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1.
Alzheimer's and Dementia ; 18(S8) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2172381

ABSTRACT

Background: Hearing and vision impairments are highly prevalent in people with dementia (PwD) and may have a negative impact on quality of life and other dementia-related outcomes. Intervening to optimize sensory function improve these outcomes. The SENSE-cog Trial evaluated whether a home-based multi-part 'sensory support' intervention (SSI) is effective in improving quality of life and other key outcomes in PwD (including hearing and/or vision problems), and their care partners. Method(s): This was a pan-European, multi-centre, observer blind, randomized controlled trial (RCT), of PwD with hearing and/or vision impairment and their companions. We compared 'care as usual' (CAU) to a multi-part complex intervention of hearing and vision rehabilitation (SSI) tailored to each participant dyad. The SSI included: assessment and correction of hearing and/or vision impairments;home-based, therapist-delivered sensory support (i.e., adherence with devices;improving the sensory environment, communication training, and signposting to other support agencies). Outcomes were collected at baseline, intervention end (18 weeks) and post-intervention (36 weeks - the primary endpoint) and included: quality of life, sensory and cognitive functional ability, relationship satisfaction, neuropsychiatric symptoms, and mental well-being. Health resource utilization was measured to estimate cost-effectiveness of the intervention. Result(s): Across 7 European centers (UK, France, Cyprus, Greece), 252 participants with dementia (median age 80 years, 53% female, 59% hearing impairment only, 4% visual impairment only and 37% both impairments) were randomized from May 2018 to May 2021 to receive either CAU or SSI (10 visits over 18 weeks). Mitigating strategies to adapt study procedures to the COVID-19 pandemic were implemented. Over 75% of participants completed the primary outcome, the DEM-QoL scale, at 36 weeks. An initial feasibility study yielded positive results for this outcome revealing an average improvement in the DEM-QoL of 4.9 points (> minimum important clinical change). Conclusion(s): Hearing and vision support in PwD is a potentially important and cost-effective means of improving the lived experience of dementia, representing a critical step in the diagnostic and care pathway. Main RCT results will be available in May 2022. Trial registration: ISRCTN17056211. Copyright © 2022 the Alzheimer's Association.

2.
Pharmaceutical Journal ; 309(7965), 2022.
Article in English | EMBASE | ID: covidwho-2196675
3.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194345

ABSTRACT

Background: The use of colchicine has been associated with reduction of adverse cardiac events in patients with coronary artery disease (CAD). The role of this drug after percutaneous coronary intervention (PCI) with bare metal stents (BMS) has not been evaluated against isolated PCI with drug eluting stents (DES). Aim(s): The study was designed to test an improved cost-effectiveness with BMS plus colchicine (group BMS+C) compared to DES alone (group DES), provided its noninferiority in terms of major adverse cardiac events (MACE) at 1 year. Method(s): This is a prospective, multicenter, randomized controlled trial performed in 4 centers. The trial has been registered at clinicaltrials.gov (NCT04382443). Study protocol and informed consent have been approved by an Independent Ethical and Review Board Committee and were presented to Argentina National regulatory authorities for Health, Technology and Medications. Patients in the BMS+C group received 0.5mg oral doses twice a day of colchicine for 3 months. Outpatient visits were scheduled at 1, 3, 6 and 12 months as well as at 3 and 5 years. Primary endpoints were to compare cost-effectiveness and MACE defined as composite of death, myocardial infarction (MI), cerebrovascular accident and ischemia-driven target vessel revascularization. Result(s): During February 2020 to April 2022, 412 patients with clinically indicated PCI were randomized in the study. Because 2 patients with COVID 19 at the time of randomization were excluded, the final study population was composed of 410 patients (205 patients in each group). Baseline demographic and angiographic characteristics were well balanced diabetes 19.5% vs 21.4%, Acute Coronary Syndromes 78% vs 75%, ST elevation MI 23% vs 21% multiple vessel CAD 44% vs 46%, culprit left anterior descending artery 58% vs 57.8%, peripheral vascular disease 3.4% in BMS+C and DES groups respectively.2.9% of patients in BMS+C didn't complete the treatment for side effects (diarrhea). Presently, patients were follow at mean of 381 days ( range 45 to 839),1 - year follow-up was completed in 61%. Conclusion(s): A 3-month treatment with colchicine after PCI with BMS was feasible and safe. Final 1- year clinical outcomes and cost-effectiveness results will be available at the time of presentation.

4.
Diabetic Medicine ; 40(1) (no pagination), 2023.
Article in English | EMBASE | ID: covidwho-2192522
5.
Colorectal Disease ; 23(Supplement 2):135, 2021.
Article in English | EMBASE | ID: covidwho-2192491

ABSTRACT

Aim: Telephone appointments have replaced face-to- face hospital clinic appointments due to the Covid-19 pandemic. We evaluated the impact of telephone appointments on patients referred on a two week-wait (2WW) suspected lower gastrointestinal tract (LGIT) cancer pathway. Method(s): Two independent patient samples between the 01/06/2019-31/ 10/2019 (face-to- face cohort) and 01/06/2020-31/ 10/2020 (telephone cohort) were identified using a prospectively maintained local database and electronic patient records. Data were retrospectively collated using Excel (Microsoft, USA). Chi-square and Man-Whitney- U statistical tests were performed using SPSS (IBM, USA). Result(s): A total 1531 (median age = 70, interquartile range [IQR] = 60-79, female = 679, 44.4%) were analysed. Of these, 757 (49.4%) were assessed via telephone;the remainder were face-to- face (n = 774,50.6%). The age, gender and ethnicity distributions across the two groups were similar. A total of 92 (6%, telephone = 44, face-to- face = 48) patients had malignant pathology and 64 (4.2%) were colorectal cancer (CRC). Of those with a CRC diagnosis, 46 (3.0%, telephone = 26, face-to- face = 20) underwent surgical or endoscopic treatment with curative intent. There was no significant difference in diagnoses made (P = 0.749) or treatment of CRC (P = 0.785) following telephone versus face-face- appointments. The median waiting times for index appointment, investigation and diagnosis for telephone appointments were significantly lower compared to face-to- face appointments (P < 0.001). There was no significant difference in median time to index treatment for CRC between the two groups (P = 0.156). Conclusion(s): Patients referred to 2WW LGIT clinics were efficiently and safely assessed and manged using telephone clinics during the Covid-19 pandemic. The cost-effectiveness and stakeholder views on permanent use of telephone assessments in these clinics must be evaluated.

6.
Open Forum Infectious Diseases ; 9(Supplement 2):S385, 2022.
Article in English | EMBASE | ID: covidwho-2189677

ABSTRACT

Background. Improper utilization of antimicrobials has impacted clinical outcomes in patient care and economical costs. Pediatric antimicrobial stewardship (Ped ASP) lowers healthcare costs by promoting efficient and judicious use of antimicrobials which improves patient outcomes and amends resource utilization. The objective of this study is to evaluate the cost-effectiveness of a Ped ASP in a non-freestanding children's hospital within an adult-centered tertiary hospital. Methods. We conducted a cost-effective analysis of our Ped ASP within a 685-bed, adult-centered medical center. Impacted by the COVID pandemic, the pediatric services reduced from 21 to 14 beds with 10 general pediatrics (PED) and 4 pediatric intensive care (PICU) beds. Our Ped ASP activities include thrice-weekly chart reviews followed by handshake rounds and quarterly reviews of documented interventions. The preset values of antimicrobial-specific interventions in the Electronic Medical Record system were utilized. An average cost savings of $732 (range: $2.5 - $2,640) per patient as determined by previous studies was used to calculate the annual cost savings. Results. During years 2020 to 2021, antibiotic days of therapy per 1000 patient days (DOT) decreased from 290.4 to 100.2 in PED but increased from 433 to 569.1 in PICU. The ratio of broad to narrow-spectrum antibiotics decreased from 0.46 to 0.20 in PED and 0.69 to 0.63 in PICU. In 2020, 286 reviews were completed of 155 patients which projected an average cost savings of $113,460 (range: $387.5 - $409,200). In 2021, 256 reviews of 116 patients projected an average cost savings of $84,912 (range $290 - $306,240). An estimated overall annual cost-savings was $99,186. The total number of ASP-specific interventions in 2020 and 2021 were 172 and 146 with projected pharmacy intervention values of $26,354 and $19,170 respectively. Conclusion. Our Ped ASP effectively reduces the usage of broad-spectrum antibiotics in both PED and PICU demonstrating cost savings. Implementing antibiotic time-out reports on specific broad-spectrum antibiotics based on local susceptibility data may further enhance the safety and appropriateness of antimicrobial therapy.

7.
Xenobiotica ; 52(8):786-796, 2022.
Article in English | EMBASE | ID: covidwho-2186781

ABSTRACT

Paxlovid, a drug combining nirmatrelvir and ritonavir, was designed for the treatment of COVID-19 and its rapid development has led to emergency use approval by the FDA to reduce the impact of COVID-19 infection on patients. In order to overcome potentially suboptimal therapeutic exposures, nirmatrelvir is dosed in combination with ritonavir to boost the pharmacokinetics of the active product. Here we consider examples of drugs co-administered with pharmacoenhancers. Pharmacoenhancers have been adopted for multiple purposes such as ensuring therapeutic exposure of the active product, reducing formation of toxic metabolites, changing the route of administration, and increasing the cost-effectiveness of a therapy. We weigh the benefits and risks of this approach, examining the impact of technology developments on drug design and how enhanced integration between cross-discipline teams can improve the outcome of drug discovery. Copyright © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

8.
New Journal of Chemistry ; 2022.
Article in English | EMBASE | ID: covidwho-2186152

ABSTRACT

The separation of highly pure single-chirality single-walled carbon nanotubes (SWCNTs) is challenging and also in demand due to their intrinsic physical, optical, and electronic properties. The use of single-chirality and their performance characteristics makes them a selective candidate for multifunctional applications and opens a new front in nanotube development. It has previously been reported that SWCNTs can be separated in various ways by employing direct control and post-synthesis approaches. Herein, we review the separation of single-chiralities of SWCNTs on account of simplicity and time/cost effectiveness by using gel chromatography. The most recent progress in the controlled synthesis of SWCNTs is comprehensively reviewed in terms of selective-diameter, single-chirality, and specific geometric shape. The method to achieve the single-chirality of SWCNTs is also highlighted. Besides addressing COVID-19 characteristics, epidemiology, and pathology, we also review the most recent developments in nano-biosensors for the rapid and early detection of COVID-19. Furthermore, the photothermal/bioimaging response of single-chirality is reviewed in order to enhance the cytotoxicity of drugs against cancer cells over simple carbon nanotubes (CNTs). The single-chirality allows for precise imaging (due to efficient absorption and emission) of tumors/blood vessels up to ~10-fold higher by injecting a low dose. We hope this review stimulates further study on single-chirality controlled SWCNTs for practical applications. Copyright © 2023 The Royal Society of Chemistry.

9.
Nurse education in practice ; : 103514, 2022.
Article in English | EMBASE | ID: covidwho-2181807

ABSTRACT

AIM: To explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy. BACKGROUND: The global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for pre-registration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere. DESIGN: Cross-sectional, sequential, mixed methods study PARTICIPANTS/SETTINGS: Nursing/nurse education leaders from across International Council of Nurses regions METHODS: Exploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants' knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes. RESULT(S): Participants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation. CONCLUSION(S): Blended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact. TWEETABLE : Blended learning plays an effective part in the education of pre-registration nursing and midwifery students to help tackle global workforce shortages, but further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

10.
Value in Health ; 25(12 Supplement):S140, 2022.
Article in English | EMBASE | ID: covidwho-2181123

ABSTRACT

Objectives: Cardiac rehabilitation (CR) is recognised as a cost-effective intervention which can be offered to people following a cardiac event. Home-based alternatives are being increasingly used (versus centre-based options), particularly since the COVID-19 pandemic. This study aimed to assess whether home-based interventions in the CR pathway have been demonstrated to be cost-effective, compared to conventional centre-based delivery, in a population undergoing CR. Method(s): Electronic searches of the PsycINFO, MEDLINE and Embase databases (via Ovid) were conducted to identify relevant published full economic evaluations. Studies were included if they reported a full economic evaluation of home-based CR programmes or an intervention that may be classed as an individual aspect of a comprehensive home-based CR programme, compared to centre-based CR options. The review was restricted to English language studies published within the last 15 years. The protocol was registered on the PROSPERO database (CRD42018108226). Result(s): Database searches identified 2,572 initial records (1,865 after the removal of duplicates). Following screening of titles/s, 53 full-text articles were assessed. Nine studies were included in the review. Interventions were heterogeneous in terms of delivery, components of care (e.g. exercise and behaviour change) and duration. All studies were economic evaluations alongside clinical trials, with sample sizes ranging from 53 to 778. All studies reported quality-adjusted life-years (QALYs), with the EQ-5D as the most common measure of health status (6/9 studies). Most studies (7/9 studies) concluded that home-based CR was cost-effective compared to centre-based options. Conclusion(s): Evidence suggests that home-based CR is cost-effective, which is particularly pertinent given the need for non-centre-based options following the COVID-19 pandemic. There were some limitations to the evidence base, including sample size and limited time horizons. Given heterogeneity in intervention design and delivery, future research is needed to investigate patient preferences for CR intervention and the cost-effectiveness of different modes of delivery. Copyright © 2022

11.
Value in Health ; 25(12 Supplement):S131, 2022.
Article in English | EMBASE | ID: covidwho-2181122

ABSTRACT

Objectives: Antimicrobial resistance is a critical public health issue in Greece, which has worsened during COVID-19 pandemic due to antibiotic overuse. The present study assesses the cost-effectiveness of ceftolozane/tazobactam(C/T) in ICU-admitted ventilated hospital-acquired bacterial pneumonia (vHABP) and ventilator-associated bacterial pneumonia (VABP) due to Multiple Drug Resistant Pseudomonas Aeruginosa in Greece. Method(s): The model is based on data from ASPECT-NP Phase-3 study and PACTS surveillance data from Italy. The model consists of two parts: a decision-tree, depicting the period from vHABP/VABP diagnosis to hospital discharge and a Markov model, projecting long-term outcomes following hospital discharge. The model calculates costs and outcomes within a 40 years' time-horizon. Costs and QALYs are discounted at an annual rate of 3.0%. Outcomes included Incremental Cost Effectiveness Ratio(ICER), Quality Adjusted Life Years (QALY's) and Life Years (LY's) for each comparator as well as hospital resource use and mortality (for each comparator).The comparator used in the base case analysis was Meropenem. A deterministic sensitivity analysis (DSA) was performed to test the parameters with the greatest impact on the ICER and a Probabilistic Sensitivity Analysis (PSA) was run to test the robustness of the results. Result(s): Patients who received C/T spent 1.97 days less (17.99 days) with mechanical ventilator support compared to Meropenem 19.97 days with mechanical ventilator support. Patients in the treatment arm with Meropenem are expected to have 8.66 LY's and 7.11 QALY's with a cost of 33,896. Whereas patients in the C/T arm are expected to have 10.18 LY's and 8.34 QALY's at a cost of 35,135. The ICER for C/T was 994 per QALY compared to Meropenem. C/T showed a 99.94% probability of being cost effective at a threshold of 52,770 per QALY (3x Greek- GDP per capita). Conclusion(s): The present study suggests that Ceftolozane/Tazobactam is a cost-effective treatment for Greek vHABP/VABP patients. Copyright © 2022

12.
Value in Health ; 25(12 Supplement):S1, 2022.
Article in English | EMBASE | ID: covidwho-2181119

ABSTRACT

Objectives: The COVID-19 pandemic dramatically highlighted health inequities and the differential impact that vaccination can have on health, depending on social advantage. In a non-pandemic setting, vaccination can improve equity, but this broader value of vaccination is not currently considered in health economic analysis despite equity being a policy priority in many countries. Method(s): A panel of health economists and policy experts convened to discuss how to capture the equity dimension of the value of vaccination. This was conceptualized using a distributional cost-effectiveness analysis framework with four steps leading to differential health impact: (i) differences in vaccine preventable disease incidence;(ii) differences in the vaccination uptake;(iii) differences in health effects;and (iv) differences in health opportunity costs. The concept was illustrated by a retrospective modelling exercise of 4-component meningococcal serogroup B (4CMenB) infant vaccination against serogroup B invasive meningococcal disease (MenB) in England, for which an existing model was adapted. Five social groups were analysed based on Index of Multiple Deprivation Quintiles (IMDQ). Result(s): 4CMenB infant vaccination disproportionately prevented MenB cases among more deprived groups: of all prevented cases, 40.3% were among the most deprived IMDQ (accounting for 25.9% of the target population <5 years of age) and 78.1% among the three most deprived IMDQs. Vaccination had a positive, though small, net equity benefit, and the direction of equity impact was robust to sensitivity analyses varying the distribution of uptake, MenB carriage prevalence, and assumptions related to life expectancy and utility stratified by IMDQ. Conclusion(s): Within a national immunisation programme, 4CMenB vaccination improves health equity by preventing disproportionately more cases in more socially disadvantaged groups. The health equity impacts of vaccination can be captured in health economic evaluation although there is a need to improve the evidence base and develop more user-friendly equity impact measures. Copyright © 2022

14.
Current Topics in Medicinal Chemistry ; 22(21):1729-1730, 2022.
Article in English | EMBASE | ID: covidwho-2141243
15.
British Journal of Surgery ; 109(Supplement 5):v138, 2022.
Article in English | EMBASE | ID: covidwho-2134882

ABSTRACT

Background: The current Surgical training is severely affected by COVID-19 pandemic with redeployment and reduced number of elective procedure across NHS hospitals, this has affected both core and higher Surgical trainees, rendering The traditional apprenticeship model obsolete. It became evident that The future of Surgical training and innovation will require a combination of simulation and operative exposure to overcome The obstacle of reduced exposure in Surgical education and operative training. Discussion(s): In our theoretical analysis, we will discuss The efficacy, safety and impact of relying on SBL to fill The gaps in Surgical training. Clinical exposure alone will not be sufficient to train procedure based speciality trainees to their highest proficiency. SBL is one design that is supported by learning theories such as Transformational Learning and Experiential Learning Theory. Ina highfidelity simulation, such as laparoscopic simulation courses, all concepts of facilitated learning are fulfilled which strongly supports our hypothesis. on balance, given The complexity of skills learnt, it remains difficult to measure The efficacy of transferring The learnt capabilities into practice and standardise this among learners. SBL also leaves non-technical skills un-assessed in depth. Conclusion(s): The disruption of training due to COVID-19 affected our procedure based learning, this leaves us with a dilemma to catch-up with these unmet training needs. SBL could be one of The adjuncts that fill in The gaps on The short and medium term. Implementing SBL in Surgical training curriculum, should be evaluated for efficacy and cost effectiveness.

16.
Open Respiratory Archives ; 4(4) (no pagination), 2022.
Article in English, Spanish | EMBASE | ID: covidwho-2132007

ABSTRACT

The intermediate respiratory care units (UCRI) are areas of monitoring and specialized care of patients with acute or chronic-exacerbated respiratory failure, whose severity does not require admission to an intensive care unit, but which due to their complexity cannot be treated in conventional hospitalization. Although the COVID-19 pandemic has proven its usefulness in the management of critical respiratory patients, the historical trajectory of the UCRI comes from many years ago, in which its cost-effectiveness has been demonstrated by far. This document presents a series of questions and answers on the history of the UCRI, in addition to the criteria for admission, infrastructure, human and technical resources, and the types of existing Units. Within the UCRI year 2021-2022 designated by the Spanish Society of Pneumology and Thoracic Surgery, any scientific dissemination linked to the in-depth knowledge of these units is timely, where multidisciplinarity and the work of professionals related to the care of critical respiratory patients converge. Copyright © 2022

17.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128138

ABSTRACT

Background: Both de-novo and relapse of Acquired Haemophilia A (AHA) have been reported following SARS-CoV- 2 infection and vaccination suggesting virus-induced immune dysregulation as a potential mechanism. The current standard of care in the potentially fatal AHA, requires the use of bypassing agents (BPA) or porcine FVIII to achieve haemostasis and immunosuppression to suppress autoantibody production. The bispecific antibody emicizumab now offers the possibility to achieve the former and reduced need for the latter but is only approved solely for use in congenital haemophilia A. Aim(s): We present a cluster of three AHA cases presenting between April to June 2021 at a single tertiary centre. Notably each patient received recent BNT162b2(Pfizer) vaccination. Method(s): Bypassing therapy and steroids were commenced with response in two cases. One case remained refractory to BPA, porcine FVIII, steroids and Azathioprine. Approval was sought for a subcutaneous biweekly injection of Emicizumab in order to avoid rituximab during the pandemic. Result(s): In 10 months since initiation of emicizumab, no further bleeding and no thrombotic events have been reported. Factor VIII (chromogenic) is now detectable in all patients. Conclusion(s): The close interaction between SARS-Cov- 2 and the haemostatic system has been evident in the COVID era. The unusual clustering of cases presented here suggests that antibody responses to SARS-Cov- 2 infection or vaccine may cross-react with coagulation factors resulting in the immunohematological phenomenon of AHA. Furthermore, to our knowledge this is the first use of Emicizumab in acquired haemophilia in the post-partum period. As well as providing excellent haemostatic efficacy and potential cost-effectiveness, emicizumab provides several advantages for a new mother during the COVID-19 pandemic. These include a return to home, contact with family and minimal attendance at hospital as well as avoiding immunosuppression conferring increased risk of infection and loss of protection from vaccinations. We note the recent application for use of emicizumab in AHA.

18.
Journal of the American Society of Nephrology ; 33:321, 2022.
Article in English | EMBASE | ID: covidwho-2126219

ABSTRACT

Background: Hemodialysis (HD) patients are at increased risk for COVID-19 infection, hospitalization, and mortality. Early COVID-19 diagnosis is thus critical to mitigate SARS-CoV-2 spread and improving patients' health outcomes. Generally, nasopharyngeal (NP) specimens are considered the most sensitive biological samples to diagnose SARS-CoV-2 infections. However, NP swabbing is considered uncomfortable by most patients, and it requires health professionals, thus impacting its cost-effectiveness. In a previous proof-of-principle study, we demonstrated that face masks worn by in-center HD patients can harbor SARS-CoV-2. In this Kidney-X funded study, we determined efficiency of face mask testing by comparing results to saliva specimen collected from same individuals. Method(s): Disposable 3-layer masks were provided to each subject at the time of entering the dialysis center. Masks were collected 4 hours after worn. Saliva was collected using Salivette kit at the time of mask collection. RT-PCR based testing were performed using Thermo Fisher COVID-19 Combo Kit (A47814). Result(s): We collected 179 pairs of saliva/masks, 114 from 42 dialysis staff and patients without recent COVID-19 infection (control group), and 65 from 30 HD patients with COVID-19, diagnosed by NP RT-PCR (COVID-19 group). Patients provided 1 to 7 sample pairs on average 11+/-8 days (0 to 36) after COVID-19 diagnosis. Thirty-one of the 65 sample pairs were SARS-CoV-2 positive either in the saliva or the mask samples (26 positive saliva;20 positive masks). Saliva and mask testing sensitivities were 84% and 65% with a mean cycle threshold (CT) of 31.8 and 32.2, respectively. Fifteen pairs tested positive for both worn masks and saliva. Mask and saliva CT values did not differ significantly. Of note, in 5 sample pairs saliva tested negative while masks tested positive. In the control group, all 114 saliva samples tested negative;one mask tested weakly positive, resulting in saliva and mask testing specificities of 100% and 99%, respectively. S gene dropout was observed in all positive samples, indicating Omicron BA.1 infection. Conclusion(s): While the sensitivity of mask testing is less compared to saliva testing, its operational ease, lack of patient discomfort, seamless repeatability, and lower costs make it a viable option for SARS-CoV-2 screening.

19.
British Journal of Surgery ; 109(Supplement 5):v31, 2022.
Article in English | EMBASE | ID: covidwho-2134900

ABSTRACT

Aims: Measure performance and cost effectiveness of a Virtual Consultation (VC) clinic, compared to face-to-face (FF) clinic, for 2-week-wait (2WW) colorectal Cancer (CRC) referrals, which did not meet The criteria for nurse-led Telephone Assessment Service. Method(s): 2WW CRC referrals were triaged by a colorectal surgeon to either a doctor-led VC or FF clinic. Demographics, referral indications, and primary outcome measures (time to clinic/results;investigation type;Cancer detection rate) were compared pre-pandemic (November 2019-January 2020) and during The pandemic (May-June 2021). Result(s): 158 (pre-pandemic) and 160 (pandemic) consecutive patients were analysed, with no difference in age (74 vs. 75 years, p=0.936). During The pandemic, patients were referred with an increased number of positive FIT tests (29 vs. 13%, p<0.001), were more likely to have computerised tomography (65 vs. 45%, p=0.003), had a longer time from referral to clinic assessment (10 vs. 8 days, p=0.002), but were informed of results more promptly (59 vs. 138 days, p<0.001) than pre-pandemic patients. During The pandemic patients were assessed earlier via VC than FF clinics (9 vs. 11 days, p=0.049). There were no significant differences in Cancer detection rate pre or during The pandemic (12 vs. 8%, p=0.187), or between VC and FF clinic during The pandemic (6 vs. 12%, p=0.294). Cost effective analysis showed 15,000 per annum saving with doctor-led VC clinic. Conclusion(s): Virtual consultation for 2WW CRC referrals may improve efficiency without compromising The Cancer detection rate, as well as reducing risk of Covid-19 transmission and being more cost effective.

20.
British Journal of Surgery ; 109(Supplement 5):v140, 2022.
Article in English | EMBASE | ID: covidwho-2134896

ABSTRACT

Aim: To determine The efficacy of single layer bowel repair with respect to postoperative complications such as leakage rates, duration of repair, overall length of hospital stay, cost effectiveness, to assess The morbidity, mortality and outcome. Method(s): This prospective study was done on 21 patients admitted under Department of Surgery from The period of January 2020 to September 2021. All The patients under bowel repair in continuous single layer extramucosal fashion for various etiology, follow up data was collected and analysed. Result(s): In our study, 81% (17 cases) of The single layer bowel repair were done in an Emergency setting. The study consisted of 42.9% (9 cases) of perforation repair and 57.1% (12 cases of resection and anastomosis of large or small bowel). The average time duration of anastomosis was 14.45 minutes with The average hospital stay of 13.2 days. Our study showed an anastomotic leak rate of 9.5% (2 cases) with an overall mortality of 19.04% (4 cases) which included 2 cases with COVID-19 related ARDS. Conclusion(s): Our study was determined to analyse The effectiveness of single layer bowel repair and found that it is a quicker and theoretically better technique for bowel repair which avoids unnecessary tissue ischemia. The leakage rates within The study was comparable with other studies published and The studies with double layer bowel repair technique in terms of leak rates and mortality. A meticulously done single layer repair will best double layer repair and Surgical trainees must be trained early to perfect The art of bowel anastomosis.

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