The effects of the COVID-19 pandemic on pharmacy education, staff and students in an Australian setting

Worldwide, COVID-19 has changed the way Pharmacy Education is being delivered. In Australia there was a rapid shift to online delivery, implementation of new technologies and new models for remote online teaching. The effects of the pandemic on pharmacy education, students and staff are discussed as well as strategies of how to maintain workforce development goals to ensure quality education. Copyright © 2020 FIP.

COVID-19 outbreaks in residential care homes in Hong Kong and effectiveness of vaccine against severe outcomes

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Longitudinal outcomes of adults and children with cystic fibrosis during the COVID-19 pandemic

Background: The onset of the COVID-19 pandemic was associated with restricted community movement, including limited access to health care facilities, resulting in a change in clinical service delivery to people with cystic fibrosis (CF). The aim of this study was to determine clinical outcomes of Australian adults and children with CF in the 12 months after the onset of the COVID-19 pandemic. Method(s): This longitudinal cohort study used prospectively entered national registry data. Primary outcomes were 12-month change in percentage predicted forced expiratory volume in one second (FEV1pp), body mass index (BMI) in adults, and BMI z-scores in children. A piecewise linear mixed-effects model was used to determine trends in outcomes in the 24 months before and 12 months after the onset of the pandemic. Comparative analysis of hospitalization and service delivery data before and after the onset of the pandemic was conducted. Result(s): Data were available for 3,662 individuals (median age 19.6, range 0-82). Overall registry data completeness was 95%. When trends in outcomes before and after pandemic onset were compared;FEV1pp went from a mean annual change of -0.13% (95% CI, -0.39 to 0.13) to a mean improvement of 1.73% (95% CI, 1.29-2.17). Annual mean annual change in BMI improved from 0.01 kg/m2 (95% CI, -0.07-0.09 kg/m2) to 0.33 kg/m2 (95% CI, 0.23-0.43 kg/m2). Therewas no change in BMI z-scores. Number of hospitalizations decreased from 2,656 to 1,957 ( p < 0.01). Virtual outpatient consultations increased from 8% of toal outpatient consultations before pandemic onset to 47% during the pandemic. Therewas an increase in average number of consultations per patient from a median of 4 (interquartile range 2-5) to 5 (interquartile range 3-6) ( p < 0.01). Conclusion(s): In the 12 months after the onset of the COVID-19 pandemic, improvement was observed in the clinical outcomes of people with CF and the model of care delivery changed from the pre-pandemic period. Health care teams must consider how best to deliver care in light of improved outcomes observed during the COVID-19 pandemic. Acknowledgements: This study was supported by a Health Service Research Grant from the HCF Research Foundation Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Implications of Pre-Transplant (tx) COVID-19 on SOT or HCT: A Multicenter Study

Purpose: Describe outcomes of patients (pt) with pre-tx COVID-19. Method(s): Multicenter study of SOT/HCT candidates who had a positive (pos) SARS-CoV-2 PCR pre-tx. Result(s): Pre-tx: Of 208 pt, median age was 56 (range 3-76). 87.8% were SOT candidates (40.5% kidney, 40.5% liver, 9.8% lung, 6.9% heart, 2.3% pancreas) and 13.9% were HCT candidates (54.2% allo, 45.8% auto). Pt underwent a median of 2 tests (range 1 - 14). In 41% of pt, > 1 neg PCR was required by the tx center before reactivation. Neg PCR was documented in 67.4% of pt at a median of 41 days (18-68) after pos PCR. Waitlist mortality was 11.0%;deaths were due to COVID-19 in 60% (12/20). Post-tx (all pt): 78 pt underwent tx at a median of 65.5 days (range 17-324) from COVID-19;71/78 have completed 4-weeks of follow-up. 24/78 (30.7%) pt were still PCR pos at time of tx (details below). 54/78 (69.2%) pt underwent routine PCR testing post-tx;62% were tested regularly for 8 weeks. Only 1 pt, who remained asymptomatic, developed recurrent pos PCR on surveillance testing 18 days post-tx. 1 pt had graft loss. There were no deaths at 4 weeks post-tx. Pt transplanted without a negative PCR: 24 pt with COVID-19 did not have neg PCR at time of tx: 9 (37.5%) kidney, 9 (37.5%) liver, 2 (8.3%) SLK, 1 (4.2%) lung, 1 heart (4.2%), 2 auto-HSCT (8.3%), 2 allo-HSCT (8.3%). Of 24 pt who were reactivated at a median of 21 days (range 8 - 38) from COVID-19 diagnosis, 7 underwent tx emergently (5 liver, 1 lung, 1 heart). 20/24 completed 4-weeks of follow-up;all were alive. PCR Cycle thresholds (Ct) increased over time, suggesting a reduction in SARS-CoV-2 viral loads with time elapsed since COVID-19 diagnosis. Conclusion(s): Short-term outcomes of transplantation in SOT/HCT candidates with prior COVID-19 were promising in this small cohort, even with a positive PCR going into transplant. Whether documentation of a negative PCR should be required for all tx candidates with a history of COVID-19 prior to transplantation should be investigated further, particularly among lung tx candidates. For certain tx candidates with COVID-19, relying time-based strategy instead of a test-based strategy may be safe.

Online OSCE in pharmacy education: Strategies to preserve academic integrity of high-stakes assessment

The Objective Structured Clinical Examination (OSCE) is a highly valued performancebased competency assessment that is extensively employed in medical and health professions education. In pharmacy undergraduate programmes, OSCE is an integral component of the curriculum, constituting both formative and summative assessments of the course. When the COVID-19 pandemic posed an overarching challenge in the delivery of face-to-face teaching and learning activities, academic institutions around the world ineluctably transitioned to online mode of education. Conducting OSCEs on virtual platforms presents its unique set of challenges. In the absence of physical isolation and invigilation of students, the risk of cheating and collusion is particularly high during virtual OSCEs. With the experience of conducting high-stakes OSCEs on virtual platforms at two different campuses simultaneously, the authors outline several strategies that can be implemented to ensure the academic integrity of the assessment.

Technical validation of a personal, home spirometer in children with chronic respiratory disorders

Introduction: COVID-19 has highlighted the importance of virtual healthcare. Accurate lung function monitoring is an essential element in the provision of telehealth for children with chronic respiratory disorders. Aim: To investigate the technical validity and reliability of a personal, home spirometer device. Secondly, to assess the ability of children to perform acceptable and reproducible spirometry, with a scientist via telehealth. Methods: Children (6-18 years) with chronic respiratory disorders performed spirometry using a conventional, laboratory spirometer (Vyntus Spiro, Carefusion, Yorba Linda, CA) and a SpiroHome, personal spirometer, on the same occasion. Spirometry was also performed on both devices, on the same occasion, by three respiratory scientists. Intra-class correlation co-efficient and Bland-Altman analysis was performed on FEV1 and FVC data. Spirometry performed via telehealth with a scientist was assessed to determine if it met ATS/ERS recommendations. Results: 97 children (mean age 12.9, range 5.9-18.3) were provided with a SpiroHome personal spirometer. 55 out of 61 children (90.16%) performed acceptable and reproducible spirometry on both devices in person with a scientist. There was a strong resemblance between the two devices for FEV1 and FVC data (Intra-class correlation coefficient 1, p<0.001 for both outcomes). Bland-Altman analysis revealed a mean difference (limits of agreement, LOA) of 0.01 L (0.23 to 0.25 L) for FEV1 and 0.03 L (-0.30 to 0.36 L) for FVC patient data between the devices, with no evidence of systematic bias. Measurements performed by respiratory scientists demonstrated similar results, with a mean difference (LOA) of 0.03 (-0.17 to 0.23) for FEV1 and 0.01 for FVC (-0.21 to 0.22). Patients (n = 61) performed acceptable and reproducible spirometry at home via telehealth with a scientist in 82 out of 94 sessions (87.23%). Conclusion: Our data suggests that SpiroHome is technically valid for performing scientist-lead, spirometry measurements via telehealth in paediatric, respiratory patients and devices can be used interchangeably, independent of setting.

Taiwan's budgetary responses to COVID-19: the use of special budgets

Purpose: The authors examine the Taiwanese government's budgetary responses to COVID-19, with a focus on the special budgets created for containing the virus, undertaking bailouts and providing economic stimulus. The authors assess the short-term and long-term fiscal implications of the budgetary measures and discuss how Taiwan's experiences could provide lessons for other countries for future emergencies. Design/methodology/approach: The authors collect data from Taiwan's official documents and news reports and compare the special budgets proposed by the Taiwanese government during the Great Recession and the COVID-19 pandemic. The authors discuss lessons learned from the 2008–09 special budget and possible concerns of the 2020 special budgets. In the conclusions, the authors discuss potential long-term implications for Taiwan's budgetary system as well as possible lessons for other countries based on Taiwan's experiences Findings: The authors found that the 2008–09 special budgets focused only on economic stimulus, whereas the 2020 special budgets covered COVID-19 treatments, bailouts and economic stimulus. In 2020, the Taiwanese government devised targeted bailout plans for industries and individuals most affected by the pandemic and created the Triple Stimulus Vouchers to boost the economy. Since the special budgets were largely funded through borrowing, the authors pointed out concerns for fiscal sustainability and intergenerational equity. Originality/value: COVID-19 has changed how the world functions massively. This work adds to the literature on COVID-19 by providing Taiwan's budgetary responses to the pandemic. This work also identifies ways for Taiwan to improve the existing budgetary system and discusses lessons for other countries. © 2020, Emerald Publishing Limited.