Influenza: epidemiology and hospital management.

Influenza is a cause of significant morbidity, mortality, economic and social disruption. Annual seasonal influenza epidemics result in 290,000-650,000 deaths worldwide, while influenza pandemics have resulted in many more - the A(H1N1) pandemic of 1918-1919 caused 20-50 million deaths. Healthcare systems struggle to effectively manage the constant threat because of the evolving nature of the virus. Since the start of 2021, there have been four events of concern related to influenza reported by the World Health Organization. To reduce the burden of disease and protect our global health security, it is essential that clinicians effectively identify and manage cases of influenza, as well as understand and collaborate with the wider public and global health systems. In particular, the rapid identification and management of novel influenza strains of concern is critical. The COVID-19 pandemic has instigated improvements in influenza preparedness guidelines and management protocols. It has accelerated healthcare innovation, with novel tools to manage respiratory disease more effectively. Innovative technologies, new pharmaceuticals and improved global surveillance are changing the way healthcare systems respond to influenza and other diseases to ensure global health resilience and effective management of future outbreaks.

Managing intensive care admissions when there are not enough beds during the COVID-19 pandemic: a systematic review.

The surge in cases of severe COVID-19 has resulted in clinicians triaging intensive care unit (ICU) admissions in places where demand has exceeded capacity. In order to assist difficult triage decisions, clinicians require clear guidelines on how to prioritise patients. Existing guidelines show significant variability in their development, interpretation, implementation and an urgent need for a robust synthesis of published guidance. To understand how to manage which patients are admitted to ICU, and receive mechanical ventilatory support, during periods of high demand during the COVID-19 pandemic, a systematic review was performed. Databases of indexed literature (Medline, Embase, Web of Science, and Global Health) and grey literature (Google.com and MedRxiv), published from 1 January until 2 April 2020, were searched. Search terms included synonyms of COVID-19, ICU, ventilation, and triage. Only formal written guidelines were included. There were no exclusion criteria based on geographical location or publication language. Quality appraisal of the guidelines was performed using the Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) and the Appraisal of Guidelines for Research and Evaluation Instrument Recommendation EXcellence (AGREE REX) appraisal tools, and key themes related to triage were extracted using narrative synthesis. Of 1902 unique records identified, nine relevant guidelines were included. Six guidelines were national or transnational level guidance (UK, Switzerland, Belgium, Australia and New Zealand, Italy, and Sri Lanka), with one state level (Kansas, USA), one international (Extracorporeal Life Support Organization) and one specific to military hospitals (Department of Defense, USA). The guidelines covered several broad themes: use of ethical frameworks, criteria for ICU admission and discharge, adaptation of criteria as demand changes, equality across health conditions and healthcare systems, decision-making processes, communication of decisions, and guideline development processes. We have synthesised the current guidelines and identified the different approaches taken globally to manage the triage of intensive care resources during the COVID-19 pandemic. There is limited consensus on how to allocate the finite resource of ICU beds and ventilators, and a lack of high-quality evidence and guidelines on resource allocation during the pandemic. We have developed a set of factors to consider when developing guidelines for managing intensive care admissions, and outlined implications for clinical leads and local implementation.

Influenza and other emerging respiratory viruses.

Acute respiratory infections are one of the top five causes of mortality worldwide and contribute to >4 million deaths per year. Consequently, emerging respiratory viruses are a continuing threat to global health security and have the potential to affect our economies. Since the millennium, there have been around a dozen different outbreaks, several capturing international interest. The outbreak of severe acute respiratory syndrome coronavirus saw the beginning of an extensive global collaboration and has influenced many outbreak preparedness protocols now in place. Avian influenza is a particular threat, with cases of A(H5N1) and A(H7N9) reported most recently. Middle East respiratory syndrome coronavirus is causing continuing concerns with outbreaks in the Arabian Peninsula. Healthcare facilities worldwide play a crucial role in identifying threats and must be vigilant. Particularly important is identifying and managing emerging respiratory viruses when they are infrequently encountered. Surveillance, continuing research, vaccine and treatment developments are key to guiding the efforts and actions of healthcare workers, international health organizations, governments and other stakeholders. Each individual has a part to play in protecting our global health.

Novel surgical management of a laryngeal granular cell tumour.

Granular cell tumour (GCT) is a rare benign tumour occurring, most commonly, in the head and neck. Multiple tumours occur in 5-16% of patients. These tumours are chemo-radio-resistant and have high recurrence rates despite their benign histopathological features. Traditional management, depending on access, involves total tumour resection with wide margins due to the high rates of recurrence with incomplete resection. We present a patient with two synchronous GCTs of their upper airway: in the larynx and the trachea. Complete excision of the supraglottic lesion would have rendered the patient's larynx incompetent. Therefore, after multidisciplinary team (MDT) discussion, and following a discussion with the patient regarding the risks and benefits, a novel surgical management approach was agreed. Subtotal CO2 laser excision of the upper GCT was performed enabling functional organ preservation. A subsequent procedure was required when the patient became symptomatic due to tumour recurrence.