Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 90
Filter
1.
Pneumon ; 35(1), 2022.
Article in English | EMBASE | ID: covidwho-1818859

ABSTRACT

INTRODUCTION In Greece, higher morbidity and mortality due to COVID-19 pandemic were recorded during the third pandemic wave. Only a small percentage of the population was fully vaccinated at the beginning of the third pandemic wave. Our effort was multi-level, from the emergency room department to the ward. The aim of this article is to communicate a single secondary center’s experience during the third pandemic wave in Greece. METHODS A retrospective cohort study was conducted at the regional Agios Andreas General Hospital of Patra, Greece, including 360 hospitalized COVID-19 patients. A standard of care protocol was applied in all cases and its outcomes are examined. RESULTS The median age of the patients was 64.2 years (IQR: 18–100) and the median duration of hospitalization was 8 days. The overall case fatality rate was 8.1%. Of the 360 patients, 12 (3.3%) needed to be intubated. Most of the hospitalized patients (n=316;87.8%) were treated with nasal canula or Venturi mask. Twenty-six patients (7.2%) were supported with HFNC and 18 (5%) received any available type of non-invasive mechanical ventilation. CONCLUSIONS An articulate protocol and coordinated collaboration among specialists were the cornerstone of proper, immediate, and individualized treatment. The international recommendations in force at that time proved to be efficient in reducing progress to SRF and intubation. Full vaccination of the medical staff ensured long and dedicated presence in the patients’ rooms.

2.
Age and Ageing ; 51(SUPPL 1):i19, 2022.
Article in English | EMBASE | ID: covidwho-1815978

ABSTRACT

Introduction: Whilst most patients during the COVID pandemic made an uneventful recovery, there was a significant minority in whom the disease was severe and unfortunately fatal. This survey aims to evaluate independent risk factors for those who died of COVID compared to survivors and to identify any markers for improvement in future management. Methods: Medical records of all COVID patients admitted to two multi-ethnic, inner city acute district general hospitals over a 6-week period in 2020 were examined. Data collected included demographic details, medical comorbidities, and type of ward where they received care. Multivariable analysis using stepwise backward logistic regression was conducted to examine independent risk factors for those who died from COVID compared to survivors. Results: Of 951 patients admitted with COVID, 284 died[30%]. Compared to survivors(n=667), univariate analyses revealed COVID deaths were associated with increasing age[mean(CI): 79.3(77.9-80.7)vs64.7(63.4-66.0);P<0.001], Black African [16.2%vs11.7%;p<0.001] & South-Asian [12%vs9.1%;p<0.001] ethnicity, Hypertension [64.4%vs49.5%;p<0.001],ChronicHeartDisease(CHD)[40.1%vs20.7%;p<0.001], Chronic Respiratory Disease [17.6%vs12.0%;p=0.02] Chronic Kidney Disease [18%vs11.1%;p=0.004], Chronic Neurological Disease 43.3%vs23.7%;p<0.001]. Gender, Diabetes, asthma, obesity, Chronic Liver Disease and immunosuppression (disease or treatment related) were not associated with increasing mortality. Death rates between those in general wards vs intensive care were comparable[4.7%vs2.5%;p=0.1]. Multivariable analyses showed age 60-70 [OR 2.3], age>70 [OR 6.5], Black Caribbean [OR 1.6], and CHD [1.5] were independent risk factors for COVID deaths. Discussion: This large multi-ethnic study showed that age>60, Black Caribbean, and chronic heart disease were independent risk factors for COVID deaths. This study provides valuable information on independent prognostic implications for COVID, which can be used in future interventional studies aiming to improve COVID outcomes or in audits of clinical practice.

3.
Malta Medical Journal ; 34(1):35-42, 2022.
Article in English | EMBASE | ID: covidwho-1812692

ABSTRACT

BACKGROUND COVID-19 was a global shock, causing challenges to many countries’ healthcare services. This paper provides a summary of Malta’s healthcare system journey during the COVID-19 pandemic with its initial preparedness for COVID-19 pandemic and the impact of COVID-19 on the service during the first 12 months of the pandemic. METHODS A literature search was conducted using Google and reviewing Maltese online newspapers. A comprehensive summary of internal operations conducted at Mater Dei Hospital, the country’s only acute general hospital, was provided by the Chief Operating Officer. RESULTS Several infrastructural changes including the increase in bed capacity and ITU areas were instituted in preparation for the pandemic. The health system showed resilience during the first wave. However, the situation was more precarious during the second wave. The end of December 2020 saw the start of the Covid-19 vaccination rollout, with over 30 health system hubs offering this service across the islands. Simultaneously health professional’s burnout is on the rise as resources and workforce are overstretched. CONCLUSION The collaborative effort between the guidance provided by the Public Health Authorities and the hospital’s multi-disciplinary team have been pinnacle during the pandemic. However, the future of the healthcare system is heavily dependent on the population’s behaviour, timely measures, the vaccination rollout and the type of immunity acquired through vaccination or infection.

4.
South African Medical Journal ; 112(4):279-287, 2022.
Article in English | EMBASE | ID: covidwho-1798764

ABSTRACT

Background. Major causes of under-5 child deaths in South Africa (SA) are well recognised, and child mortality rates are falling. The focus of child health is therefore shifting from survival to disease prevention and thriving, but local data on the non-fatal disease burden are limited. Furthermore, COVID-19 has affected children's health and wellbeing, both directly and indirectly. Objectives. To describe the pattern of disease on admission of children at different levels of care, and assess whether this has been affected by COVID-19. Methods. Retrospective reviews of children's admission and discharge registers were conducted for all general hospitals in iLembe and uMgungundlovu districts in KwaZulu-Natal Province, SA, from January 2018 to September 2020. The Global Burden of Disease framework was adapted to create a data capture sheet with four broad diagnostic categories and 37 specific cause categories. Monthly admission numbers were recorded per cause category, and basic descriptive analysis was completed in Microsoft Excel. Results. Overall, 36 288 admissions were recorded across 18 hospital wards, 32.0% at district, 49.8% at regional and 18.2% at tertiary level. Communicable diseases, perinatal conditions and nutritional deficiencies (CPNs) accounted for 37.4% of admissions, non-communicable diseases (NCDs) for 43.5% and injuries for 17.1%. The distribution of broad diagnostic categories varied across levels of care, with CPNs being more common at district level and NCDs more common at regional and tertiary levels. Unintentional injuries represented the most common cause category (16.6%), ahead of lower respiratory tract infections (16.1%), neurological conditions (13.6%) and diarrhoeal disease (8.4%). The start of the local COVID-19 outbreak coincided with a 43.1% decline in the mean number of monthly admissions. Admissions due to neonatal conditions and intentional injuries remained constant during the COVID-19 outbreak, while those due to other disease groups (particularly respiratory infections) declined. Conclusions. Our study confirms previous concerns around a high burden of childhood injuries in our context. Continued efforts are needed to prevent and treat traditional neonatal and childhood illnesses. Concurrently, the management of NCDs should be prioritised, and evidence-based strategies are sorely needed to address the high injury burden in SA.

5.
Int J Nurs Sci ; 7(2): 143-147, 2020 Apr 10.
Article in English | MEDLINE | ID: covidwho-1796684

ABSTRACT

OBJECTIVE: This article summarizes the experience in the prevention and control of coronavirus disease 2019(COVID-19) epidemic in non-isolated areas in a general hospital. METHODS: Based on refined management theory, we professionally developed the standards for prevention and control of COVID-19 in non-isolated areas, systematically implemented various prevention and control measures, performed gridding audits, effectively communicated among teams and between medical staff and patients assisted by information techniques, and reported results for quality improvement. RESULTS: There was no hospital-acquired COVID-19 infections among staff in the hospital. The rates of mask-wearing, epidemiological history screening, and the medical supplies disinfection were all 100% in the hospital. The accuracy rate of mask-wearing of patients and their families was 73.79% and the compliance rate of their hand hygiene was 40.78%. CONCLUSION: Refined management strategies for the prevention and control of COVID-19 infection in non-isolated areas of the general hospital are effective. The accuracy rate of mask-wearing and hand hygiene compliance of patients and their families need to be further improved.

6.
European Heart Journal Cardiovascular Imaging ; 23(SUPPL 1):i363, 2022.
Article in English | EMBASE | ID: covidwho-1795314

ABSTRACT

Introduction: Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes respiratory disease and affects primarily the lungs, it may also lead to cardiovascular complications and late manifestations like myocarditis, arrhythmias and myocardial damage. Nevertheless, it is not clear whether cardiovascular involvement remains after Covid-19 recovery. Two-dimensional speckle tracking echocardiography (2D-STE) can detect subclinical myocardial dysfunction, if present, and has been widely used for left (LV) and right (RV) ventricular function assessment in several clinical conditions. Purpose: The aim of our study was to evaluate prospectively myocardial systolic function and hence cardiac involvement in patients after the recovery from Covid-19, using 2D-STE. Methods: 100 Covid-19 recovered patients with preserved left ventricular ejection fraction (LVEF), were prospectively recruited from March 2021 until June 2021 at the General hospital of Korinthos and at the General hospital of Elefsina, 'Thriassio'. Based upon clinical manifestation of the disease, they were divided into two groups, those with mild symptoms, who were treated ambulant and those with respiratory insufficiency who were hospitalized. Conventional echo parameters as wells as LV global longitudinal strain (LVGLS), regional strain of all LV walls and right ventricular global longitudinal strain (RVGLS) were measured in all patients and compared to controls. Results: The mean time of performed echo examination of all patients was 33.28 ± 9.4 days after the initial confirmed covid-19 infection diagnosis. Although overall LV systolic function expressed by EF was normal and similar to controls, LVGLS was found to be significantly lower in Covid-19 recovered patients in compare to controls (-18.47±-2.4 vs -21.07±-1.76% respectively, p < 0.0001). More specifically, it seemed that especially the lateral wall longitudinal strain (LATLS) and posterior wall longitudinal strain (POSTLS) were significantly reduced in all patients compared to controls (-17.77±-3.48 vs -20.97±-2.86% respectively, p < 0.0001 for LATLS and -19.52±-5.3 vs -22.23±-2.65% respectively, p = 0.01 for POSTLS). RVGLS was found significantly diminished only in the hospitalized group of Covid-19 recovered patients, compared to controls (-21.29±-5.58 vs -26.03±-4.55% respectively, p < 0.0001). Conclusions: LVGLS is affected in almost all individuals after covid-19 infection independently of the infection severity, with LATLS being the most sensitive marker of LV impairment and with POSTLS to follow. RV shows impaired GLS only in severely ill patients highlighting RVGLS as a helpful tool of prognosis. Recovered patients from Covid-19 infection have to be monitored for a long time, since the duration and evolution of these lesions is unknown, and the term 'long covid disease' might also include the cardiac function.

7.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793898

ABSTRACT

Introduction: High flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) therapy are recognised treatments for hypoxia which were widely used throughout the COVID-19 pandemic. Large scale studies such as RECOVERY-RS [1] compared HFNO and CPAP to conventional oxygen therapy in patients suitable for mechanical ventilation. TSDFT had capacity to offer ward based HFNO/CPAP to patients deemed both suitable and not suitable for mechanical ventilation. We set out to review the outcomes of all patients who received HFNO/ CPAP for COVID-19 pneumonitis at our trust. Methods: A retrospective observational study of all patients with COVID-19 Pneumonitis who received CPAP/HFNO was conducted at a district general hospital in South West England. Electronic records and ICD10 diagnostic codes were reviewed between September 2020 and October 2021. Results: 90 patients received HFNO or CPAP. The median age was 68 years. 50 (55%) survived to hospital discharge. Survival to hospital discharge was greater in females (71%) than males (42%). Survival decreased from 100% in the 21-30 years age group, to 33.3% in the > 70 years age group. On review of co-morbidities the overall survival rate was similar, except for patients with cardiac failure or valvular disease, of which only 4 of 19 patients survived (21%) All patients under 40 years survived to hospital discharge. There was no relationship between number of days of therapy and survival to discharge. Conclusions: Among this cohort, survival to hospital discharge after HFNO or CPAP for COVID-19 Pneumonitis was greater in younger patients, females and those without cardiovascular failure.

8.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793891

ABSTRACT

Introduction: Evidence shows COVID-19 patients requiring RRT have an increased incidence of filter cartridge failure [1], this study aimed to reduce filter changes using an increased citrate dose protocol. Frequent filter changes can lead to reduced therapy delivery, increased cost and anaemia, however, the benefits of preserving filter lifespan must be balanced against the risks of anticoagulation associated bleeding. Methods: A retrospective observational study was performed of our COVID-19 patients requiring RRT using an increased citrate presciption of 4 mmol/l and continuous venovenous haemodiafiltration (CVVHDF). Results: The unit treated 106 patients with COVID 19 of whom 15 required RRT. 8 patients were managed exclusively on the adjusted protocol. The median duration spent on RRT was 188 h. The average lifespan of a filter in COVID-19 patient was improved from 37 to 45 h using the increased citrate protocol. There were no adverse bleeding outcomes and no documented evidence of citrate toxicity. Conclusions: This small study showed an improved filter life for patients on an increased citrate dose protocol of CVVHDF without any adverse outcomes. This results in cost savings and more appropriate resource usage during a pandemic without increased bleeding risk. Another suggested measure to reduce filter malfunctions was that centres returned to using heparin anticoagulation but this is known to have increased bleeding risk [2]. Further research in a larger cohort is required but this is a promising improvement in a complex patient group.

9.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793871

ABSTRACT

Introduction: The aim of the study was to determine the impact of COVID-19 pandemic on intensive care workload [1,2] at our only acute main general hospital on the island. During the pandemic surge in March 2021, our intensive care was running at 200% capacity. Mater Dei Hospital has a 20-bedded adult intensive care catering for a population of 500,000. Methods: This is a prospective cohort study conducted in the COVID- 19 Intensive Care Unit at Mater Dei Hospital, Malta. Data analysed is from March 2020 to May 2021. Data collected daily from admission until death or discharge from ICU. Results: A total of 261 patients with severe acute respiratory distress syndrome coronavirus 2 (SARS-Cov-2) required admission to our intensive care. ICU facilities required expansion into a total of 5 Intensive Care Units, therefore reaching a capacity of 44 intensive care beds during the peak month of March 2021. A maximum of 21 patients were admitted per week culminating to a total of 33 COVID-19 Intensive Care beds during the month of March 2021. A total of 179 patients (68.6%) required mechanical ventilation for a median duration of 11 days per patient. Proning was required in 124 mechanically ventilated patients (70.5%). 50 patients (20%) required CRRT with a maximum number of 7 patients per day requiring CRRT. Conclusions: COVID-19 pandemic transformed the way how we provide critical care with improved bed capacity, ICU triage and ICU devices. This study highlighted the need for more clinical guidelines and their availability for online use. This will positively impact the care of non-COVID patients. It also highlighted the need for more training of non-ICU staff to allow for surges in ICU capacity. The COVID-19 pandemic has seen Mater Dei hospital already investing in ICU personnel and equipment as this cannot be reactive to large scale events but must be a proactive planned strategy to enhance resilience of our ITU.

10.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793870

ABSTRACT

Introduction: The aim of this study was to describe the use of high flow nasal oxygen (HFNO) in COVID-19 intensive care unit (ICU) patients [1] locally, and establish their demographics and outcomes. Mater Dei Hospital is the only main acute general hospital on the island. It houses a 20-bedded adult ICU catering for a population of 500,000. Methods: We conducted a single-centre prospective observational cohort study at the ICU at Mater Dei Hospital in Malta between March 2020 and May 2021. Data collected included use of HFNO, mechanical ventilation (MV), duration of MV, length of stay, and 28-day survival. Results: 240 COVID-19 ICU patients were included. 108 (45%) received HFNO for a median of 3 days, the rest received MV for a median of 12 days. No major differences in demographics were noted (age: 66.5 vs 68 years, p = 0.225;70% male, 30% female vs 79% male, 21% female, p = 0.191). Forty-two (38.2%) patients failed HFNO after a median of 2 days, needing MV for a median of 10 days (p < 0.001). Median length of stay was lower in HFNO patients (6 vs 13 days;p < 0.001). 28-day survival was highest in the HFNO-only group (94%), followed by the HFNO + MV group (61%), and finally the MV-only group (52%;p < 0.0001). This is not simply due to severity since FiO2 was higher for HFNO patients and PaO2 tended to be lower. Cox proportional hazards analysis showed that respiratory support was more significant than admission P/F ratios, PaO2s, or SOFA, with MV being linked to a hazards ratio of 8.4 (p < 0.001) when adjusted for the above criteria. Conclusions: HFNO offers considerable practical advantages over MV. Avoiding MV might be linked to a reduced incidence of ventilator-associated pneumonias, shorter ICU stay and lower mortality. It is also a safe tool to use and the risk of aerosolization should not deter from its use.

11.
Journal of Clinical and Diagnostic Research ; 16(4):EC23-EC26, 2022.
Article in English | EMBASE | ID: covidwho-1791825

ABSTRACT

Results: Out of total 193, 120 (62.17%) were regular donors. Introduction: Most Sri Lankan blood donations (93%) are from Majority donors were male donors (168,87.04%) and among mobile blood donation campaigns. Restricted community gathering 25-35 years group (85,44.05%). Most had completed grade during the Coronavirus Disease-2019 (COVID-19) pandemic has 13 exam (66,34.19%), only 28 (14.5%) had a degree and 106 adversely affected the blood supply. Further, Kilinochchi has lower (54.92%) donors were within 10 km from the blood bank. The blood donation rates than other Sri Lanka areas. majority of 122 (63.21%) were aware from a friend, and 16.06% Aim: To describe the level of donor satisfaction, identify the (n=31) were aware from Youtube. Gaining information from a barriers and factors to increase in-house blood donors of a District friend was statistically associated with the distance to the blood General Hospital, Kilinochchi. bank (p-value=0.036). A majority 190 (98.44%) of the in-house Materials and Methods: This questionnaire-based cross-blood donors were satisfied with the services provided by the sectional study was conducted with 193 in-house voluntary blood blood bank staff, and 188, 97.40% had stated they are confident donors in blood bank at District General Hospital (DGH) Kilinochchi, about the facilities provided by the blood bank for in-house blood Sri Lanka, from April 2021 to July 2021. Donors with at least one donation. year of residence in Northern province were included, and data Conclusion: Majority of the in-house blood donors were was collected by pretested, self-administered questionnaire. satisfied with the services provided by the blood bank staff and The parameters assessed were socio-demographic data, donor blood bank facilities. Delivering information regarding blood satisfaction, blood donation information receiving methods, donation via friends to the population who reside close to the factors affecting blood donation, and factors to improve blood blood bank and awareness programs by health care workers donation. Data entered and analysed using Statistical Package would be the best method to improve in-house blood donations of Social Sciences (SPSS) version 22.0. in this area.

12.
Pakistan Paediatric Journal ; 46(1):75-81, 2022.
Article in English | EMBASE | ID: covidwho-1790687

ABSTRACT

Objective: To determine the perceptions of medical students towards online learning during COVID 19 Study Design: Cross sectional online survey Place and Duration of Study: The Department of Pediatrics, Post Graduate Medical Institute/Ameer-ud-Din Medical College, Lahore General Hospital, Lahore, Punjab, Pakistan from November 2020 to March 2021. Materials and Methods: Undergraduate medical students of fourth and final year MBBS were included in the study after approval from Institutional Review Board. They had to answer a questionnaire sent to them as Google Forms TM. Responses from 171 students were received and analyzed using SPSS version 24. Results: Among 171 students, 56 (32.7%) were male and 115 (67.3%) were female. Smart phone (56.7%) was the most common gadget used for online learning. Ability to stay home (69%) was the most frequent advantage recorded followed by access to online materials (68.4%),. while lack of patient interaction was the most common disadvantage (73.7%) followed by technical problems with IT equipment (52.6%). Online learning was considered to be less effective than traditional learning in terms of ability to increase knowledge, clinical skills and social competences. Students were less active during online classes as compared to traditional face to face teaching and majority (66%) rated online learning as unenjoyable. Conclusion: Undergraduate medical students rated online learning less effective and less enjoyable than traditional learning. Necessary measures should be taken to improve quality of online learning of undergraduate medical students during COVID 19 pandemic.

13.
Open Access Macedonian Journal of Medical Sciences ; 10:525-528, 2022.
Article in English | EMBASE | ID: covidwho-1780098

ABSTRACT

BACKGROUND: Decrease of smell-taste has become a cardinal symptom of COVID-19. Some previous studies have reported that most of the COVID-19 patients complained of early smell-taste impairment. AIM: Hence, this study was aimed to investigate the relationship between smell and taste impairment against PCR test results. METHODS: This study was an observational study with a cross-sectional study among 193 patients who were diagnosed as COVID-19 that had smell-taste impairment between March and August 2020. Parameters were evaluated in this study included age, sex, ethic, occupation, smell-taste impairment, coagulation state, comorbid condition, obesity, and the result of the swab PCR test. The relationship between smell and taste impairment and the PCR test result was analyzed by Chi-square and regression logistic. RESULTS: This study showed that most COVID-19 patients were female (32.1%) aged 18−40 years old (25.9%). Meanwhile, the most comorbid condition owned by the COVID-19 patient in the General Hospital of Adam Malik Medan was diabetes, followed by hypertension, cardiovascular disease, and stroke. Moreover, this study also revealed that the smell (adjusted OR: 3.92;95% CI: 1.30−11.87) and taste (adjusted OR: 3.64;95% CI: 1.30−10.22) impairment significantly associated with COVID-19 (p < 0.05) CONCLUSION: Overall, it can be concluded that the smell-taste impairment can be used to early symptoms to predict the COVID-19 with the positive PCR test result.

14.
Blood ; 138(SUPPL 1):316, 2021.
Article in English | EMBASE | ID: covidwho-1770200

ABSTRACT

The efficacy of COVID-19 vaccines in cancer populations remain unknown. Myeloproliferative neoplasms (MPNs), including chronic myeloid leukemia (CML), essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF) remain a vulnerable patient population and are immunocompromised due to impaired innate and adaptive immunity, heightened inflammation, and effects of ongoing treatment. We evaluate antibody and T-cell responses in MPN patients following completion of the BNT162b2 (Pfizer/BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccine series. Patients with a known diagnosis of MPN presenting at Massachusetts General Hospital and eligible for COVID-19 vaccination were recruited. All participants gave informed consent and the study protocol was approved by the Institutional Review Board. 33 MPN patients were enrolled and 23 patients completed vaccination. Baseline and post-vaccination peripheral blood samples were collected and peripheral blood mononuclear cells (PBMCs) isolated. 26 vaccinated participants with no history of malignancy were included as healthy controls (PMID 33972942). Baseline characteristics are tabled below. Qualitative ELISA for human IgG/A/M against SARS-CoV-2 spike protein using donor serum was performed per manufacturer instructions. Seroconversion occurred in 22/23 (96%) of MPN patients and 25/26 (96%) of healthy controls (Figure). To measure SARS-CoV-2 T-cell immunity, an IFNγ ELISpot assay previously developed in convalescent and vaccinated healthy individuals was used. Freshly isolated PBMCs from patients were stimulated with commercially available overlapping 15mer peptide pools spanning the SARS-CoV-2 spike and nucleocapsid proteins. Given its size, the spike protein was split into two pools (Spike A or B). IFNγ-producing T-cells were quantified by counting the median spot forming units (SFU) per 2.5x10 5 PBMCs from duplicate wells. A positive threshold was defined as >6 SFUs per 2.5x105 PBMCs to either Spike A or B after subtraction of background, based on prior receiver operator curve (ROC) analysis of ELISpot responses (sensitivity 90% specificity 92%). Post-vaccination ELISpot responses occurred in 21/23 (91%) of MPN patients and 26/26 (100%) of healthy controls (p=0.99) (Figure). The median SFU to total spike protein (Spike A+B) increased after vaccination in both MPN patients (0 to 38, p=0.02) and healthy controls (6 to 134, p=0.002). MPN patients had significantly lower median SFU's on post-vaccination ELISpot compared to healthy controls (38 vs 134, p=0.044), although this was not significant after adjusting for age in multivariable logistic regression. MF patients had the lowest seroconversion and ELISpot response rates, and lowest median post-vaccination SFUs, although this was not significant. There were no other differences in post-vaccination SFUs with regards to gender, vaccine type, number of days postvaccine, treatment, and absolute lymphocyte count. Whole-blood assay based on the in vitro diagnostic QuantiFERON TB Gold Plus assay was also used to assess T-cell response. Heparinized whole blood from donors was stimulated with S1 and S2 subdomains for the SARS-CoV-2 spike protein, with measurement of IFNγ released into plasma with the QuantiFERON ELISA. IFNγ release of >0.3 IU/mL was considered a positive threshold, based on prior ROC analysis (sensitivity and specificity 100%). MPN patients had significantly lower IFNγ response rates compared to healthy controls (57% versus 100%, p=0.003) (Figure). Our findings demonstrate robust antibody and T-cell responses to BNT162b2 and mRNA-1273 vaccination in MPN patients, with >90% serologic and ELISpot responder rates. We detected subtle differences in T-cell responses in MPN patients compared to healthy controls. MPN patients had lower median post-vaccination ELISpot SFUs and lower rates of T-cell responses on IFNγ-whole blood assay compared to healthy controls. As the whole blood assay uses whole protein antigen rather than peptide pools, differences from ELISpot testing may reflect deficiencies in antigen pr cessing and presentation. It is unclear whether these subtle differences translate into less clinical protection from COVID-19, or to what extent our results are confounded by the older age of MPN patients. Further evaluation of B and T-cell responses to COVID-19 vaccination in a larger sample size of MPN patients is warranted.

15.
British Journal of Surgery ; 109(SUPPL 1):i64, 2022.
Article in English | EMBASE | ID: covidwho-1769167

ABSTRACT

Introduction: Litigation costs the NHS billions each year. To avoid litigation against known risks of elective surgery it is important that proper consent it obtained. The initial aim was to establish the percentage of patients consented fully for inguinal hernia repair at Warrington and Halton teaching hospitals, a moderately sized district general hospital. The Trust uses the information produced by EDIO as their standard of informed consent. One of the main outcomes was the rate of consent for risk of chronic pain as this is the 3rd most commonly litigated complication and an identified risk of inguinal hernia repair. Method: A retrospective audit looking at consent forms for adult men who underwent elective open inguinal hernia repair, over a 6-month period in 2019, was undertaken. After the first audit the results were discussed at the local audit meeting and teaching was given for what should be included on a consent form for inguinal hernia repair. A second cycle of the audit was run in 2021, after the COVID pandemic, to assess if consenting had improved. Results: 66 vs 22 cases met the inclusion criteria for the first and second 6-month periods respectively. An improvement in consent for chronic pain was observed with 91% of patients in the second cycle being consented for chronic pain vs 79% in the first cycle. In the second cycle 32% of patients were also consented for the risk of 'COVID'. Conclusions: Teaching proper consent works effectively to improve consenting.

16.
British Journal of Surgery ; 109(SUPPL 1):i63, 2022.
Article in English | EMBASE | ID: covidwho-1769163

ABSTRACT

Aim: Accurate determination of core body temperature in critically ill patients is required for initiating diagnosis and management. (1) Ideally, temperature measurement should be non-invasive, hygienic, convenient, and affordable. Infrared thermometers are convenient and noninvasive but sensitive to environmental factors. Alternatively, tympanic thermometers are cost effective but invasive. Various observational studies have concluded that tympanic thermometers have high specificity/ sensitivity compared to infrared thermometers (2,3). We aimed to demonstrate accuracy of tympanic over infrared thermometers. Method: In this observational prospective study, eighty patients (forty each) admitted in intensive care from February 2021 - July 2021 were included. Temperature measurements with were conducted - measuring differences between digital and tympanic thermometers. A Plan Do Study Act cycle was used to facilitate change. Excel and SPSS software were used for data analysis. Results: Our study concluded a statistically significant (p,0.01) difference in readings with mean difference of 1.18°C (highest -6°C, lowest- 0.5°C). Pyrexia was undetected in 4 of 40 patients with digital thermometers. Additionally, two patients undergoing hypothermia correction were not adequately measured. Therefore, infrared thermometers were significantly less sensitive and were replaced with tympanic thermometers. A second cycle conducted again demonstrated significant (p<0.01) difference with mean difference of 1.92°C. (highest -6.5°C, lowest -1°C). Conclusions: Tympanic thermometers have higher accuracy and precision over digital thermometers. We managed to establish change during our audit with concluding evidence showing infrared thermometers procure false observations affecting patient care, hence, unsafe. In conclusion, tympanic thermometers should be encouraged in critical care settings for vigilant care.

17.
British Journal of Surgery ; 109(SUPPL 1):i40-i41, 2022.
Article in English | EMBASE | ID: covidwho-1769158

ABSTRACT

Introduction: Medical record keeping is a fundamental part of the GMC's Good Medical Practice [1,2]. Surgeons must ensure accurate, comprehensive, and legible records are maintained [3]. An operation note is essential to ensure continuity of care between operating team and other colleagues and provides a medicolegal record of a patient's care [4]. Handover errors have been implicated in as many as 80% of sentinel events [5], highlighting the importance of ensuring accurate record keeping. Method: We aimed to assess compliance of surgical operation notes against the Royal College of Surgeons guidance and identified areas for improvement. 48 operation notes were reviewed at a district general hospital in the west midlands over two weeks. Operation notes on standard intranet proforma and custom operation notes were compared to determine better compliance. Results: We identified areas of most compliance vs areas of least compliance. Most and least compliant outcomes are listed below: • Name of operation, operative findings, post-operative instructions, and incision type - 100%. • Date of operation and name of operating surgeon - 98% time. • Operating assistant -96%. • Post-operative VTE plan intraoperative antibiotic use - 73% • Time of operation and details of tissue removed - 69% • Postoperative complications - 7% Conclusions: Good compliance was noted. Using the proforma on the intranet resulted in higher compliance than custom notes (84% vs 53% respectively). Adding a complications section to standard proforma can increase compliance. This audit was performed during COVID-19 restrictions therefore investigated emergency operation notes only which limited the audit.

18.
British Journal of Surgery ; 109(SUPPL 1):i121, 2022.
Article in English | EMBASE | ID: covidwho-1769146

ABSTRACT

Introduction: Covid-19 has had a significant impact on all aspects of healthcare. We aimed to characterise our experience of oncological general surgery during the first 4-months of the pandemic and compare with the same period in 2019. Method: A prospective cohort study was performed from 23/03/20 to 08/ 07/20. All elective oncological operations were included. Data on patient demographics, waiting times, inpatient characteristics and oncological outcomes were recorded. Statistical analysis was used to compare with retrospective data from 2019. Results: 78 patients were included in total, 38 in 2019 and 40 in 2020. There were no differences in length of stay (2.5 vs 3.5 days, p=0.355) or waiting list time (27.2 vs 24.2 days, p=0.574). Oncological outcomes were comparable with no statistical difference in clear resection margin status (94.4 vs 84.6%, p=0.168) or positive nodal status (24.1 vs 37.1%, p=0.298). The percentage of staging CT scans requested externally was higher in 2020 (4 vs 32%, p=<0.05). There was no difference in time from urgent referral to first assessment (30.5 vs 26.4 days, p=0.384) or time to operation (96.6 vs 85.7 days, p= 0.618). Conclusions: Oncological surgery during Covid-19 can be performed safely with favourable oncological outcomes. The longer-term effects from delayed diagnoses remain to be evaluated.

19.
British Journal of Surgery ; 109(SUPPL 1):i72, 2022.
Article in English | EMBASE | ID: covidwho-1769140

ABSTRACT

Introduction: NICE guidelines state that medication reconciliation should occur within 24 hours of admission or as soon after as possible. Accurate and timely prescription of these medications is crucial to ensure optimal care. Due to the COVID-19 pandemic, primary care is busier and thus difficult to contact and with neck of kin not present, the challenges of accurate medicine reconciliation may be exacerbated. Method: A retrospective audit was performed over a fortnight of all acute surgical admissions to a district general hospital. Data was collected as to the time regular medications were prescribed, the source of medical reconciliation and the access to GP network systems for patients. Results: A total of 66 patients were admitted during the time period. 44 patients had regular prescriptions. Of those 68% had regular medications prescribed within 24 hours. 22% did not have regular prescriptions prescribed throughout their inpatient stay. 91% of the patients prescribed medications within 24hours had a working link to the GP network whereas only 58% of those who were never prescribed had a working system. Conclusions: Although a good proportion of acute surgical admissions are prescribed their medications within 24 hours, the proportion who are prescribed past this point is low and a sizeable proportion are never prescribed. A significant contributing factor to this could be poor infrastructure relating to the connection between secondary and primary care and poor handover between on-call and post-take teams. Accurate drugs history during the initial clerking is crucial to mitigate these errors long term.

20.
European Urology ; 79:S1016, 2021.
Article in English | EMBASE | ID: covidwho-1747419

ABSTRACT

Introduction & Objectives: Day-case Transurethral Resection of Bladder Tumour (TURBT) is currently only performed in 18% cases across the United Kingdom. Concerns exist regarding the quality of TURBT, early recurrence rate and the high-risk patient cohort that makes this approach less popular in some centers. The Primary Outcome was to determine 30-day readmission rate and 30-day morbidity using the Clavien-Dindo classification. The Secondary Outcomes were to determine patient cohort selection, quality of TURBT and early recurrence rate and to report patient feedback following day-case TURBT. Materials & Methods: A retrospective audit of day-case TURBTs in a District General Hospital (DGH) over 3 years pre-COVID19 (January 2017 - March 2020) was performed. We only included patients who underwent a TURBT and excluded any cystoscopy, biopsy or fulguration. A day-case TURBT pathway is in place, for postoperative recovery, instillation of intravesical chemotherapy postoperatively if required and re-admission for trial without catheter when indicated in the hospital. Case notes were reviewed manually. Feedback was obtained from patients who had new tumour TURBT in the last year using hospital patient feedback forms. Results: We included 77 patients who underwent TURBT in the day-case theatre, of these 5 patients required in-patient stay after the surgery. Of the remaining 72 discharged on the same day, 8 were re-admitted (11%) for Clavien-Dindo I complications. The mean age of the patients was 71 years (34-94 years);77% (59/77) were male;reported ASA scores were 3/77 ASA 1 (4%), 43/77 ASA 2 (56%), 28/77 ASA 3 (36%);30% (23/77) patients were on anticoagulants or antiplatelets;the average tumour size was 2cm (1mm – 5cm), 69% (53/77) were papillary in nature and 36/77 were newly diagnosed tumours (47%) and the remainder were recurrences or re-resections. Of the new tumours, 32/36 (89%) received mitomycin C as indicated. On final histology, muscle was present in specimen in 50/77 (65%). The readmission/failed discharge group had a higher rate of older patients, with higher ASA scores and longer operative times, however resection quality and tumour characteristics were not different from the day-case TURBTs. The recurrence rate at first check cystoscopy for the newly diagnosed tumours was 3% (1/36) while 1 patient had residual disease in a bladder diverticulum. All patients reported an overall positive experience. Conclusions: In the first of its kind audit patients reported outcomes after day-case TURBT, though readmission rate was relatively higher than previous reports in the literature, the overall patient experience was favorable and the outcomes of TURBT quality and early recurrence were satisfactory. The data obtained can provide guidance to employ better patient selection to reduce readmission rates. Hence, day-case TURBT can be a feasible option in appropriately selected patients, with a suitable pathway in place.

SELECTION OF CITATIONS
SEARCH DETAIL