Should states restrict recipient choice amongst relevant and available COVID-19 vaccines?

Several COVID-19 vaccinations have been authorised worldwide. Whilst some vaccines are contraindicated for certain age groups or health conditions, there are often multiple clinically suitable authorised vaccine brands available. Few states have allowed recipients to choose amongst them, though there are multiple reasons why choice would be valued. We consider the policy justifications for state controls on recipient choice amongst COVID-19 vaccine brands, focusing on European countries and drawing on the UK context as an example. We contrast justifications for not offering choice at the height of the early pandemic crisis, and as some states seek to de-escalate their response and transition towards living with COVID-19. We argue that in the latter context public expectations of choice between available vaccine brands and platforms may rise, but that several considerations may justify continued restrictions on choice. A key factor which states should continue to take into consideration is the global nature of the pandemic. Insofar as offering recipient choice at a national level might exacerbate global inequity in vaccine distribution, states retain a normative and legal justification for restricting choice amongst available and clinically suitable vaccine brands.

Covid-19 Pandemic Strategy for Treatment of Acute Uncomplicated Appendicitis with Antibiotics- Risk Categorization and Shared Decision-Making.

BACKGROUND: During the Coronavirus disease 2019 (COVID-19) pandemic, a protocol was adopted by our department on antibiotics treatment for Acute Uncomplicated Appendicitis (AUA). Our study aimed to determine the feasibility and safety of non-operative treatment (NOT), compared to upfront laparoscopic appendectomy (LA), for AUA in children during the pandemic. METHOD: Our prospective comparative study was conducted from May 1, 2020 to January 31, 2021. Patient selection criteria included: age ≥5 years, abdominal pain duration ≤48 h, ultrasound (US)/Computered Tomography scan confirmation of AUA, US appendiceal diameter 6-11 mm with no features of perforation/abscess collection and no faecolith. For NOT patients, intravenous antibiotics were administered for 24-48 h followed by oral for 10-day course. Comparison was performed between patients whose parents preferred NOT to those who opted for up-front appendectomy. Primary outcomes were NOT success at index admission, early and late NOT failure rates till 27 months. Secondary outcomes were differences in complication rate, hospital length of stay (LOS) and cost between groups. RESULTS: 77 patients were recruited: 43 (55.8%) underwent NOT while 34 (44.2%) patients opted for LA. Success of NOT at index admission was 90.7% (39/43). Overall, NOT failure rate at 27 months' follow-up was 37.2% (16/43). Of the NOT failures, 1 appendix was normal on histology while only 1 was perforated. There were no significant differences in secondary outcomes between both groups except for LOS of late NOT failure. Cost for upfront LA was nearly thrice that of NOT. CONCLUSION: Our stringent COVID protocol together with shared decision-making with parents is a safe and feasible treatment option during a crisis situation. LEVEL OF EVIDENCE: Treatment study, Level II.

Revolution in abortion care? Perspectives of key informants on the importance of abortion method choice in the era of telemedicine.

Patient choice of medical or surgical abortion is a standard of quality abortion care, but the choice of surgical abortion is constrained in England and Wales, particularly since the COVID-19 pandemic and introduction of telemedicine. This qualitative study explored the perspectives of abortion service providers, managers, and funders on the need to offer a choice of methods within early gestation abortion services in England and Wales. Twenty-seven key informant interviews were conducted between August and November 2021, and framework analysis methods were used. Participants presented arguments both for and against offering method choice. Most participants felt that it was important to maintain choice, although they recognised that medical abortion suits most patients, that both methods are very safe and acceptable, and that the priority for abortion services is to maintain timely access to respectful care. Their arguments related to practicalities around patient needs, the risk of reinforcing inequalities in access to patient-centred care, potential impacts on patients and providers, comparisons to other services, costs, and moral issues. Participants argued that constraining choice has a greater impact on those who are less able to advocate for themselves and there were concerns that patients may feel stigmatised or isolated when unable to choose their preferred method. In conclusion, although medical abortion suits most patients, this study highlights arguments for maintaining the option of surgical abortion in the era of telemedicine. More nuanced discussion of the potential benefits and impacts of self-management of medical abortion is needed.

Evaluating the effectiveness of an online group programme to manage Multiple Sclerosis-related fatigue

Background and aim: A group-based fatigue management programme called FACETS has typically been delivered face-to-face to people living with MS within a neuropsychology service. In response to Covid-19 government guidelines, this service adapted to online delivery of their fatigue management group intervention. This study aims to evaluate two FACETS group interventions which were delivered online consecutively within this service. Methods: Group 1 was delivered face-to-face for the first three sessions before being adapted for virtual delivery for the final three sessions. Group 2 was delivered virtually for all six sessions. Quantitative data was collected from outcome measures collected pre-and post-group. Qualitative feedback was gathered to explore participants’ experience of the group as well as the adapted virtual delivery. A thematic analysis was undertaken to identify key themes. Results: Participants in both groups felt they had more control over managing their fatigue and it was having less of an impact on their quality of life. Five themes were identified from participants’ qualitative feedback (knowledgeable content, awareness and learning, validating experience, accessible amendments, patient choice). Discussion: Feedback was largely positive from both groups following the adaptation to online delivery as it offered a cost-and time-effective solution. Participants reflected on the value of a mixed delivery option for future group interventions to facilitate rapport with other participants and empower self-management of their fatigue. © 2022, British Psychological Society. All rights reserved.

Hospital at Home: another piece of the armoury against COVID-19.

Introduction: Hospital at Home (@Home) services bring the ward to the patient, providing acute care in the home. The @Home team adapted to support the care of patients with COVID-19 in the community who would otherwise have required hospitalisation. Methods: An evidence-based guideline and treatment bundle (dexamethasone, oxygen, intravenous fluids and thromboprophylaxis) for managing severe COVID-19 was developed. Data were retrospectively extracted from notes of patients with COVID-19 admitted between 16 December 2020 to 14 February 2021, and service users contacted for feedback. Results: One-hundred and twenty-five adults with COVID-19 were treated by @Home; 42 severe (34%) and 83 non-severe (66%) infections; average length of stay was 7 days (interquartile range 4-8). Eight-hundred and seventy-five hospital-occupied bed days were saved. Service users emphasised the importance of being with loved ones and the value of respecting peoples' wishes to be at home. Conclusion: @Home gave people with COVID-19 a choice of active treatment at home, thereby extending available healthcare capacity beyond the acute hospital setting.