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The application of telerehabilitation system has gained popularity and acceptance recently due to the restrictions in controlling the COVID-19 pandemic. This paper described the development of an elbow-wrist telerehabilitation system that complement the disrupted routine rehabilitation session. The developed system consists of a wearable exoskeleton system that assist in rehabilitation of the elbow and wrist joints for individuals with neurological conditions such as Parkinson's and Spinal Cord Injuries that affects movements of the upper extremities. The two modes of operation available enables the adoption of the 5G technology in the near future. This system also potentially fulfills the requirement of Accessibility, Availability, Affordability, and Acceptability (4As) of Telerehabilitation System in Malaysia. Overall development cost of the system is approximately MYR 500. The system enable rehabilitation to be performed at home-setting with a cloud-based monitoring system that will provide long-term monitoring for clinician's assessment. The project provides a proof-of-concept of such system in the Malaysian context.Clinical Relevance - This work demonstrated the proof-of concept of a 4A system is applicable in the Malaysian context. © 2022 IEEE.
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Introduction: Chronic respiratory diseases (CRDs) are growing problems worldwide. Pulmonary rehabilitation (PR) has proven benefits for patients with CRDs, but programmes need to be adapted to low resource settings, in the context of the recent COVID-19, to home-based delivery. Aim(s): To evaluate the feasibility of delivering home-based PR for patients with CRDs in Malaysia. Method(s): We recruited people with CRD from two hospitals in Klang Valley, Malaysia to home-based PR programme. Patients were provided education sessions, and assessments [functional exercise capacity {6-Minutes walking test (6MWT)}] and [Health-Related Quality of Life (HRQOL) {COPD Assessment Test (CAT)}] were made at centres prior to the start of programme. They performed exercise at least 5 sessions per week for 8 weeks at home and were supervised weekly via phone calls. Post PR, we assessed the attendance and retention rate and measured 6MWT and CAT at centre. Result(s): We recruited 30 patients. The retention rate was 93.3%;2 dropped out due to hospitalization. However, only 11(36.7%) attended post PR assessment at centres, of these 9 (81.8%) had performed all 40 sessions of home exercises. The attendance for post- PR assessment was limited due to COVD-19 restrictions that forbade travel in Malaysia at that time. Data from the 11 patients showed significant change in CAT scores, 5.09;pre: 22.45, post: 17.36(95% confidence interval (CI) 1.48, 8.70, p=0.01) but no significant change in 6MWT distance -24.36;pre: 276.36, post: 300.72(95% CI -80.52,-31.79, p=0.356). Conclusion(s): Home-based PR is feasible and can be a valuable method to deliver PR remotely.
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Objectives: To investigate the risk of flare-ups after COVID-19 vaccination in patients with rheumatic disease. Method(s): A total of 1,617 patients with rheumatic diseases were identified from three rheumatology clinics. Patients were interviewed for demographic data, disease activity, and vaccination status. Disease flare-up was determined clinically by independent rheumatologists. Change of serum markers and medications were retrieved from medical records. The risk of exacerbation of rheumatic disease, change in serum markers, and escalation of rheumatic medications between vaccinated and nonvaccinated patients were determined using Cox, linear, and logistic regression models, respectively. Possible confounding factors were also taken into consideration. Result(s): Among 562 (34.76%) patients who received COVID-19 vaccination, rheumatic disease (HR = 2.10, P < 0.001), inflammatory arthritis (HR = 2.71, P < 0.001), rheumatoid arthritis (RA) (HR = 2.03, P = 0.002), spondyloarthritis (SpA) (HR = 4.78, P < 0.001), autoimmune disease (HR = 1.77, P = 0.01), and systemic lupus erythematosus (SLE) (HR = 1.99, P = 0.02) were associated with postvaccination clinical flare-up. Adult Still's disease (B = 12.76, P = 0.03) was associated with increased serum C-reactive protein (CRP). No association was found between vaccination and escalation of rheumatic medication. Subgroup analyses showed that only the mRNA vaccine was associated with flare-ups. Conclusion(s): COVID-19 vaccination was associated with minor disease flare-up but not escalation of rheumatic medications. In the absence of absolute contraindications, COVID-19 vaccination is recommended in patients with rheumatic disease. KEY MESSAGES 1. Vaccination is effective in the prevention of morbidity due to COVID-19 in patients with autoimmune diseases. 2. The mRNA vaccine was associated with mild rheumatic disease flare-up. 3. Inactivated virus vaccine is preferable to mRNA vaccine in patients with active autoimmune disease. Copyright © 2023 The Author(s).
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Background Real-world data is currently limited on the association between oral antiviral therapy and healthcare system burden in patients with mild-to-moderate COVID-19. This study aims to evaluate the clinical and cost effec-tiveness of Molnupiravir and Nirmatrelvir-ritonavir use in reducing mortality in this population. Methods This is a retrospective cohort study involving 54,355 COVID-19 patients during February 22-March 31,2022 in Hong Kong. Inverse probability of treatment weighting (IPTW) was used to adjust patient characteristics. Our exposure of interest was Molnupiravir/Nirmatrelvir-Ritonavir prescription, with all-cause mortality as the pri-mary outcome. IPTW-adjusted multivariate regressions were used to estimate treatment impact on clinic re -atten-dance and unplanned admissions. Finally, attributed cost and incremental cost-effectiveness ratios (ICER) were estimated. Findings In the outpatient cohort (N = 33,217, 61.1%), 16.1% used Molnupiravir and 13.4% used Nirmatrelvir-Ritona-vir, while in the inpatient cohort (N = 21,138, 38.9%), 3.8% used Molnupiravir and 1.3% used Nirmatrelvir-Ritonavir. IPTW-adjusted Cox model estimated that Molnupiravir (hazard ratio (HR)(95%CI)=0.31 (0.24-0.40), P< 0.0001) and Nirmatrelvir-Ritonavir (HR=0.10 (95%CI 0.05-0.21), P< 0.0001) were significantly associated with a reduced mortality hazard. In the outpatient cohort, both antiviral prescriptions were associated with reduced odds for unplanned hospital admissions (Molnupiravir: odds ratio (OR) =0.72 (0.52-0.98), P=0.039;Nirmatrelvir-Ritonavir: OR=0.37 (0.23-0.60), P<0.0001). Among hospitalised patients, both antiviral prescriptions were associated with sig-nificant reductions in the odds ratios for 28-days readmission (Molnupiravir: OR=0.71 (0.52-0.97), P=0.031;Nirma-trelvir-Ritonavir: OR=0.47 (0.24-0.93), P=0.030). ICERs for death averted for Molnupiravir stood at USD493,345.09 in outpatient settings and USD2,629.08 in inpatient settings. In outpatient settings, Nirmatrelvir-ritonavir cost USD331,105.27 to avert one death, but saved USD5,502.53 to avert one death in comparison with standard care. Interpretation In high-risk patients in Hong Kong with mild-to-moderate COVID-19, Molnupiravir and Nirmatrel-vir-Ritonavir prescriptions were associated with reduced all-cause mortality and significant cost savings.
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COVID-19 has brought about a lot of disruption, and education was one of the areas that was very significantly impacted. In many places in the world, students and teachers were forced to learn or teach online, oftentimes with very little preparation, in other places, schools shut down altogether and students' learning was interrupted. In this paper, we describe a case study that attempts to alleviate some of these challenges through an online STEM workshop series. Focus group studies were used to inform the design of the workshops, which were run as part of a service-learning program, incorporated student-directed, tangible learning, virtual experiential learning alongside theoretical content delivery to complement the formal curriculum. We present evaluation information as well as lessons learned for future similar endeavours.
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In the wake of the COVID-19 pandemic, contact tracing apps have been developed based on digital contact tracing frameworks. These allow developers to build privacy-conscious apps that detect whether an infected individual is in close-proximity with others. Given the urgency of the problem, these apps have been developed at an accelerated rate with a brief testing period. Such quick development may have led to mistakes in the apps' implementations, resulting in problems with their functionality, privacy and security. To mitigate these concerns, we develop and apply a methodology for evaluating the functionality, privacy and security of Android apps using the Google/Apple Exposure Notification API. This is a three-pronged approach consisting of a manual analysis, general static analysis and a bespoke static analysis, using a tool we've developed, dubbed MonSTER. As a result, we have found that, although most apps met the basic standards outlined by Google/Apple, there are issues with the functionality of some of these apps that could impact user safety.
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The coronavirus disease 2019 (COVID-19) pandemic is placing an increasing burden on liver transplant (LT) services worldwide. At the peak of the pandemic, many LT services worldwide reduced or halted their activities. With the gradual easing of lockdowns, LT teams face new challenges when restarting activities. The numbers of LTs are likely to drop in the immediate post-COVID era. Prolonged and intermittent lockdowns are likely to lead to a shortage of supplies, especially in poor resource settings. Special attention is needed to avoid nosocomial COVID-19 infection among cirrhotic patients awaiting transplant, post-transplant patients, and members of transplant teams. LT programs may have to revise existing strategies in selecting donors and recipients for transplants. Redesigning service provision, restructuring outpatient care, carefully screening and selecting donors and recipients, and performing LT with limited resources will have to be initiated in the post-COVID era if long-term recovery of LT services is to be expected. Costs involved with LT are likely to increase, considering the change in protocols of testing, quarantining, and interstate traveling. This paper discusses the different elements affecting and the widespread impact of the COVID-19 pandemic on LT and strategies to minimize the impact of these factors and to adapt so LT services can meet the health care needs during this pandemic and beyond.