Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 746
Filter
1.
American Journal of Public Health ; 112(8):1089-1091, 2022.
Article in English | ProQuest Central | ID: covidwho-1958134

ABSTRACT

t is well established that socioeconomic and demographic factors, such as race and ethnicity, income, and education, are independently linked to health disparities.1 Tools that combine multiple socioeconomic and demographic variables into an overall rank, such as the Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) Social Vulnerability Index (SVI), provide a quantitative framework that can be used by policymakers to identify communities that have higher overall social vulnerability with regard to disparate health outcomes and living conditions across multiple factors, and to develop targeted interventions.2 Historically, the SVI and similar frameworks have been crafted for emergency preparedness and response and used for study and practice in more extreme natural and human-caused disaster scenarios. Over the years, the SVI has been used for public health research and practice, communications, and accessibility planning, and to target geographically specific interventions related to natural disasters such as flooding and hurricanes,3, human-caused events such as chemical spills,2 and disease outbreaks like the recent COVID-19 pandemic.4 However, addressing issues of health inequity attributable to environmental injustice is imperative, and should not be restricted to alleviating the impact of event-specific hazards. Environmental injustice in the built environment is often associated with the disproportionate placement of hazardous and industrial sites and polluting transportation infrastructure in socially vulnerable neighborhoods,5 where residents often lack the social or economic capital to influence policy decisions.6 Although existing research links housing and health equity,7 the impact of poor housing conditions and household exposures to lead, pests, and indoor air pollutants on the health and well-being of socially vulnerable populations is an important and often overlooked aspect of environmental injustice.7,8 The Environmental Protection Agency's definition of environmental justice is all-encompassing and espouses the idea that environmental justice is only achieved when "everyone enjoys: The SVI has already been used outside the realm of disaster management to better characterize obesity10 and physical fitness.11 Hollar et al. set a new precedent for the value it may bring to the environmental justice sector, and additional research should be done to understand its utility in identifying communities that may be more likely to experience other socially linked conditions associated with environmental injustice, such as routine exposure to indoor and outdoor environmental pollutants, chronic disease burden, poor working conditions, lack of greenspace, and other issues with the built environment, in addition to housing conditions.

2.
Webology ; 19(2):4593-4603, 2022.
Article in English | ProQuest Central | ID: covidwho-1957928

ABSTRACT

In the modern business environment, there is an evident mismatch of the skills possessed by individuals and those businesses are sourcing. Despite business leaders ensuring automation, digitisation and extraction of value of data (for example by artificial intelligence) are core organisational priorities, the workforce should still be in a position to complement the value of technology. The rising popularity of technology has impacted the manner in which knowledge is acquired. This is particularly important for the Millennials and Generation Z who are currently transitioning to the new world of work and largely acquiring knowledge through the internet. However, the COVID-19 pandemic has upset the balance of this new world of work, involving business, digital technologies and new ways of working. The solution to a successful transition by Millennials and Generation Z requires embracing technology and upgrading training programmes. Therefore, this paper has identified the best practice in using digital learning to harness the transition to the new world of work. Also, this paper has evaluated on the ways in which the markets evolve or change over time. It has been pointed out that their implications would include varying employment markets, changing demands and supplies for skills, and demographic trends (Millennials and Generation Z.) The current COVID-19 pandemic has been noted to have an impact on the labour markets today and in future.

3.
Turk Geriatri Dergisi ; 25(2):230-235, 2022.
Article in English | EMBASE | ID: covidwho-1957656

ABSTRACT

Introduction: To investigate the effects of the COVID-19 pandemic on epidural steroid injection treatment in elderly patients and to inform our colleagues to take possible precautions concerning treatment strategies. Materials and Methods: Retrospectively, patients who received lumbar epidural steroid injections between January 2019 and March 2021 were included in the study. The procedures performed between January 2019 and January 2020 before the pandemic were classified as Group A, and those performed during the pandemic period between March 2020 and March 2021 were classified as Group B. Demographic data, baseline pain scores, and waiting times for procedures and medical treatments in both groups were compared. Results: There were 186 and 81 patients in groups A and B, respectively. The mean age was 74 in Group B and 73 in Group A. Lumbar spinal stenosis and disc herniation were the most common diagnoses in both groups. The waiting time for epidural steroid injection was 39.4 days (0–160) in group B and 23.4 days (0–149) in group A. There was no significant difference between the two groups in terms of medical treatment for neuropathic pain. Conclusions: COVID-19 has caused a significant decrease and delay in the number of epidural procedures related to lower back pain in elderly patients. In the future, this decrease may create a burden on the health system. However, more observational and prospective studies are needed to inform our colleagues about the possible effects of COVID-19 on the elderly.

4.
Signa Vitae ; 18(4):15-23, 2022.
Article in English | EMBASE | ID: covidwho-1957639

ABSTRACT

The COVID-19 pandemic has affected trauma practices all over the world. Despite the increasing number of studies focused on the epidemiology of vertebral fractures (VFs) in COVID-19 patients, the impact of the pandemic on the incidence of trauma pathologies at the emergency department (ED) remains unclear. In Spain, very few studies have explored how the pandemic has affected the care of patients with osteoporotic vertebral fracture (OVF) in the ED and on their follow-up. The aim of this work is to evaluate the impact on the demand for care and diagnosis of VF during the COVID-19 pandemic, as well as the repercussions on patient follow-up. A longitudinal retrospective observational study was designed comparing two cohorts (pre-COVID and COVID) of patients for whom an emergency computed tomography scan was requested due to suspected vertebral fracture. Information was gathered on patient demographics, number and type of OVFs, time of day at which the diagnosis was made, follow-up, and treatment received. Comparative analyses were performed between both patient groups, with stratification by time intervals according to the pandemic waves in the COVID cohort. A total of 581 eligible patients were included in the study. The analyzed cohorts included 288 patients (145 and 143 in the pre-COVID and COVID cohorts, respectively), with a mean age of 73.4 ± 13.8 years and 205 (71.4%) women. No significant differences were observed on most measured variables. In the COVID cohort, the group of patients who received follow up care had a significantly lower mean age than the group that did not receive follow up care (70.2 ± 12.7 vs 76.2 ± 14.1 years, respectively, p = 0.008). In conclusion, the COVID-19 pandemic has had little impact on the diagnosis and management of patients with OVF in our hospital. This could be explained by the specific characteristics of OVFs and the type of patients it affects. Our study has some limitations, mainly derived from its retrospective and single-center nature with a short follow-up interval.

5.
Open Public Health Journal ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1957131

ABSTRACT

Background: During the past two years, a new health crisis that affected the world was the emergence of the novel coronavirus disease 2019 (COVID-19). Currently, most health challenges and problems are mainly due to behavioral factors, so identifying these factors can play an important role in promoting public health. Therefore, this study was designed and conducted to investigate Iranians’ attitude, practice, and perceived self-efficacy towards COVID-19 preventive behaviors. Method: This descriptive-analytical study was conducted online among 387 Iranian cyberspace users selected by convenience sampling method and invited through social media messaging apps (Telegram, WhatsApp). The data gathering tool was a researcher-made questionnaire divided into 4 parts (demographic information, items related to attitude, practice, and perceived self-efficacy). The validity of the questionnaire was confirmed by the content validity ratio (CVR) and content validity index (CVI) and its reliability by Cronbach's alpha. Kolmogorov-Smirnov, Mann-Whitney, analysis of variance, Pearson’s correlation, and linear regression tests were used to analyze the collected data. Results: The results of the Pearson’s test showed that there was a direct and significant correlation between the participants’ attitude with practice (r = 0.23, p <0.001) and perceived self-efficacy (r = 0.21, p <0.001) regarding coronavirus preventive behaviors. There was also a direct and significant relationship between self-efficacy and practice (r = 0.46, p <0.001). The results of univariate regression test also showed that occupation (p=0.002, β=-0.16), marital status (p = 0.003, β=-0.15), attitude (p <0.001, β=0.23), and self-efficacy (p <0.001, β = 0.45) are predictive and influential variables of the participants’ practice towards coronavirus preventive behaviors. Conclusion: Various factors affect people's practice in relation to preventive behaviors. Paying attention to people's attitudes and self-efficacy can be considered in policies related to improving people's performance as well as planning future interventions to promote coronavirus preventive behaviors.

6.
Sexually Transmitted Infections ; 98:A73-A74, 2022.
Article in English | EMBASE | ID: covidwho-1956943

ABSTRACT

Introduction Services had to rapidly adopt new ways of working following the onset of the COVID-19 pandemic. Face to face (F2F) appointments had to be rationalised and virtual or non-face to face (non-F2F) options adopted. There was no time to consult service users before these changes were implemented. It is therefore important to seek feedback and evaluate experience and acceptability of these changes in service provision. Methods A questionnaire to measure patient experience and acceptability of non-F2F consultations was developed as part of a fourth year medical student project and launched on-line in January 2022, accessed via a QR code. Results 100 fully completed questionnaires were available for analysis. Preliminary analysis of the data are as follows Demographics Age (years) >45 21% The majority of respondents were white British (81%) and female (65%). Responses as to preference for future consultations: 68.7% Preferred F2F appointments, 28.9% no preference and only 2.9% selecting non-F2F Discussion The perception has been that people prefer non- F2F contacts for convenience. The majority (76%) were happy/neutral with non-F2F appointments as long as there was an option to come into clinic. Concerns were raised in the comments section regarding privacy whilst taking the call. Ongoing consultation with service users will be needed to review any future changes in provision of Sexual Health/HIV services. (Table Presented).

7.
Sexually Transmitted Infections ; 98:A71, 2022.
Article in English | EMBASE | ID: covidwho-1956940

ABSTRACT

Introduction Our service switched routine PrEP consultations to telephone appointments from May2020 due to the Covid- 19 pandemic. We undertook an audit of revised service, on patients first prescribed Emtricitabine/Tenofovir as HIV preexposure prophylaxis (PrEP) in August/September2021. Methods Retrospective review of electronic patient records conducted on first 60 patients attending PrEP start appointment from 02/08/21-22/09/21. Demographics, referral pathway, tests performed, vaccine status and prescription outcome recorded. Results compared to national BHIVA/BASHH and service guidelines. Results 10 patients excluded: 8 on NHS-PrEP already, 2 failed criteria and did not start PrEP. All 50 patients were cis-men who have sex with men, 14% bisexual. Median age 25- 34years (range:16-55+). 93%(26/28) of documented patient ethnicity was white. Self-referrals accounted for 46%(15/33) of documented referral-routes. 25(50%) patients waited ≥2months for appointment. 46 patients prescribed NHS-PrEP met recommended BHIVA/BASHH criteria, 4(8%) failed criteria and to self-source. 36(72%) patients met BHIVA/BASHH guidelines for HIV testing, negative in 4weeks before first appointment(BFA). 73%(24/33) of patients with HIV risk after testing had repeat within 6weeks. In 3months BFA, 45(90%) patients had sexual health screen (SHS) and 26(52%) patients received hepatitis B&C testing. In 4months after, 39%(7/18) repeated hepatitis B, 54%(7/13) hepatitis C tests. 94%(29/31) patients requiring vaccinations agreed to receive. 48(96%) patients had eGFR checked in 6months BFA, no eGFR<60. Discussion Our service ensures patients meet recommended criteria for NHS-PrEP prescription and undertake renal testing and SHS. Vaccines initiated for most patients in need. Proportion of patients receiving baseline hepatitis B&C testing requires improvement. Patient pathways are being reviewed to ensure testing 2-3weeks BFA.

8.
Sexually Transmitted Infections ; 98:A65, 2022.
Article in English | EMBASE | ID: covidwho-1956938

ABSTRACT

Introduction The COVID-19 pandemic precipitated widespread implementation of telemedicine. Initial evaluation of our telemedicine service found high satisfaction rates [1]. Anticipating continuing demand for remote services we undertook a further patient survey, gauging shifting attitudes towards telemedicine. Methods We sent an anonymised, on-line survey to all patients who received telephone consultations in a six-week period (08/02/22- 22/3/22). We collected demographic data, reasons for consultation and patient satisfaction, using the standardised telemedicine satisfaction questionnaire [2]. Results 275 responses were received (∼10% response rate). 80.4% of respondents were female. 50.5% of consultations were for contraception. 60.3% of GUM consultation respondents were female. The modal age group was 30-44 years in both categories. 65.5% of patients chose an initial telephone consultation as their preferred modality, compared to 22.9% preferring walk-in-clinics. 44% of all patients surveyed would prefer not to share genital images for remote assessment in theory, however only 16.7% of the subgroup actually asked to send an image (n=18) expressed the same. Only 22% preferred video consultations. 80% reported that they were 'overall happy' with their telemedicine consultation (agree/strongly agree). Discussion Telemedicine is more convenient for many patients, cost effective, clinically efficient and aligned to the NHS global impact agenda. It is fast becoming an integral part of modern healthcare. Survey data may disproportionately represent more engaged and technologically literate patients. However, it also has the potential to engage previously unreached patient groups. This survey supports a permanent role for telemedicine. We will continue to integrate patient feedback to build a high quality, sustainable service.(Table Presented).

9.
Sexually Transmitted Infections ; 98:A62, 2022.
Article in English | EMBASE | ID: covidwho-1956933

ABSTRACT

Introduction Men and gender diverse people who have sex with men (MGDSM) are at higher risk of sexually transmitted infections (STIs). COVID-19 related lockdown restrictions at the beginning of the pandemic might have altered their sexual behaviours and thus their susceptibility to STIs. We examined the impact of the first UK-wide lockdown on sexual behaviours and explored factors related to casual sexual activity at the time when it was discouraged by official guidelines. Methods In April-May 2020, we conducted an online 40-item survey, promoted on social media and Grindr, which assessed engagement in various sexual activities, anxiety about COVID- 19 and relevant demographic factors. We performed regression analyses to identify changes in sexual behaviour during the lockdown and characteristics of those who engaged in casual sex. Results Out of 1429 respondents (mean age=36, 84% White), 76% reported not having any casual sex, 12% engaged in casual sex with only one person and 5% with four or more sexual partners during lockdown. Reporting casual sex during lockdown was associated with: lower level of education OR=2.37[95%CI:1.40-4.01];identifying as a member of an ethnic minority OR=2.27[1.40-3.53];more frequent (daily) usage of sexual networking apps OR=2.24[1.54-3.25];being less anxious about contracting COVID-19 through sex OR=1.66[1.12-2.44];using PrEP before lockdown OR=1.75 [1.20-2.56];continuing to use PrEP OR=2.79[1.76-4.57];and testing for STIs during lockdown OR=2.65[1.76-3.99]. Discussion Three-quarters of respondents ceased sexually activity with casual sex partners and those sexually active were also more likely to use PrEP and utilise sexual health screening, which may partially explain the temporary decline in STIs.

10.
Sexually Transmitted Infections ; 98:A59-A60, 2022.
Article in English | EMBASE | ID: covidwho-1956930

ABSTRACT

Background Pelvic inflammatory disease (PID) usually results from infection ascending from the endocervix. The British Association for Sexual Health and HIV guidelines state that the diagnosis of PID should be considered in women under 25 with recent onset, bilateral lower abdominal pain and local tenderness on bimanual examination where pregnancy has been excluded. They recommend testing for chlamydia, gonorrhoea and mycoplasma genitalium. Method Electronic patient records were reviewed to identify episodes coded C5A during the last six months of 2019 and 2020. 46 patients were identified in 2019 and 43 in 2020. The following were recorded: demographics, symptoms, sexual history, examination findings, investigations, treatment, partner notification, follow-up. Results The age range of the 89 patients was 18-62, 51% were aged 25-34. Patients came from a range of ethnicities reflecting the diverse population. All patients were tested for chlamydia and gonorrhoea, none for mycoplasma genitalium. A pregnancy test was not performed in 19/89 (21%) patients. Documentation of examination findings was sometimes absent. Follow-up was recorded in 8/89 (9%) cases. Results were similar in 2019 and 2020, although ceftriaxone administration was more common pre-pandemic. Key results are summarised in the accompanying table 1. Conclusions PID management in 2019 and 2020 was similar. Increased testing for mycoplasma could guide antibiotic therapy. The importance of pregnancy testing in women presenting with lower abdominal pain should be highlighted to clinicians. Telephone calls could be used to facilitate follow-up appointments. (Figure Presented).

11.
Sexually Transmitted Infections ; 98:A53-A54, 2022.
Article in English | EMBASE | ID: covidwho-1956927

ABSTRACT

Introduction This study evaluates the impact of the re-introduction of self-selection for sexual health screening following the COVID-19 pandemic on chlamydia testing and diagnoses within Scotland's largest sexual health service. There was an additional focus on identifying groups that may have been excluded by the current testing strategies and groups where a higher incidence of chlamydia has been noted. Methods We identified all chlamydia tests and diagnoses across our service between August to October 2021, compared to March 2019 to February 2020. Data describing demographics were also extracted. To simplify comparisons between cohorts, the results within each group were converted into a cohort proportions. Descriptive analysis was used to compare cohorts. We offer a limited service for at-home self-testing, outsourced to an external company, which was not included in our testing figures;positive samples will have been captured in this analysis due to how they are reported locally. Results A 9% decrease was seen in testing after COVID although diagnoses remained at similar level to that pre- COVID. Testing rates were lower and positive rates were greater in areas where there currently aren't any testing centres. Testing rates were also lower in females and under 25-year-olds. Discussion It is difficult to draw final conclusions about increased chlamydia prevalence in demographic groups due to how outsourced tests and positive cases are recorded on our EPR, but what has been clearly demonstrated is the need for increased access to testing in localities where local testing clinics have been closed during the pandemic.

12.
Sexually Transmitted Infections ; 98:A45, 2022.
Article in English | EMBASE | ID: covidwho-1956919

ABSTRACT

Introduction During Covid, we adopted telephone consultations for initial history taking, with in person follow-up appointments where clinically indicated. This review was undertaken to identify the proportion of patients managed remotely only and to adjust algorithms for future appointments. Methods We retrospectively audited consultations over the course of one month. We reviewed basic demographic data, along with presenting complaints and management. Results Of 176 telephone consultations, 36 (20.45%) were managed remotely. The majority were either positive on online testing (8) or chlamydia contacts (10) and received postal treatment. Of the 16 remaining, 4 were signposted to online testing, 4 received management for known herpes and a further 4 needed advice or wanted to discuss prior results. Amongst the 48/140 attendees reviewed, the commonest presentations in women were vaginal discharge (9/26), skin lesions (8/26, 4 confirmed warts) and pain (6/26). In men, 10/ 22 had skin lesions (6/22 with warts) and 6 had discharge/ dysuria. Three contacts of infections attended due to symptoms or needing additional testing, 1 patient because of insufficient bloods from home testing, and 1 following a needlestick injury. Two under 18's were assessed by telephone, both subsequently reviewed in the department. Safeguarding issues were addressed for one of these. Discussion This review has identified that very few asymptomatic patients required triage, and about 1/5 presentations were managed remotely. Younger and vulnerable patients were still signposted into service, as were those needing further examination or testing. Our future approach for blended service provision will reflect this.

13.
Sexually Transmitted Infections ; 98:A42-A43, 2022.
Article in English | EMBASE | ID: covidwho-1956917

ABSTRACT

Introduction Significant changes occurred in delivery of HIV care due to COVID-19. Our department recognised the benefits of some changes but understanding the impact on patients is essential in establishing a plan for recovery. Methods We conducted a survey using Microsoft forms, delivered via text message to approximately 3000 patients across two HIV departments. The patient experience, communications and information governance teams were involved in the design. Patients were given 4 weeks to respond. Results There were 325 responses. Demographics of respondents roughly matched the cohort, excepting a bias towards slightly older patients. Care was reported to be better than prior to the pandemic by 15%, with another 63% saying it was equally as good. A minority (19%) said their care was not as good. Almost half preferred telephone consultations, 48% said they were more convenient and another 33% said they were equally as convenient, 64% were happy to continue with telephone consultations. 37% said they would want to be seen in person at least every 6 months, 39% said every 12 months, and 13% 18 months. Off-site phlebotomy was popular with 42% saying this was more convenient and 71% happy to continue using it. Discussion This feedback is extremely valuable in shaping provision of future care. The department is proud to have maintained high quality care for the vast majority in the face of enormous pressures. However, a minority of patients have experienced negative impacts on their care;patient choice is clearly vital moving forwards. A patient survey to understand the impacts of COVID-19 on delivery of HIV care from the patient's perspective (Table Presented).

14.
Sexually Transmitted Infections ; 98:A27, 2022.
Article in English | EMBASE | ID: covidwho-1956906

ABSTRACT

Introduction With the advent of COVID, PrEP services and supplies were disrupted. We audited from April 2021 as restrictions were coming to an end. Methods Retrospective case note analysis for those attending a London GU/SRH clinic from 12th April 2021. Basic demographics and clinical parameters were collected and analysed using STATA 13. Results 75 records were returned. Median age was 34 years (IQR 28-39) with 89% (67/75) identifying as male and 73% (47/75) as white. 70% (52/75) reported using daily dosing. Only 5% (4/75) reported chemsex in the previous 3 months. 16% (12/75) had an STI diagnosed at this visit, with 33% being a new syphilis diagnosis. Only 48% (36/75) had been fully vaccinated for HPV and 64% (48/75) for Hepatitis B. At baseline, 57% had eGFR >90mls/min and 37% (28/75) between 6-90 mls/min. There were no patients with evidence of renal decline on taking PrEP (defined as loss of >30 mls/ min eGFR). Only 65% (49/75) were coded correctly. Conclusion The PrEP cohort we are seeing are young, predominately MSM but with an appreciable minority of female and trans patients (10%). Low rates of chemsex and comparatively low rates of STI's indicate a lower risk population than compared to the PROUD study. This may be a result of more MSM attending for PrEP, and not just those who are very high risk of HIV acquisition. We need to ensure vaccination against HPV and HBV are prioritised and ensure correct coding to be able to monitor the number of people starting PrEP.

15.
Journal of Clinical Periodontology ; 49:226-227, 2022.
Article in English | EMBASE | ID: covidwho-1956759

ABSTRACT

Background and Aim: The pandemic caused by the SARS-CoV-2 virus has generated a social, economic, health and educational collapse of unsuspected dimensions, paralyzing teaching in dental schools around the world and modifying their clinical protocols. To evaluate the knowledge of the students of the University Clinic of Dentistry of the University of Oviedo (CLUO) about the infection by SARS-CoV-2. Methods: A descriptive observational study was carried out through a survey made in “GOOGLE FORMS.” Five sections were included: demographic data, questions about the acquisition of knowledge about COVID-19, questions about general knowledge of COVID-19, questions about knowledge of COVID-19 in dentistry and resolution of clinical COVID-19 cases. Results: A total of 110 surveys were collected. The predominant age range was 18 to 28 years (82.7%) and female the predominant sex (72.6%). Television and the internet were the media where they were first informed about the pandemic. The general knowledge about Covid-19 of the surveyed students (67.93% correct) was higher than the specific knowledge (COVID-19 in dentistry) (27.5% correct). At the clinical cases, the area of less knowledge about the specific COVID-19 management was those applied to Periodontology. Conclusions: Our results indicate that the students had a moderate knowledge about COVID-19, suggesting the need to increase basic training on infection control and promote workshops on protection measures based on the risks inherent to the specific dental practice.

16.
BJU International ; 129:94-95, 2022.
Article in English | EMBASE | ID: covidwho-1956728

ABSTRACT

Introduction & Objectives: Minimally invasive transurethral therapies for benign prostatic hypertension are becoming increasingly common in Europe and America. They may be performed under local anaesthetic and provide a good alternative to invasive procedures in a COVID era. REZUM, a minimally invasive transurethral water-vapor therapy, has been shown to be a safe and effective treatment for BPH, especially where preserved sexual function is a priority. Although short-term clinical outcomes are promising, long-term data from robust studies is lacking. In Australia, there are few providers of REZUM, which utilises steam injections to reduce prostatic tissue. This study aims to investigate the safety and efficacy of REZUM in an Australian cohort. Methods: A clinical audit was conducted of 50 patients who underwent REZUM to treat symptoms of BPH over a 12-month period. Procedures were performed under general anaesthetic. Demographics, comorbidities, sexual function, prostate volume, PSA, voiding flow rate, post-void residual volume and International Prostate Symptom Score were extracted from medical records, in addition to patient's reasons for seeking minimally invasive treatment. Corresponding post-operative data was collected. Descriptive statistics of the cohort were obtained using Stata 16.0. Paired t-test was used to identify if there was a significant difference between IPSS scores pre- and postprocedure Results: Patients accessing treatment ranged from 48 to 84 years (mean 64.6). Median prostate volume was 55mL (inter-quartile range 45-78mls) and mean International Prostate Symptom Score (IPSS) was 20.3. 28% of the cohort cited concern for ejaculatory function, either from medication side effects or TURP, as their primary reason for seeking minimally invasive treatment. A further 25% of the cohort was additionally concerned about other side effects from medications and/or TURP or had experienced medication failure. The mean follow up period was 6 months (range 6-weeks-26 months). 69% of men were satisfied with their symptom improvement at the time of review, with the expectation of ongoing improvement in men who had attended a 6-week post-operative review only. Postprocedure mean IPSS was 7.9 (range 2-33). Mean reduction in IPSS score post-procedure was 12.7 points (p<0.001). 3 men experienced complications (retention, infection, bulbar stricture). Conclusions: REZUM provides a safe alternative to traditional invasive prostatic treatments. It may be performed under local anaesthetic, providing an effective alternative in a COVID era. Men concerned about medications, more invasive treatments and ejaculatory dysfunction are increasingly seeking relief from this minimally invasive option and experiencing good outcomes including significant symptom improvement sustained over medium-term follow up.

17.
BJU International ; 129:77-78, 2022.
Article in English | EMBASE | ID: covidwho-1956727

ABSTRACT

Introduction & Objectives: Renal colic is a common presentation to emergency departments. Non-contrast CT is the gold standard for diagnosing ureteric stones. Ultrasound (USS) is also commonly used, however has lower sensitivity and specificity. Uncertainty in imaging findings can delay diagnosis and thereby prolong the length of stay (LoS) in the emergency department. The aim of this study was to assess the current imaging practices for assessment renal colic in the emergency department setting and the impact of imaging modality choices on patient flow. Methods: Patient presentations were identified from Emergency Department Information System for renal colic and urinary calculus diagnosis codes from October 2019 to September 2020. This was correlated with radiology departmental records for imaging modalities used. Clinical records were reviewed for demographics, LoS, disposition, imaging findings and radiation dose. Results: 590 presentations were identified, with 431 first presentations, 86 re-presentations (within 30 days) and 73 interhospital transfers. Imaging was performed in 74.7% of presentations (n = 441). Patients had a median age of 46 years and were mostly male (69%). 73.3% of first presentations had CT as first-line imaging. Those who had USS as first-line imaging were predominantly female (59%) and younger (mean 31.1 vs 46.6 years, p<0.01). They had longer total LOS when compared to CT for first presentations (mean 604 vs 443 minutes, p < 0.01) and all presentations (mean 599 vs 440 minutes, p<0.01). Compared to CT +/- abdominal x-ray, patients having USS were more likely to be admitted to the short stay unit (71.4% vs 43.7%) for longer periods (mean 511 vs 401 minutes, p = 0.05). 17% of patients who initially had USS subsequently had a CT, with this group having the longest mean LoS (total 713 minutes, short stay 720 minutes). Conclusions: USS is more likely to be used in younger and female patients. Compared to CT, first-line USS in renal colic correlated with longer time spent in ED, more admissions to short stay and longer LoS in short stay. Given constraints on hospital resources with the Covid-19 pandemic, renal colic imaging pathways should be examined for opportunities to improve patient flow.

18.
British Journal of Dermatology ; 186(6):e244, 2022.
Article in English | EMBASE | ID: covidwho-1956708

ABSTRACT

The association between COVID-19 and biologics - drugs that modulate the immune system through stimulatory or inhibitory actions - is currently not well understood. COVID-19 is associated with the presence of a cytokine storm. This suggests the inflammatory response may influence disease progression and pathogenesis (Tang Y, Liu J, Zhang D et al. Cytokine storm in COVID-19: the current evidence and treatment strategies. Front Immunol 2020;11: 1708). To the authors' knowledge there is minimal research outlining the effect of biologics on patients with skin disease who are infected with COVID-19. The aim of this case series was to evaluate the effect of COVID-19 infection on patients taking biologics for dermatological conditions. Clinical characteristics of 14 patients under Dermatology care on biologics and COVID-19 positive confirmed by polymerase chain reaction were reviewed retrospectively. A 20-item tool was used to collect quantitative data. This encompassed demographics, skin disease, biologics, hospitalization, intensive care admission, severity of disease as determined by oxygen therapy, imaging and symptoms, and presence of long COVID. The majority of patients included had multiple comorbidities (71%), 21% of which had a respiratory condition. Approximately one-third of cases required hospitalization (36%) and oxygen (29%). However, none required intensive care admission or noninvasive ventilation, and chest X-ray findings from all participants were clear, illustrating no scarring or evidence of long-COVID clinical changes. Patients on biologics infected with COVID-19 in this series appear to have been mildly affected by COVID despite being a comorbid group. The outcomes of patients following infection with COVID-19 on a biologic were good and this did not seem to affect the clinical outcomes or mortality in this cohort. Biologics appeared to demonstrate a protective benefit.

19.
Neuro-Oncology ; 24:i166, 2022.
Article in English | EMBASE | ID: covidwho-1956580

ABSTRACT

INTRODUCTION: Central nervous system (CNS) tumors account for 20 - 30% of all childhood cancers. The Philippines is a lower-middle income country, wherein brain centers are located mostly in urban areas. We aimed to identify challenges that pediatric patients with CNS tumors encountered during the COVID-19 pandemic, which aggravated delays in their diagnosis and treatment. METHODS: This is a retrospective review of all pediatric patients who underwent neurosurgery for CNS tumors at the Jose R. Reyes Memorial Medical Center, a tertiary referral center, from January 2020 until December 2021. We summarized patients' demographic data, clinical course, and perioperative outcomes. RESULTS: A total of 38 pediatric patients underwent neuro-oncologic surgery in our center during the study period. There were 18 males and 20 females, with a mean age of 7.5 ± 4.9 years. Tumor was biopsied and/or resected in 35 cases (92%). The most common histologic diagnoses were medulloblastoma (n=8, 21%) and high-grade glioma/glioblastoma (n=5, 13%). Median preoperative length of stay and total length of stay were 10 (IQR: 17) and 28 (IQR 33.75), respectively. There was a high perioperative mortality rate in 2020 (71%), but this decreased to 20% in 2021. Six patients (16%) developed COVID-19 infection during the perioperative period. There were nine patients (24%) who had documented tumor progression because of delays in adjuvant therapy. DISCUSSION: Aside from geographic barriers and catastrophic health expenditure, the major challenges that disrupted the care of pediatric patients with CNS tumors in our center during the COVID-19 pandemic were delays in neuroimaging for diagnosis, unavailability of operating room slots, deficiency in critical care beds, and workforce shortage due to COVID-19 infection among health workers. Health care systems must adapt to the changes brought about by the pandemic, so that children with CNS tumors are not neglected.

20.
Neuro-Oncology ; 24:i149, 2022.
Article in English | EMBASE | ID: covidwho-1956577

ABSTRACT

Primary central nervous system (CNS) tumors are a leading cause of death and disability amongst pediatric cancer patients. The early identification of symptom onset is critical in preventing diagnostic delays. In 2018, Akron Children's Hospital published data on our response time to brain tumor diagnosis and launched educational programs in an effort to decrease diagnostic delays. The goal was to reduce the total diagnostic interval (TDI) in our patient population and reduce tumor- and treatment-related morbidities for these patients. Our post intervention group (2018-2021) was drastically affected by the numerous hospital changes secondary to the COVID-19 pandemic. We sought to examine the impact of COVID-19 related changes on TDI and attempted to identify groups at potential increased risk for diagnostic delays due to the unique pandemic constraints. A retrospective chart review was performed on patients at Akron Children's Hospital to evaluate both for pre- (diagnosed Jan 1, 2018-February 29, 2020) and post- COVID-19 (diagnosed Mar 1, 2020-June 8, 2021) groups. Both subsets were evaluated statistically and were similar in all respects including demographics, symptomatology, tumor location, tumor type, and survival. The pre-COVID-19 group demonstrated a median TDI of 43.5 days, while the post-COVID-19 group demonstrated a 30-day median. The TDI for low-grade lesions increased from 32 to 59 days and for high-grade lesions decreased from 60 to 27.5 days in the post-pandemic cohort. Overall, this demonstrates a maintained average time to diagnosis for patients despite the pandemic restrictions in place. In addition, the differences in low vs. high-grade lesions suggest that tumors with a more subtle onset of symptoms were disproportionately affected, and highlight a population for intervention during the continued pandemic.

SELECTION OF CITATIONS
SEARCH DETAIL