Patient Assessment Analysis (CPAA) based on operational research, which examines the patient profile, taking into consideration characteristics like gender and age, and also categorizes the experiencing COVID-19 symptoms and the dependency of patient's clinical status from potential comorbidities. Finally, evaluating all the aforementioned features, CPAA ranks COVID-19 cases based on the severity of each case in low-, medium-, and high-risk groups. For the modeling and the implementation of the CPAA, the Pairwise Comparison (PWC) has been used as an integral part of a decision-making process. The outcomes of the paper are the first step towards an overall operational research framework that would be used to evaluate the clinical status of patients and take automate decisions for their potential hospitalization. © 2023, The Author(s), under exclusive licence to Springer Nature Switzerland AG.
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Aim: To describe Brazilian web survey methods termed DIABETESvid by assessing the diabetic individuals' self-care practices and their resilience in the COVID-19 pandemic. Method(s): This is a cross-sectional study on data collected from web surveys in the period between 1st September and 19th October 2020, in which socio-demographic, clinical, self-care and resilience variables were investigated. A questionnaire was elaborated and implemented by using the Research Electronic Data Capture platform. Result(s): A total of 1,633 participants were eligible for this study, with a higher frequency of females, 46.5% being aged between 18 and 39 years old, 40.9% being diagnosed with diabetes within 1 to 10 years and all having high level of education. Most of the participants was living in south-eastern Brazil, self-reported type 1 diabetes mellitus and had access to the survey link on WhatsApp. In this 7-week study, it was evidenced that the survey response rate was higher in the first week (38.5%) and number of accesses were increased on Thursdays (20.2%) and in the night (40.2%). Conclusion(s): The method used here can be useful as a baseline for future web surveys involving diabetic individuals so that several analyses can be conducted in the clinical care and academic contexts.Copyright © 2021 The Authors
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Introduction: NIRS reduces intubation rate in COVID-19 pneumonia. Outcome is related to age, comorbidities, and baseline illness severity. Thoracic CT has prognostic value in COVID-19 pneumonia. Forced Oscillatory Technique (FOT) allows non-invasive assessment of respiratory reactance (Xrs) that is related to lung compliance. A pilot study showed FOT feasibility in patients with COVID-19 pneumonia receiving NIRS (1). Aim(s): Measuring Xrs in COVID19 patients receiving NIRS and correlate with CT. Method(s): The local ERB approved the study. 32 consecutive patients with moderate-severe COVID-19 ARDS were enrolled. Patients underwent non-invasive ventilation (NIV) alternated to High Flow Nasal Cannula (HFNC). In the first 24 hours of hospitalization triplicate FOT measurements were performed (Resmon ProFULL) according to current guidelines during HFNC. Within 1 week 28 patients underwent computed tomographic pulmonary angiography (CTPA) and collapsed, infiltrated and normally inflated areas were quantified (3D Slicer software). Result(s): 12 patients had altered Xrs-z score. Collapsed areas correlated with Xrs z-score (rho=0.37;p=0.046) and almost with inspiratory Xrs (rho=-0.36;p=0.055). Inflated areas correlated with inspiratory Xrs (rho=0.42;p=0.024) while infiltrated areas didn't. In our cohort CTPA and FOT parameters didn't discriminate outcomes but inflated areas were inversely related to hospitalization (rho=-0.43;p=0.04). Conclusion(s): FOT showed abnormal Xrs in a subset of patients. Xrs z-score is a noninvasive index of collapsed areas in COVID-19 pneumonia and could be useful in patients assessment and follow up.
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Background: The purpose of this case study is to describe how post-exertional symptom exacerbation (PESE), a hallmark of long COVID, may affect the clinical course of physical therapy. Physical therapists can provide patient education and activity guidance to individuals with long COVID to improve clinical outcomes. Case Description: The patient was a 39-year-old female with a 20-year history of bilateral knee pain. Following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the patient developed PESE and increased bilateral knee joint effusion and pain, affecting her ability to perform cognitive tasks and walk, respectively. Outcomes: Following 8 weeks of intervention, the patient's Lower Extremity Functional Scale score improved from 35/80 to 59/80 and numeric pain rating scale decreased from 7/10 to 4/10 at maximum, but she experienced an apparent PESE relapse. Discussion: Post-exertional symptom exacerbation can affect multiple body systems, which may affect a patient's ability to participate in physical therapy. Clinical Relevance: Physical therapy management of individuals with long COVID must include monitoring during and after exertion for signs and symptoms of PESE.
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There are a host of changes that will affect family physicians, including new vaccine codes and bundled Medicare payments for chronic pain management.
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Management of persistent COVID-19 symptoms requires multidisciplinary input, particularly in primary care. Pharmacists should support patients who are experiencing prolonged symptoms by ensuring concerns are heard, providing advice on symptom management and recognising when further medical review is required. Copyright © 2021 Pharmaceutical Press. All rights reserved.
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The proceedings contain 102 papers. The topics discussed include: stepwise approach to a competency-based curriculum development of a new undergraduate doctor of pharmacy program (PharmD) at the University of Ottawa;an approach to promote student wellbeing in the faculty of pharmaceutical sciences at UBC;assessing the effectiveness of a novel wellness check-in activity among third-year pharmacy students;let it go: a novel way to facilitate professional identity formation as students transition to practice;integration of online virtual simulation to support the acquisition of patient assessment skills during the COVID-19 pandemic;a curricular framework for an interprofessional approach to deprescribing;two for one: merging continuing professional development and faculty development for pharmacy preceptors);beyond the stigmas: preparing graduates to address heteronormativity and systemic discrimination towards 2SLGBTQ+ people in pharmacy settings;predicting which applicants will most likely succeed in a PharmD program: challenges and realistic expectations;and supporting patient-centered practice: a workshop for pharmacy students to provide strategies for empowering patient self-efficacy and health behavior change.
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Introduction: Prone positioning is commonly used when treating ventilated Covid-19 patients. Whilst there have been some reports of ICU proning-related injuries to the brachial plexus well before the pandemic (Goettler et al. 2002), it is usually a very uncommon complication. Despite guidance from the Faculty of Intensive Care Medicine on the care of the proned patient, cases of peripheral neuropathies following ICU admission have significantly increased during the Covid-19 pandemic at our centre (Miller et al. 2021). Nerve injury is associated with reduced quality of life, impaired activity participation and persistent pain (Bailey et al. 2009). Objectives: The aim of this quality improvement project was to identify the effect that new guideline development and related healthcare professional education had on the number and severity of peripheral neuropathies identified following Covid-19 ICU admission. Methods: Between March 2020 and May 2021, we collected clinical data from patients who sustained peripheral neuropathies during their inpatient stay for Covid-19. Data were collected via face-to-face patient assessments within acute nerve clinics or post-ICU rehabilitation wards. A grading system was used to categorise the peripheral nerve injuries into severe, intermediate and mild (Power et al. 2020). Electronic ICU clinical noting was examined to identify the frequency and duration of each proning episode for each patient who presented with nerve injury. Following the first surge in 2020 updated proning guidelines were developed with ICU team leaders and disseminated. This involved face-to-face education of frontline staff. Results: At our centre 93 patients survived Covid ICU between March -June 2020 (surge 1) and 21 of those sustained nerve injury (22.58%). 309 patients survived Covid ICU between September 2020 -May 2021 (surge 2) and 12 of those sustained nerve injury (3.88%). For patients who sustained nerve injury, the average number of prones changed between surges from 6 to 13. The average duration of each episode of proning changed from 17.8hrs to 18.6hrs. Despite the increase in prone frequency, nerve injury occurrence reduced (proportionate to the number of patients who survived Covid ICU) by 82%. 14/21 (66%) injuries acquired in the first surge were of high grade and 4/ 12 (33%) were of high grade during the second surge. Conclusion: Optimising positioning of the proned ventilated patient may reduce the incidence of nerve injury. However, we must also acknowledge that changes in medical management between surges (i.e. use of dexamethasone, remdesivir) may have contributed to this. Individuals still developed severe injury despite this change in practice. Further research looking into risk factors and further methods of optimising the prone positioning on ICU is warranted to reduce the occurrence of this potentially life-changing injury.
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Background: Appropriate management of inflammatory bowel disease (IBD) often requires multiple specialist appointments per year. Living in rural locations may pose a barrier to regular specialist care. Saskatchewan (SK) has a large rural population. Prior to COVID-19, telehealth (TH) in SK was not routinely used for either patient assessment or follow up. Furthermore, TH was exclusively between hospitals and specific TH sites without direct contact using patient's personal phones. Aims: The objective of this study was to assess the differences in demographics, disease characteristics, outcomes, and health care utilization between patients from rural SK with IBD who used TH and those who did not. Methods: A retrospective chart review was completed on all rural patients (postal code S0∗) with IBD in SK who were followed at the Multidisciplinary IBD Clinic in Saskatoon between January 2018 and February 2020. Patients were classified as using TH if they had ever used it. Information on demographics, disease characteristics, and access to IBD-related health care in the year prior to their last IBD clinic visit or endoscopy was collected. Data was not collected for clinic visits after March 1, 2020 as all outpatient care became remote secondary to the COVID-19 pandemic. Mean, standard deviations, median and interquartile ranges (IQR) were reported. Mann-Witney U and Chi-Square tests were used to determine differences between the groups. Results: In total, 288 rural SK IBD patients were included, 30 (10.4%) used TH and 258 (89.6%) did not. Patient demographics were not significantly different between the two groups;although, there was a statistically significant difference in the proportion of ulcerative colitis patients (17% TH vs. 38% non-TH, p=0.02). The percentage of patients with clinical remission was 87% for TH patients and 74% for non-TH patients (p=0.13). There were no significant differences in health care utilization patterns and biochemical markers of disease, including c-reactive protein (CRP) and fecal calprotectin (FCP) (p>0.05). Conclusions: Prior to the pandemic, a small percentage of patients with IBD in rural SK ever used TH. A small proportion of UC patients used TH. No significant differences in disease characteristics, outcomes, or health care utilization were identified. Further study is warranted to identify barriers to use of this technology to tailor care to this patient group and improve access to care, especially now as the COVID-19 pandemic has drastically changed the use of virtual care.
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Introduction: In Portugal, in 2020, 5415 new lung cancer patients were diagnosed and 4797 deaths were caused by lung cancer. Lung cancer ranks third in terms of cancer incidence and is the leading cause of cancer mortality. Early diagnosis, complete and fast patient assessment and staging, multidisciplinary approach, access to personalized medicine, new treatment options and research are essential to improve survival and quality of life. Access to clinical trials is critical for this improvement.The aim of this study is to assess the techniques available to the diagnostic work-up, treatments, the waiting time and the needs perceived by physicians. Methods: The Portuguese Lung Cancer Study Group launched a survey in order to study the diagnostic approach and treatment of lung cancer patients in Portugal. An online survey with 47 questions was sent to all Portuguese hospitals that treat lung cancer, referring to the pre-COVID-19 pandemic experience. Results: Responses from 31 Portuguese hospitals were collected, between May and September 2020. Availability to bronchoscopy, image-guided transthoracic needle biopsy (TNB), endobronchial ultrasound- transbronchial needle aspiration (EBUS-TNBA), PET/CT, molecular biology testing is presented in table I. In 58% (n=18) the molecular biology test was performed as a "reflex test". About 68% (n=21) of hospitals used next generation sequencing. Two hospitals (7%) reported not having access to liquid biopsies.Video-assisted thoracoscopic surgery was the main surgical technique (61%;n=19). The waiting time for the first radiation oncology consultation was less than 15 days in 71% (n=26). About 61% (n=19) of hospitals had clinical trials. A wide majority of doctors (77%) would like to have more clinical trials. In 71% (n=22) of the hospitals, it was possible to refer patients to Palliative Care receiving systemic anticancer therapy. [Formula presented] Conclusions: Despite the limitations of the methods, this study allowed us to deepen our knowledge about the work-up technologies and treatments available for lung cancer patients in Portugal. It has also identified future opportunities, such as increasing accessibility to some diagnostic tools and clinical trials. Keywords: Diagnosis and treatment approach, Lung Cancer in Portugal, Health Services Research - Portugal
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Introduction: The COVID-19 pandemic has caused disruption to the worldwide provision of acute and chronic care to patients. The effect has been particularly marked in rheumatology in Ireland, where the ability to provide acute and chronic care has been dramatically curtailed due to the combined effects of social distancing, staff redeployment and the repurposing of rheumatology units. Prior to the pandemic, there were significant challenges from an infrastructural and staffing level in Irish rheumatology. Methods: Using a questionnaire, the authors evaluated the effect of the first wave of the COVID 19 pandemic on rheumatology services. Results: Responses from 87% of Rheumatology specialist services in Ireland indicate that 83% of review appointments were remote, with 87% of new patient assessments in OPD were “in person”. Only 41% of usual outpatient activity could occur within existing infrastructure given guidelines re social distancing which would result a shortfall of 42000 patient appointments. Significant numbers of staff were reassigned from Rheumatology to services elsewhere. Conclusion: The COVID-19 pandemic has had a significant negative impact on access to struggling Irish Rheumatology services. Implementation of agreed recommendations for augmenting services must occur urgently.
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As a national nursing service providing community nursing support for patients receiving enteral, parenteral nutrition and other intravenous therapies employing over 300 nurses, it was important to support the NHS during the Covid-19 pandemic. An NHS support campaign was launched which began by implementing a guiding principle across our service in relation to sending patients to hospital. The guiding principle was framed around keeping the patient at home safely to avoid admission. The guiding principle was: ‘why hospital, why today’. This was communicated out across our nursing service and our standard operating procedures were updated to reflect this. To help raise awareness to this initiative we also launched a logo. This was added to the email footers of the nursing team and shared with our NHS partner hospitals. We increased the nursing service offering to further support admission prevention, to include the following: • Blood taking visits • Additional drug administration • Virtual patient assessments and training • Support/facilitate virtual clinics • Condensed patient training to aid reduced number of visits for training • Rapid discharge for nursed patients We reduced the number of nursing visits our patients were having to reduce the risk through contact: • Patients were offered training for themselves or a carer • Where clinically safe and in agreements with the referring centres and our patients, we reduced patient’s visits to once a day from twice per day by administering 24-hour infusions, thus reducing contact and exposure to nurses and patients We offer a 24hour nurse Advise Line to support our patients and nurses in the community. As part of the ‘Why Hospital Why Today ‘initiative, the Advice Line worked hard to find ways to keep patients safely at home rather than advising hospital, along with discussions with the manager on call were able to reduce the number of out of hours hospital admissions. We also considered our patients mental health and well-being. Our patient cohort is a vulnerable group and they were being isolated from family and friends as well as reduced nursing visits which could impact on their mental health and well-being. We initiated weekly supportive calls to all our patients which were well received. During 2020 at the height of the pandemic, 27 hospital admissions were avoided, 6 patients completed the condensed patient training package, 160 patients had amendments to their prescription regime to reduce number of nurse visits, 63 patients initiated 24-hour parenteral nutrition infusions, halving their contact with nurses.