ABSTRACT
Background/Aims Rheumatology referrals classified as non-urgent/routine are commonly non-inflammatory conditions or medically non-urgent and can have significant waiting times for appointments. These waits were further escalated by the COVID-19 pandemic. Early intervention for noninflammatory conditions can be crucial to good outcomes and long wait-times can have significant adverse impacts while appropriate care pathways are determined. Recent UK GIRFT recommendations include using non-medical health professional expertise in assessment and management pathways to support right place, right time, right care. This study evaluated effectiveness, impacts and patient experiences of Advanced Practice Physiotherapist (APP) and Advanced Practice Nurse (APN) Triage and Assessment Clinics for routine new referrals. Methods The non-urgent/routine referral waiting list was e-triaged by a Rheumatology APP and APN supported by clinical record searches. Patients were contacted by telephone to update on clinical status and appointment requirements determined. Triage criteria were applied to determine new referrals suitable for APP and APN Rheumatology clinics, which included low likelihood of inflammatory disease or new referrals for known diagnosis/stable conditions. Clinics were undertaken with collocated Consultant clinical supervision. Assessment findings were discussed and management agreed, or seen if needed. With waiting list attrition, clinics were expanded to include Consultantdetermined stable condition reviews and follow-up reviews for nonsuspected inflammatory disease. Results At 01 July 2021, 214 new routine referrals were waiting a Consultant appointment (n=103 over 2yrs). Since service initiation, clinic outcomes to date include: 69% (n=243/358) new routine referrals discharged to GP or directed to right pathway with information, advice and self-management resources;8% (n=29) escalated to urgent;3% (11/358) with medical complexity remained on Consultant waitlist. Most common presentations seen included: Osteoarthritis (general or hand);Back and other spinal pain;Fibromyalgia;Persistent Fatigue and Widespread Pain;JHS/hEDS;Positive ANA without clinical features;Musculoskeletal conditions- other. To date, no patients have been re-referred and 329 new patient and 89 follow-up Consultant direct consultations have been spared. There is currently no wait-time for non-urgent/routine appointments. Patient experience feedback on the service has offered a 100% recommendation to continue and expressed highly positive experiences with the MDT approach. Patients value the breadth of expertise and care support, and the timely, thorough and professional service provided. Conclusion Rheumatology non-urgent/routine new referrals with low probability of underlying autoimmune conditions may be effectively and efficiently managed in a collaborative model using an advanced practice physiotherapist and nurse. This innovation has expanded a traditionally medical pathway to an MDT model utilising value-adding nonmedical expertise in service delivery. It has enhanced interdisciplinary learning and is a valued, collaborative approach to patient care. The initiative provides support to GIRFT recommendations of using an MDT skill-set to support improved patient access, service efficiencies and earlier intervention.
ABSTRACT
Rhino-orbital-cerebral mucormycosis is an invasive disease caused by fungi. Diabetes mellitus and solid organ transplantation are known risk factors, while it is increasingly recognized in patients with COVID-19 although the exact causal relationship is unknown. Early diagnosis and treatment with liposomal amphotericin B with surgical debridement carries a better outcome in these patients. We present a case of extensive rhino-orbital-cerebral mucormycosis involving the paranasal sinuses, left orbit, cavernous sinus, middle cranial fossa with abscess formation in the left middle cerebellar peduncle in a 46-year-old kidney transplant recipient with concomitant COVID-19 infection.
ABSTRACT
The construction industry is a major economic driver in Sri Lanka. However, the construction industry was significantly affected by the responses made by the Sri Lankan government to prevent the spread of the COVID-19 pandemic. The effects of those government responses on construction projects are diverse as time, cost, and quality-related impacts. These effects resulted in numerous contractual effects that were mostly to be dealt with reference to the provisions made in the standard forms of contracts such as ICTAD/SBD/02 and FIDIC 1999 in Sri Lanka. Since no similar pandemic has affected Sri Lanka at this magnitude before, neither ICTAD/SBD/02 nor FIDIC 1999 have been drafted giving due consideration to such exceptional circumstances. Furthermore, no studies that researched these kinds of aspects can be found in the existing literature. Hence, this research aims to explore the effects of the responses made by the Sri Lankan government to prevent the spread of the COVID-19 pandemic on the construction industry and the possible adaptations of standard forms of contracts to address the contractual implications of those effects to mitigate the effects on the contractual parties in both building and civil engineering projects. A desk review was carried out to identify the existing provisions of ICTAD/SBD/02 and FIDIC 1999 to overcome the effects of pandemic situations, and three case studies, including two building projects and one civil engineering project, were used for the empirical data collection. Representing contractors, consultants, and employers, twelve semi-structured interviews were conducted within the three case studies. The research findings reveal that a collaborative approach with cost and time-sharing is the best approach to address the effects of a pandemic situation. Furthermore, defining terminologies, developing transparency in contractual relationships, and establishing an equal assessment basis can all aid in the contractual development of the ICTAD/SBD/02. As a result, the study suggests improving documentation practices, developing guidelines for amicable settlement, and eliminating the adversarial effects of ICTAD/SBD/02 through an equal assessment process. Thus, this research contributes to the further development of ICTAD/SBD/02 while also improving Sri Lankan building and civil engineering projects by reducing contractual issues in future pandemics. © 2022, Ceylon Institute of Builders. All rights reserved.
ABSTRACT
As countries emerge from lockdowns, vaccine passports are being implemented around the world to allow unrestricted movement of people. However, the implementation of vaccine passports has proven to be a double-edged sword that can compromise an individual's privacy in manifold ways. This paper provides a comprehensive review of the privacy, ethical, and regulatory issues associated with the implementation of vaccine passports. It also engages in a theoretical analysis incorporating the concept of ethical data governance and the health belief model (HBM) with a view to making sense of the technological adoption of vaccine passports. Finally, key ethical and legal issues that may arise following the implementation of vaccine passports and the necessary policy implications are discussed. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Background: Tumor necrosis factor-alpha (TNFɑ) is a cytokine that manages the host defense mechanism, which may play a role in the pathogenesis of COVID-19 patients. Several single-nucleotide polymorphisms, described in the promoter region of the TNFα gene, have a significant role on its transcriptional activity. These include the − 308A > G polymorphism which increases the TNFα levels with the expression of the A allele. The aim of this study was to explore whether the TNFα.− 308A > G polymorphism affects the clinical state of COVID-19 patients. The study included a total of 1028 individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which were distributed in 3 groups: asymptomatic, mild symptomatic and severe symptomatic patients. The amplification-refractory mutation system was used to determine the genotype of the TNFα.− 308A > G polymorphism. Results: Results show a higher tendency of being asymptomatic in individuals carrying the GG genotype (336 of 411;OR 1.24, 95% CI 0.91–1.70). The development of a severe form of SARS-CoV-2 infection was not found in subjects with the A allele compared to those with the G allele (OR 0.96, 95% CI 0.51–1.79), except in the eastern region of the country where the risk increased (OR 4.41, 95% CI 1.14–17.05). However, the subjects carrying the A allele had a higher chance of developing symptoms (OR 1.24, 95% CI 0.91–1.70) compared to those with the G allele. Conclusion: The TNFα.− 308A allele has an influence on developing symptoms of COVID-19 in Cuban patients, and that it particularly increases the risk of presenting severe forms of the disease in the eastern region of the country. © 2022, The Author(s).