scholarly journals O47 Safe delivery of surgical tracheostomies in COVID-19 patients during the pandemic

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
N Angamuthu ◽  
D Baker ◽  
J Tsui ◽  
E Gagasa ◽  
R E D'Souza
Keyword(s):  
High Risk ◽  
Virus Disease ◽  
Antibody Test ◽  
Symptomatic Treatment ◽  
Strict Adherence ◽  
Operation Theatre ◽  
Surgical Tracheostomy ◽  
Safe Delivery ◽  
Related Data ◽  
Local Resources

Abstract Introduction During the corona virus disease (COVID-19) pandemic, frontline units worldwide faced the challenging task of providing high-risk services (like surgical tracheostomy) while safe-guarding the very people performing the high risk procedures. The aim of our study was to assess the incidence of COVID-19 infection among staff involved in surgical tracheostomy on COVID-19 patients Method A surgical tracheostomy protocol and operation theatre modifications were put in place at our centre, dictated by local resources, staff availability and previous tracheostomy experience. Between 26/03/2020 and 27/05/2020, staff participating in 71 tracheostomy procedures were sent a questionnaire. The presence of COVID-19 symptoms (new onset continuous cough, fever, loss of taste and/or loss of smell) in tracheostomy staff and patient related data were analysed. Result Among the responders (72/122), compliance with personal prophylaxis equipment use was 100%. Eleven (15%,11/72) reported key COVID-19 symptoms and self-isolated. 10 had a COVID-19 swab test and three tested positive. One staff attended (1/72) hospital for symptomatic treatment, none required hospitalisation. 43/72 staff (60%) underwent a COVID-19 antibody test, 18.6% (8/43) were positive. Among the tracheostomised patients, the mean age was 58 years(29–78) and 65.5% were males. The median time from intubation to ST was 15 days (range 5–33, IQR = 9). There were no tracheostomy related deaths and overall mortality was 11%(6/55). Conclusion Safe delivery of tracheostomy during a pandemic like COVID-19 is possible with strict adherence to personnel protective equipment, surgical protocols and regulation of traffic flow in theatres to mitigate the potential transmission of COVID-19 among surgical staff. Take-home Message Compliance with PPE, adherence to tracheostomy protocol and local modifications can mitigate potential COVID-19 transmission among health care personnel.

Screening at ports of entry for Ebola Virus Disease in England—a descriptive analysis of screening assessment data, 2014–2015

2020 ◽  
Author(s):  
Nicki L Boddington ◽  
Sophia Steinberger ◽  
Richard G Pebody
Keyword(s):  
Public Health ◽  
High Risk ◽  
Secondary Care ◽  
Ebola Virus ◽  
Virus Disease ◽  
Descriptive Analysis ◽  
Health Assessment ◽  
Ebola Virus Disease ◽  
Screening Assessment

Abstract Background In response to the outbreak of Ebola Virus Disease (EVD) in West Africa in 2014 and evidence of spread to other countries, pre-entry screening was introduced by PHE at five major ports of entry in the England. Methods All passengers that entered the England via the five ports returning from Liberia, Guinea and Sierra Leonne were required to complete a Health Assessment Form and have their temperature taken. The numbers, characteristics and outcomes of these passengers were analysed. Results Between 14 October 2014 and 13 October 2015, a total of 12 648 passengers from affected countries had been screened. The majority of passengers were assessed as having no direct contact with EVD cases or high-risk events (12 069, 95.4%), although 535 (4.2%) passengers were assessed as requiring public health follow-up. In total, 39 passengers were referred directly to secondary care, although none were diagnosed with EVD. One high-risk passenger was later referred to secondary care and diagnosed with EVD. Conclusions Collection of these screening data enabled timely monitoring of the numbers and characteristics of passengers screened for EVD, facilitated resourcing decisions and acted as a mechanism to inform passengers of the necessary public health actions.

Should pulmonary radiographs be taken routinely following paediatric tracheostomy?

2021 ◽  
pp. 021849232110063
Author(s):  
Nazik Yener ◽  
Muhammed Üdürgücü ◽  
Fatma Alaçam ◽  
Muhammed Şükrü Paksu ◽  
İrem Sarı ◽  
...  
Keyword(s):  
High Risk ◽  
Tracheostomy Tube ◽  
Risk Groups ◽  
Age Group ◽  
Paediatric Radiology ◽  
Surgical Tracheostomy ◽  
Emergency Tracheostomy ◽  
New Findings ◽  
Paediatric Age ◽  
Study Support

Aim As the rates of complications related to tracheostomy procedures have fallen in recent years, the routine taking of pulmonary radiographs following tracheostomy has become a matter of debate. The aim of this study was to compare the incidence of complications developing in 120 children who had pulmonary radiographs taken following surgical tracheostomy and to thereby evaluate the necessity of routine pulmonary radiographs after tracheostomy. Methods The data were retrospectively reviewed of 120 children who had pulmonary radiographs taken following surgical tracheostomy between January 2012 and January 2018. The pulmonary radiographs taken before and immediately after tracheostomy were evaluated independently by two paediatric radiology specialists and the results were recorded. Results The incidence of complications after tracheostomy was determined as 23.3%, and no pneumothorax was determined in any patient. An increase was not seen in the complication incidence in those who had undergone emergency tracheostomy and patients aged < 2 years, which are accepted as high-risk groups. In the evaluation of the pre- and post-tracheostomy radiographs, new findings were determined on the post-tracheostomy radiograph that had not been there previously in eight patients (6.6%). These findings were newly formed infiltration in seven patients (5.8%), and malposition of the tracheostomy tube in one patient (0.8%). No pathology requiring intervention was determined on the radiographs of any patient. Conclusion The results of this study support the view that it is not necessary to take pulmonary radiographs routinely following tracheostomy in the paediatric age group, including those at higher risk.

MEASLES IMMUNIZATION INCORPORATED IN THE ROUTINE SCHEDULE FOR INFANTS: EFFICACY OF A COMBINED INACTIVATED-LIVE VACCINATION REGIMEN

PEDIATRICS ◽  
1964 ◽  
Vol 34 (6) ◽  
pp. 795-797
Author(s):  
Saul Krugman ◽  
Shirley Stone ◽  
Rose Hu ◽  
Harriet Friedman
Keyword(s):  
Virus Vaccine ◽  
Measles Virus ◽  
Gamma Globulin ◽  
Virus Disease ◽  
Indirect Evidence ◽  
Antibody Test ◽  
Vaccine Virus ◽  
Inactivated Vaccine ◽  
Measles Vaccine ◽  
Subclinical Disease

1. Live attenuated measles virus vaccine without gamma globulin was extremely well tolerated by infants 12 to 14 months of age if they received 3 doses of inactivated vaccine at about 2, 3, and 4 months of age. This phenomenon was observed in spite of no detectable antibody after inactivated vaccine and a consistent antibody response after live vaccine. 2. Three inoculations of inactivated vaccine appeared to have an attenuating effect on measles infection acquired within 9 months by 17 infants; at least 70% of these infants were proved to have a subclinical disease by serologic studies. 3. The failure to detect antibody following three inoculations of killed vaccine probably reflects the lack of sensitivity of the HI antibody test which was employed in this study. The attenuating effect of the killed vaccine on the natural disease and on the measles vaccine-virus disease provides indirect evidence of antibody formation. 4. If killed measles vaccine can be successfully incorporated with diphtheriapertussis-tetanus toxoid it should be a useful preparation for primary immunization during the first 6 months of life. However, it would be most important to complete the immunization with an inoculation of live attenuated measles-virus vaccine at 12 to 14 months of age.

Clinicopathological characteristics and impact on efficacy of three versus six months of adjuvant chemotherapy in early-onset colon cancer: ACHIEVE and ACHIEVE-2 trials.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 60-60
Author(s):  
Eiji Oki ◽  
Masahito Kotaka ◽  
Dai Manaka ◽  
Manabu Shiozawa ◽  
Yasuhiro Sakamoto ◽  
...  
Keyword(s):  
Colon Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Early Onset ◽  
Lung Metastases ◽  
Age Groups ◽  
Disease Free Survival ◽  
Clinicopathological Characteristics ◽  
Related Data ◽  
Incidence And Mortality

60 Background: Colorectal cancer (CRC) incidence and mortality have decreased since the 1970s but several data such as the SEER CRC registry show that the incidence of early onset colon cancer (eoCC, age 20-49) and RC keep increasing. There is limited results suggesting eoCC may have different behaviors compared to traditional CC (tCC, age ≥ 50). Methods: Individual patient data of 1,805 high-risk stage II/III colon cancer (CC) patients (pts) as the modified ITT population in ACHIEVE and ACHIEVE-2 trials were investigated. Clinicopathological features and treatment-related data were assessed by age group. Disease-free survival (DFS) was assessed by Kaplan-Meier curves and Cox multivariable models adjusted by trials, regimen, T and N. Results: Of the 1,805 pts, eoCC were 155 pts (8.6%). Using 5% difference between age groups as clinically meaningful cutoff, eoCC had similar gender (female, 52 vs 48%), PS (PS = 1, 1 vs 4%), risk group (high-risk, 43 vs 42%) and T stage (T4, 30 vs 30%) as tCC, while eoCC were less likely right-sided colon primary (32 vs 39%), had N1 disease (48 vs 54%), and treated by FOLFOX (16 vs 23%). Overall, eoCC significantly had a worse DFS than tCC (3y-DFS, 75 vs 82%; Adjusted Hazard Ratio = 1.40: 95% Confidence Interval, 1.00-1.95: p= 0.0478); in addition, similar DFS were observed among tCC pts (age 50-69 vs >70). eoCC experienced less neutropenia, thrombocytopenia and stomatitis, but had more diarrhea, nausea and/or vomiting. There were 38 and 297 pts with an initial relapse in eoCC and tCC, respectively. Of those, peritoneal metastases were more frequently seen in eoCC (n = 13, 34%) than in tCC (n = 63, 21%) (p = 0.097), whereas liver and lung metastases were similar between the two groups. Impact on DFS of 3 versus 6 months of adjuvant chemotherapy in eoCC (3y-DFS, 75% vs 76%) is similar to that in tCC (83% vs 81%). Conclusions: eoCC had unique characteristics; the difference in DFS between eoCC and tCC were potentially due to a different metastatic spread. eoCC had a different adverse event profile compared to tCC. No impact on DFS of treatment duration in eoCC was suggested. Clinical trial information: UMIN000013036.

scholarly journals Protecting the most vulnerable during COVID-19 and beyond: a case report on the remote management of heart failure patients with cardiac implantable electronic devices

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6
Author(s):  
Fozia Zahir Ahmed ◽  
Carol Crosbie ◽  
Matthew Kahn ◽  
Manish Motwani
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Electronic Devices ◽  
Management Strategies ◽  
Phone Call ◽  
Cardiac Resynchronization ◽  
Physiological Data ◽  
Related Data ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk

Abstract Background Heart failure (HF) patients with cardiac implantable electronic devices (CIEDs) represent an important cohort. They are at increased risk of hospitalization and mortality. We outline how remote-only management strategies, which leverage transmitted health-related data, can be used to optimize care for HF patients with a CIED during the COVID-19 pandemic. Case summary An 82-year-old man with HF, stable on medical therapy, underwent cardiac resynchronization therapy implantation in 2016. Modern CIEDs facilitate remote monitoring by providing real-time physiological data (thoracic impedance, heart rate and rhythm, etc.). The ‘Triage Heart Failure Risk Score’ (Triage-HFRS), available on Medtronic CIEDs, integrates several monitored physiological parameters into a risk prediction model classifying patients as low, medium, or high risk of HF events within 30 days. In November 2019, the patient was enrolled in an innovative clinical pathway (Triage-HF Plus) whereby any ‘high’ Triage-HF risk status transmission prompts a phone call-based virtual consultation. A high-risk alert was received via remote transmission on 11 March, triggering a phone call assessment. Upon reporting increasing breathlessness, diuretics were initiated. The prescription was remotely issued and delivered to the patient’s home. This approach circumvented the need for all face-to-face reviews, delivering care in an entirely remote manner. Discussion The challenges posed by COVID-19 have prompted us to think differently about how we deliver care for patients, both now and following the pandemic. Contemporary CIEDs facilitate the ability to remotely monitor HF patients by providing rich physiological data that can help identify individuals at elevated risk of decompensation using automated device-generated alerts.

scholarly journals Assessment of indications of caesarean section among high risk women by Robson criteria: a prospective study

2018 ◽  
Vol 7 (7) ◽  
pp. 2623
Author(s):  
Kaveri Shaw Patel ◽  
Roma S. Nag
Keyword(s):  
High Risk ◽  
Caesarean Section ◽  
Care Center ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
Group Classification ◽  
Classification Systems ◽  
World Health ◽  
Qualitative Assessment ◽  
Safe Delivery

Background: Caesarean section (CS) is a surgical intervention for safe delivery other than natural vaginal route. World Health Organization (WHO) has recommended ten group classification systems of Robson criteria which we have used to analyse CS at our center. The objective of the study to analyse the lower section caesarian section (LSCS) data under Robson criteria for implementation in regular practice in tertiary care center and to understand the need of it for future practice.Methods: A prospective analysis done for deliveries in Obstetric Department of Shalby Multispecialty Hospital of central India by Robson ten group classification criteria. The study was carried out for the period of two year from April 2016 to April 2018 including antenatal women attending labour room with high risks or referred cases from other centers.Results: The study reflected overall 196 live birth of high risk cases which were having other co morbidities like pre-eclampsia, eclampsia, hypothyroidism, diabetes, acute viral hepatitis. The data compared with Robsons guidelines and reflected that the centre is dealing with high risk primigravida (47.51%, 35-42% Robson criteria) cases with high CS rate (16.8%, group 5). There was multiple pregnancy, group 8, (2.32 %, >1.5-2% Robson Criteria) and preterm births as in group 10, 18.02 % (5% in Robson Criteria), exclusively high.Conclusions: The Robson criteria help to classify the population handled by the canter to develop the strategies for betterment of services. It has limitation in view of qualitative assessment of the data for comorbidities and severity of the disease.

scholarly journals Prediction of Heparin Induced Thrombocytopenia (HIT) Using a Combination of 4Ts Score and Screening Immune Assays

2020 ◽  
Vol 26 ◽  
pp. 107602962096285
Author(s):  
Rajat Thawani ◽  
Srikant Nannapaneni ◽  
Vivek Kumar ◽  
Phone Oo ◽  
Michael Simon ◽  
...  
Keyword(s):  
High Risk ◽  
Community Hospital ◽  
Antibody Test ◽  
Elisa Test ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
T Score ◽  
Risk Patients ◽  
Immune Assays ◽  
Antibody Tests

Clinical assessment (4Ts) followed by testing for Heparin/platelet factor 4 (HPF4) antibody in intermediate and high risk patients is the standard algorithm of pretest for Heparin induced thrombocytopenia (HIT), and the diagnosis is confirmed by serotonin releasing assay (SRA) in those who have positive antibodies. We conducted a retrospective analysis in a cohort of patients treated in a community hospital who had HIT antibody test by either ELISA or a rapid Particle Immunofiltration Assay (PIFA), regardless of their 4Ts scores. Among 224 patients, 17 had HIT. The PPV for those with a 4 T score ≥4 was 10.4%, which misdianosed 3 patients with HIT who tested positive for antibodies. Combining 4 T score ≥4 AND positive HIT antibody showed a PPV of 20.3% and a sensitivity of 70.6%, misdiagnosing 5 HIT patients. Using 4Ts ≥4 OR positive HIT antibody showed 100% sensitivity and 100% negative predictive value (NPV). The ELISA test had 100% sensitivity and 100% NPV, while the PIFA test missed 2 HIT patients, with sensitivity of 60% and NPV of 96.7%. Our results suggest that SRA testing should be conducted if a patient presents with a 4 T score ≥4 OR a positive HIT antibody, and antibody tests should be conducted for every patient suspected of HIT.

A phase II study of gemcitabine, ifosfamide, and oxaliplatin (GIFOX) as upfront treatment for high-risk, non-anaplastic large cell, peripheral T-cell lymphomas.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 8564-8564
Author(s):  
Gaetano Corazzelli ◽  
Gianpaolo Marcacci ◽  
Ferdinando Frigeri ◽  
Gaetana Capobianco ◽  
Francesco Volzone ◽  
...  
Keyword(s):  
T Cell ◽  
High Risk ◽  
Nk Cell ◽  
Autologous Transplantation ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Early Death ◽  
Free Survival ◽  
Safe Delivery

8564 Background: Patients (pts) with peripheral T/NK cell lymphomas (PTCL) and intermediate-high/high IPI risk have a 5-yr overall survival < 20%. Current chemotherapy is unsatisfactory while benefit of upfront autologous transplantation (ASCT) is limited by high pre-transplant progression rates and pts advanced age. We evaluated efficacy and stem cells (SCs)-mobilizing activity of a biweekly regimen of gemcitabine (G), ifosfamide (Ifo) and oxaliplatin (Ox) (GIFOX), as an upfront strategy ensuring fast cytoreduction and early ASCT access or an effective alternative to CHOP-like programs in transplant-inelegible pts. Methods: Six biweekly courses of GIFOX [G 1000 mg/m2 D1, Ox 130 mg/m2 D2, Ifo 5 g/m2 D2 as 24h infusion (fractionated over days 2-4 in pts>65 yrs), G-CSF DD 7-11] were planned for all pts, with SCs mobilization at course 3 in ASCT-eligible pts. Simon's minimax two-stage design was adopted with the primary and secondary endpoints of response rate (RR) and progression-free survival (PFS), respectively. Results: Thirty-four pts (median age 63 yrs, r 42-80) [PTCL, nos (n=16), AITL (n=7), extranodal NK/T-cell (n=5), SS (n=6)], with IPI score intermediate-high (62%) or high (38%) were accrued [stage IV: 71%; BM involvement: 38%; E-site >1: 47%; hi LDH: 71%; ECOG>1: 38%; B-symptoms: 44%]. A total of 172 courses was delivered (median 6, r 2-6). Only 5 pts received <4 courses, due to progression (n=4) or early death (n=1). Overall RR was 82% [95% CI, 66-92; 22 complete (CR) and 6 partial (PR) responses]. Twelve pts mobilized SCs (median CD34+ cells harvest: 4.36x106/kg) and 8 (7CRs,1PR) underwent ASCT, 6 to 13 weeks after the 6th course. Estimated 5-yr PFS was 48% (95%CI: 28-65); median PFS for non-transplanted pts was 15 mo.s. Estimated 4-yr disease-free survival was 58%. Relevant toxicities were G4 thrombocytopenia (13%), G4 anemia (23%), G3/G4 infection (29%/6%), G3 encephalopathy (6%). Conclusions: Response and survival rates of GIFOX in high-risk PTCL compared more than favorably to CHOP-based regimens. Effective cytoreduction and prompt access to ASCT were ensured, together with safe delivery of a full induction program to transplant-ineligible pts.

scholarly journals Results of Annual Screening in Phase I of the United Kingdom Familial Ovarian Cancer Screening Study Highlight the Need for Strict Adherence to Screening Schedule

2013 ◽  
Vol 31 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Adam N. Rosenthal ◽  
Lindsay Fraser ◽  
Ranjit Manchanda ◽  
Philip Badman ◽  
Susan Philpott ◽  
...  
Keyword(s):  
United Kingdom ◽  
High Risk ◽  
Surgical Intervention ◽  
Transvaginal Ultrasound ◽  
High Risk Population ◽  
Predictive Values ◽  
Strict Adherence ◽  
Screening Interval ◽  
The United Kingdom ◽  
The Impact

Purpose To establish the performance characteristics of annual transvaginal ultrasound and serum CA125 screening for women at high risk of ovarian/fallopian tube cancer (OC/FTC) and to investigate the impact of delayed screening interval and surgical intervention. Patients and Methods Between May 6, 2002, and January 5, 2008, 3,563 women at an estimated ≥ 10% lifetime risk of OC/FTC were recruited and screened by 37 centers in the United Kingdom. Participants were observed prospectively by centers, questionnaire, and national cancer registries. Results Sensitivity for detection of incident OC/FTC at 1 year after last annual screen was 81.3% (95% CI, 54.3% to 96.0%) if occult cancers were classified as false negatives and 87.5% (95% CI, 61.7% to 98.5%) if they were classified as true positives. Positive and negative predictive values of incident screening were 25.5% (95% CI, 14.3 to 40.0) and 99.9% (95% CI, 99.8 to 100) respectively. Four (30.8%) of 13 incident screen-detected OC/FTCs were stage I or II. Compared with women screened in the year before diagnosis, those not screened in the year before diagnosis were more likely to have ≥ stage IIIc disease (85.7% v 26.1%; P = .009). Screening interval was delayed by a median of 88 days before detection of incident OC/FTC. Median interval from detection screen to surgical intervention was 79 days in prevalent and incident OC/FTC. Conclusion These results in the high-risk population highlight the need for strict adherence to screening schedule. Screening more frequently than annually with prompt surgical intervention seems to offer a better chance of early-stage detection.

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