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1.
Acta Pharmaceutica Hungarica ; 91(3-4):120, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2033589

RESUMO

A drawback of the current mRNA-lipid nanoparticle (LNP) COVID-19 vaccines is that they have to be stored at (ultra)low temperatures (2). Understanding the root cause of the instability of these vaccines may help to rationally improve mRNALNP product stability and thereby ease the temperature conditions for storage. In this presentation we discuss proposed structures of mRNALNPs, factors that impact mRNA-LNP stability and strategies to optimize mRNA-LNP product stability. Analysis of mRNA-LNP structures reveals that mRNA, the ionizable cationic lipid and water are present in the LNP core. The neutral helper lipids are mainly positioned in the outer, encapsulating, wall. mRNA hydrolysis is an important driver for mRNA-LNP instability. It is currently a matter of debate whether water in the LNP core can freely interact with the mRNA and to what extent the degradation prone sites of mRNA are protected through a coat of ionizable cationic lipids. To improve the stability of mRNALNP vaccines, optimization of the mRNA nucleotide composition should be prioritized. Secondly, a better understanding of the milieu the mRNA is exposed to in the core of LNPs may help to rationalize adjustments to the LNP structure to preserve mRNA integrity. Moreover, drying techniques, such as lyophilization, are promising options still to be explored. As vaccines turn out to be the major weapon against the COVID-19 viral attack, the urge to develop more stable formulations is still growing and alternative, not-mRNA based products, may come to the forefront in situations where the (ultra) cold chain cannot be guaranteed. (Table Presented).

2.
Acta Pharmaceutica Hungarica ; 91(3-4):106-107, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2033588

RESUMO

ATMPs - a new era A boy from Hungary, Zente, was one and a half years old when the crowd-funding campaign to finance his life-saving medicine Zolgensma concluded with a happy end. He was the third European patient that received the new gene therapy, which replaces the function of the missing or nonworking survival motor neuron 1 (SMN1) gene with a new, working copy of a human SMN gene that helps motor neuron cells work properly and survive. From a European perspective, it has been almost 15 years by now since regulatory framework for advanced therapy medicinal products (ATMPs) had been established to ensure the free movement of these medicines within the European Union, to facilitate their access to the EU market, and to foster the competitiveness of European pharmaceutical companies in the field. Zolgensma has been approved in the EU in May 2020. The FDA expects it will be reviewing and approving up to 20 cell and gene therapies each year until 2025. Rapid development of technology and better understanding of the manufacturing challenges are not the only prerequisites of the growth. Assessment of products like Zolgensma requires very specific knowledge and often an adaptive approach from regulators. They have to gain enough experience and need to be able to summarize knowledge in guidelines that would help developers of products that are substantially different from traditional medicines. FDA issued seven new guidelines in January 2020, in which, for example, they highlight the importance of long-term follow-up for gene therapies that offer one-time fix for inherited diseases and where pre-market studies may have limited value. 2. Regulatory tools These examples may already show that rapid change in technology leads to new kinds of medicines that require a properly adapted regulatory system. Patients would expect state-of-the-art medicines within the shortest possible time frame, however, authorities are traditionally more cautious. Still, there are several various initiatives from the EMA and the FDA to foster early access to medicines. Some of these have been available for a longer time. EMA's accelerated assessment reduces the timeframe for review of innovative applications of medicines with major public health interest. Conditional marketing authorisation grants authorization before a complete dataset is available, and compassionate use allows the use of an unauthorized medicine for patients with an unmet medical need. A more recent regulatory tool of EMA is the priority medicines scheme (PRIME) that aims to enhance support for the development of medicines that are expected to make a real difference to patients. Early dialogue between EMA and the developers is a crucial part of the tool, together with accelerated assessment and continuous scientific advice and protocol assistance. Up to now, 282 applications for PRIME eligibility have been assessed by the CHMP of which 95 have received a green light. Most of the applicants are small and medium size enterprises, and the major therapeutic area is oncology. FDA has similar programs, such as the Fast Track, Breakthrough Therapy and Priority Review designations, and is also aiming to facilitate and accelerate development and marketing authorization of key medicines. By 2018, about 70% of new drug approvals by the FDA were expedited, compared to about 50% in 2010. The result is a growing pro-portion of medicines authorized with less premarket evidence, a trade-off, that most patients with fatal or debilitating disease would likely accept. Nevertheless, conditional approval requires a strong post-marketing attention from regulators, and lack of enough evidence sometimes leads to difficult decisions. In April 2019 a fast-tracked cancer drug, Lartruvo was withdrawn because a large study was not able to prove a favourable benefit-risk profile, which was established previously on a smaller patient population. The regulators approach is not expected to be changed, but experience from such cases would gradually be built into the decision-making process. In addition to this real world evidence (RWE) and patient recorded outcomes may also help in decision making. 3. Digital revolution The rapid development of biotechnology is not the only area where an adaptive regulatory approach is needed. Digital medicine is a new field, as smartphones and sensors open up new ways of generating data. For example, collecting and analysing RWE seems to be a good solution for single arm studies where randomized trials are not feasible. FDA has approved easy-to-use devices that are able to track several physiological systems of our body, which in turn can give a boost to developments in this field. In addition to these simpler devices, digital revolution in terms of artificial intelligence (AI) and cognitive machine learning is another challenge that our regulatory systems should tackle. It has been recently announced that a new drug candidate, a long-acting and potent serotonin 5-HT1A receptor agonist, which was created using an artificial intelligence platform, will enter into clinical study. There are also numerous radiological applications based on AI, including computer aideddetection and diagnosis software, where images are analysed, and clinically relevant findings suggested to aid diagnostic decisions. Many of these new developments require a tailored approach from regulators to find a way for authorization within the existing regulatory framework. The fact, that many of these new developments are carried out by academic research groups or small companies without extensive regulatory experience, adds an extra layer of difficulty. To meet this challenge, EMA and the Heads of Medicines Agencies have established the EU-Innovation Network, to support medicine innovation and early development. As a milestone of its function, beginning in 1 February 2020 a pilot for simultaneous scientific advice is starting, where the applicants will receive a consolidated advice from the participating agencies. Innovative products often require specific expertise;therefore this new form of advice is also extremely beneficial for regulators as they are able to learn from each other and broaden their knowledge. 4. Conclusions The rapid development of pharmaceutical and digital technology requires a concerted action from all stakeholders. Or, as we all experience, a global pandemic can be an important driving force of the evolution of regulatory policies. Appropriate usage of currently available regulatory tools and a continuous discussion between academia, industry and regulators would be the only way to ensure quick access to state-of-the-art, safe and efficacious medicines, and medical devices. It is clearly shown currently by the concerted action of various stakeholders and series of rolling reviews which led to the expedited authorization of COVID-19 vaccines.

3.
Acta Pharmaceutica Hungarica ; 91(3-4):95-96, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2033587

RESUMO

Introduction Pfizer-BioNTech collaboration started in 2018 in order to develop mRNA flu vaccine. Because of the covid19 pandemic the two companies started to focus on mRNA vaccine development for the prevention of covid19 infection. In March they signed the Letters of Intent. Initially there were four vaccine candidates including unmodified mRNA, nucleoside-modified mRNA and self-amplifying mRNA. For further development the nucleoside- modified mRNA was chosen. In April Phase 1/2 study was completed in Germany and in May in the USA. Two 30 μg doses 3 weeks apart induced neutralizing antibody titers comparable to natural infection and strong CD4+ and CD8+ Tcell responses were observed. Phase 2b/3 clinical trial started in July involving more than 43.000 participants in 153 sites. The result showed 95% efficacy with mild and moderate local and systemic events. For safety reason all participants will be followed for 2 years after the second dose. Based on rolling review regulatory agencies were able to approve within a short period of time in December 2020, first MHRA in UK, then FDA authorized for Emergency Use and EMA granted Conditional Marketing Authorization on 21 December 2021 for 16 years old and older. The first shipments were sent all European countries on 27 December. Direct shipments to vaccination centers on ultra-low temperature (minus 9060 degree of centigrade) using dry ice. Each thermal shipping container has a temperature monitoring device. All shipments are tracked via GPS monitoring device to ensure end-to-end distribution within required temperatures. In May EMA granted an extension of indication for covid-19 vaccine to include in children aged 12-15. The effect of vaccine was investigated in 2260 children aged 12-15, about half of them received dummy injection. Of the 1,005 children receiving the vaccine, none developed COVID-19 compared to 16 children out of the 978 who received the dummy injection. This means that, in this study, the vaccine was 100% effective at preventing COVID-19. The most common side effects in children aged 12 to 15 are similar like those in people aged 16 and above. They include pain at the injection site, tiredness, headache, muscle and joint pain, chills and fever. These effects are usually mild or moderate and improve within a few days from the vaccination. EMA granted approval for booster dose (third dose) for immune weakened people 28 days after the second dose, and 6 months after the second dose for 18 years of age and older. Approval is based on the clinical program evaluating the safety, tolerability and immunogenicity of a booster dose of covid-19 vaccine. A booster dose of the vaccine elicited significantly higher neutralizing antibody titers against the initial SARS-CoV-2 virus (wild type), as well as the Beta and Delta variants, when compared with the levels observed after the two-dose primary series. The reactogenicity profile within seven days after the booster dose was typically mild to moderate, and the frequency of reactions was similar to or lower than after dose two. The efficacy is this trial was 95,6%. In October 2021 FDA authorized for emergency use of covid-19 for children 5 through 111 years of age. For this age group, the vaccine is to be admin-istered in a two-dose regimen of 10 μg (0,2 ml) doses given 21 days apart. EUA is supported by clinical data showing a favorable safety profile and high vaccine efficacy of 90.7% in children 5 through 11 years of age during a period when Delta was the prevalent strain. In 2021 we have already distributed 1,8B doses to 146 countries by end of September. In 2022 we plan to distribute 4B doses. (Figure Presented).

4.
Acta Pharmaceutica Hungarica ; 90(2-3):109, 2020.
Artigo em Inglês | EMBASE | ID: covidwho-2033586

RESUMO

Background: As we have seen in the last six months, emerging and re-emerging viruses could be the biggest threat for the human population nowadays in our modern, accelerated and globalized world. Both of influenza and coronaviruses have the potential to cause serious pandemics worldwide. Unfortunately, there are no effective enough medications against most of these viruses. Aims: As some glycopeptide antibiotics and their derivatives proved to be effective against several viruses1, therefore we planned to synthesize some new derivatives equipped with highly fluorinated lipophilic groups. Methods: Perfluorobutyl and perfluorooctyl groups were conjugated to the N-terminus of teicoplanin pseudoaglycone and vancomycin aglycone derivatives through ethylene glycol and tetraethylene glycol linkers by means of photoinitiated addition and azide-alkyne click reaction. The effect of the derivatives were evaluated against several viruses including influenza and human coronavirus. Results: Vancomycin aglycone derivatives were inactive against all of the studied influenza strains, while 3 out of the 4 perfluorobutyl and perfluorooctyl derivatives of teicoplanin pseudoaglycone displayed very good activity against influenza H1N1, H3N2 and B strains. Two of the derivatives were active against human coronavirus as well. Conclusion: We hope that these results can open a new way in finding more effective antivirals based on glycopeptide antibiotics.

5.
Acta Pharmaceutica Hungarica ; 90(2-3):61, 2020.
Artigo em Inglês | EMBASE | ID: covidwho-2033585

RESUMO

Vaccines, currently used for prophylactic purposes, prevent more than three million deaths every year from diseases like diphtheria, pertussis, tetanus, poliomyelitis, measles and influenza. The general six stages of the development of a new vaccine are: i) Exploratory stage;ii) Pre-clinical stage;iii) Clinical development;iv) Regulatory review and approval;v) Manufacturing;vi) Quality control. Clinical development is a three/four-phase process. During Phase I, small groups of people receive the trial vaccine. In Phase II, the clinical study is expanded. In Phase III, the vaccine is given to thousands of people and tested for efficacy and safety. Many vaccines undergo Phase IV formal, ongoing studies after the vaccine is approved and licensed. Phase IV studies, also referred to as postmarketing surveillance studies (PMS). These processes are very similar to drug developments. However, there are several differences compared to drug development, namely: i) unlike drugs, which are given to patients, vaccines are received by healthy individuals, thus the safety margin should be very high;ii) as vaccines have to be stored under refrigeration, there are always logistical challenges during clinical trials;iii) Adjuvants are incorporated into vaccine formulations to modulate and improve the immune response (antigen/adjuvant formulation are important aspects of clinical development);iv) The immune response primarily measured during early stages of vaccine development (Phase I/II) should evaluate: Humoral/ cell-mediated/ cross-reactive antibodies or immune complexes/ immune landscape. A challenge in responding to pandemic diseases is that vaccines may not exist for them. For newly emerging threats without licensed vaccines, such as SARS, MERS, Marburg virus, Nipah virus, SARS CoV-2 and the like, the time required to develop and produce a safe, effective vaccine is unknown and would depend on the nature of the threat and the state of current vaccine research for that threat. In almost all cases, several months would be needed to respond with the first doses of vaccines. Unfortunately, six month later than WHO declared the public health emergency of international concern (27/01/2020) there are five important questions, essential for vaccine development that remain open for scientists, namely: 1) Why do people respond so differently to infection? 2)Has the virus developed any worrying mutations? 3)How well will a vaccine work? 4)Can we develop immunity and if so, how long does it last? 5)What is the origin of the virus? Until a safe, effective vaccine was ready, other public health and medical measures (social distancing, quarantine, and aspecific medications) would need to be employed to try to limit disease spread.

6.
Acta Pharmaceutica Hungarica ; 90(2-3):47-48, 2020.
Artigo em Inglês | EMBASE | ID: covidwho-2033584

RESUMO

In all countries, where electronic health services such as e-prescriptions have been introduced, patient safety has improved and the standard of medical and pharmaceutical care has increased. ePrescription (eRecept) - launched in Hungary as well - has become the most used eHealth module of the EE SZT (National eHealth Infrastructure) by all healthcare providers in the past near 3 years. During the COVID epidemic emergency e-prescription system has been a huge help to patients, relatives and caregivers too. In this period the proportion of electronic issued prescriptions exceeded 90% of all prescriptions written. The e-prescription system contributes to the better and faster information of healthcare professionals, supports the well-based therapy decisions, helps preventing and eliminating medication errors. Adverse drug reactions (allergies, interactions, polypharmacy etc.) can be more easily identified with the daily use of this service. Less paper administration can increase the time and quality of patient counseling both at the doctor's and in the pharmacies. Medication adherence can also be simply monitored by pharmacist as well. After patient registration - using social security number (SSN / TAJ) -, written maximum 1 year earlier and/ or by other pharmacy dispensed prescriptions will be also downloadable soon from the central database. These functions and real time data contribute to the implementation of high-quality pharmacotherapy advising services in pharmacies as healthcare institutions, made in accordance with the specific standards and protocols. The new functions of the Patient Portal (e.g. Legal Representation) and mobile surfaces provide patients and their relatives access to follow their care process, prescriptions, labs, etc., already on their smartphone too. From the beginning of May 2020, serial-produced medical aids mostly sold in pharmacies, can be electronically issued. The full integration of all the medical aids may be completed next year in a separated module. A simple web-based prescriber (socalled miniHIS) has been developed for connected private doctors, who do not consult in institutions. Measured values of the (smart) medical devices can be uploaded into the personal data repository of the Patient Portal on a voluntary basis. Good measurement results of the blood pressure, sugar, body weight, etc. recorded here demonstrate therapy fidelity, providing feedback to the patient and professionals. Telemonitoring services can be build on this module, so the software can send alerts to the assigned doctor, pharmacist or family member. Keeping data protection rules strict, depersonalized pharmacotherapy data uploaded to the central eHealth database will be searchable soon for professional and scientific purposes.

7.
BMJ Supportive and Palliative Care ; 11:A92-A93, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032543

RESUMO

Background Most palliative care is provided by GPs and wider palliative care and community services (Mitchell, Loew, Millington- Sanders, et al., 2016). The Daffodil Standards (DS) were created in order to provide a free, accessible, evidencebased support around end-of-life care (see: https://www.rcgp. org.uk/clinical-and-research/resources/a-to-z-clinical-resources/ daffodil-standards/introduction.aspx). This work presents the quality improvement (QI) methodology used to establish an ongoing, national level process that helps engage practices in working to improve end-of-life care through QI and reflective practices. Aims•Supporting GP practices and Primary Care Networks, to provide high quality end-of-life care across their populations.•Offering a structured approach - minimising variation in endof- life care experienced.•Supporting GP teams - learning and development.•Improving equity.•Connecting GP care within compassionate community development (see: https://www.rcgp.org.uk/clinical-andresearch/ resources/a-to-z-clinical-resources/daffodil-standards/ the-daffodil-standards/standard-8-general-practice-being-hubswithin- compassionate-communities.aspx). Methods The QI methodology of Diagnose, Plan and Test, Implement and Embed, Sustain and Spread (NHS England, 2019) has been employed to evidence, establish and continually improve the Daffodil Standards. Results The process: Diagnose•Review of learning from policy and research for gaps.•Review of GP QI programmes/curriculum for scale service improvements to support general practice.•Triangulation matrix between end-of-life care 'Ambitions', Istatements, GP qualitative research and feedback. Plan and Test•Development of draft DS headings.•Consultation with end-of-life care partners.•Reviewed from 9 to 8 core DS based on feedback.•Organisational sign-off. Implement and Embed•Launch February 2019.•Connected with England end-of-life care QOF 19/20. Sustain and Spread (including developments)•COVID-19 learning.•Development of Older People's Care Home Standard.•End-of-life care GP lead review from each nation to make more devolved nation accessible.•Refresh of the Daffodil Standards.•RCGP end-of-life care suite of webinars 2021.•Planned evaluation 2021/22. Conclusions This review of processes demonstrates how QI methodologies can be used on a national level to support clinical care and deliver improved end-of-life care in the community.

8.
BMJ Supportive and Palliative Care ; 11:A90, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032540

RESUMO

Social prescribing is a fundamental aspect of the NHS Long Term Plan. The roll-out of social prescribing is underpinned by the belief that individuals have the capacity to define and solve their own problems and that local communities are rich in social assets, skills and talents which can be tapped into to enhance and improve health and wellbeing. Social Prescribing Link Workers (SPLWs) aim to focus on what matters to each client holistically, looking at social, economic and environmental factors and creating personalised care plans to improve wellbeing linking in to local community resources and assets. This philosophy aligns with both the person centred ethos of hospice care and the Public Health model of Palliative Care. Aims To adopt a partnership approach to develop and deliver social prescribing through hospice partnerships with local VCSE organisations and local PCNs to develop and deliver social prescribing. Commitment to learning and developing together rather than 'doing' social prescribing through service provision, drawing on the strengths of the local community and the partner organisations. Actions•Social prescribers in post fully funded through PCN with commitment for five years - links built with GPs, hospice and other services.•Partnership approach embedded, service launch in March 2020 - impacted by COVID-19 pandemic, an opportunity and a threat. Outcomes•Social prescribing now embedded in local community and GP practices. Over 500 referrals received in year 1: bereavement, end-of-life care plans, carers support identified as some of the key challenges people face.•Data and case studies support difference Social Prescribing is making on individual and system perspective.•NHS Graduate evaluation report completed. Conclusion Involvement in a partnership approach to social prescribing is supporting the hospice in facilitating a public health model to palliative and end-of-life care being adopted as part of the wider system change.

9.
BMJ Supportive and Palliative Care ; 11:A84, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032532

RESUMO

Background With changes in NHS commissioning which aim for greater integration across larger areas and increased resourcing pressures experienced by hospices;strategic partnerships between hospices have never been more necessary. The recent Hospice UK Future Vision Programme (2020) set out principles of sustainability for hospices, many of which can be best achieved by working together. In 2017 our two hospices established a partnership;managed through a memorandum of understanding (MOU), it set out a shared ambition, agreed principles for engagement and the partnership's governance structure. Aims The partnership agreed to:•Work together with integrity and probity for the benefit of patients and the public.•Improve outcomes and experiences through early collaboration and planning.•Deliver high-quality standards of patient care, consistently and equitably across the system.•Lead the way in strategic planning of services that are safe and sustainable•Identify/share opportunities for good practice in transparent and value-for-money partnership arrangements. Achievements so far/Results Our hospices have developed supportive relationships and regular communication between leadership teams, operational managers and boards. Working collaboratively in:•Joint external education delivery - sharing resources, contacts and income.•Rehabilitation - supporting development of one partner's service through senior leadership and joint occupational therapy post.•Fundraising - trialling a joint mass-participation event.•Retail - supporting personal development of new income generation director and establishing improvements for retail.•Commissioning -to support negotiations with commissioners and increase influence across integrated care system.•Medical support - sharing senior medical resource to support development/business continuity.•Bed capacity - sharing inpatient capacity during COVID-19 - related closures.•Staff wellbeing - shared health/wellbeing month funded by NHS England. Conclusions By working together, we've achieved service improvements, shared expertise, increased efficiency and maintained business continuity. We continue to look for opportunities to work together for the furtherance of our stated aims as outlined in the MOU.

10.
BMJ Supportive and Palliative Care ; 11:A82, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032528

RESUMO

Project ECHO is an innovative tele-mentoring programme designed to create virtual communities of learners by bringing together health care providers and subject matter experts using videoconference technology, brief lecture presentations, casebased learning, fostering an 'all teach, all learn' approach. In April 2020 a six-month pilot of Project ECHO was commenced to support end-of -life care education in primary care as a response to the COVID-19 pandemic. A scoping exercise was undertaken with the multidisciplinary primary care team across a defined geographical area. Following the scoping exercise a curriculum was devised. Speakers were arranged which included a palliative care medical consultant, a specialist pharmacist and speciality doctor who led the taught aspects of each of the six sessions drawing on their clinical expertise and previous teaching experience. The attendees had the opportunity to submit a case study for discussion during each ECHO session, the case studies were used to evoke discussion, promote shared learning and develop a community of practice. During the pandemic this format also created an opportunity for peer supervision and sharing of clinical knowledge and experience across a wider network of practitioners. Considering the project took place during a pandemic there was 83% attendance from those that had booked onto the sessions. At the end of each session an instant poll was available to be completed by the attendees to evaluate the session. Attendees fed-back how valuable they found the sessions especially the opportunity to discuss case studies, share best practice and debrief during what has been a particularly difficult time for the primary care sector. The online format allowed more people to attend than would normally be achieved in face-to-face training. Due to the project's success further funding was agreed to extend the project beyond the original sixmonth pilot.

11.
BMJ Supportive and Palliative Care ; 11:A77, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032523

RESUMO

Wellbeing and Mental Health initiatives put in place during the pandemic. The emotional and psychological pressures of working within hospice care are well documented, however, the addition of a global pandemic plunged hospice workforces into an unknown and unchartered way of working. Suddenly the switch from dealing with the everyday death and dying of patients, changed to having staff 's own mortality, fear and anxiety thrust into reality. Unforeseen challenges within the workplace led to many staff experiencing emotions and anxieties that could not have been predicted. The quick succession of events that changed everyday practice at the beginning of the pandemic gave rise to a number of initiatives implemented to support staff mental health and wellbeing. These have included:•Wobble room - a designated safe place for staff to visit and relax in.•Wobble room booklet for those working offsite.•Gifts of meals and drinks from local companies.•Mindfulness and relaxation.•Self-help videos. The number of Mental Health First Aiders and freedom to speak up guardians has been increased across the workforce. In addition to this, staff were given information and contact details for a multitude of both national and local support avenues such as the Samaritans, NHS, Here for you and MIND, enabling support virtually through websites, webinars, online training and apps. Within the hospice a focus on wellbeing was central to communications on the workplace intranet. This then resulted in the sign up of 15 new workplace health champions who will support ongoing activities throughout the year. The initiatives that have proved successful will continue to be offered and available to staff as we transition away from COVID-19 and maintain a focus on staff wellbeing within the organisation.

12.
BMJ Supportive and Palliative Care ; 11:A68-A69, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032510

RESUMO

St Christopher's Hospice and Greenwich and Bexley Community Hospice established HELP in 2019 to respond to the learning needs of end-of-life care professionals in South East London. This already successful partnership was mobilised during the pandemic to meet the demands of the clinicians asthey dealt with the significant increase in people dying from COVID-19 and this poster explores the themes that emerged by undertaking this work. Initially a whole scale digital pivot was required as the pandemic hit: moving all existing education activity online utilising tools such as Zoom for live teaching and providing asynchronous, self-study opportunities using an online learning platform to ensure professionals could continue to be upskilled during this time. An innovative example of this was the development of a fully asynchronous product on Nurse Verification of Expected Death, a clinical need that grew exponentially during this time. The HELP team provided two bespoke webinar series, which responded to clinical needs and was developed in collaboration with a range of clinicians who were able to provide case studies and examples to secure the learning. The first webinar series in April 2020 focused on two distinct areas, supporting GPs and supporting colleagues in care homes. The team provided weekly care homes webinars and additional ECHO sessions for them. The positive feedback received resulted in further consultation to design the second wave webinar series in November which was open to all professionals in the region and included topics continuing the conversation around wellbeing along with the opportunity to contextualise dying during COVID-19 and highlighting the value of joint working during this difficult time. This poster explores this range of activities that were undertaken during the pandemic and focuses specifically on the values that underpin the approach including the need to be responsive and flexible, collaborative, current and contextspecific in the design of these learning opportunities.

13.
BMJ Supportive and Palliative Care ; 11:A53-A54, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032500

RESUMO

Background Nottinghamshire Hospice's day therapy unit closed its doors to patients during the COVID-19 pandemic. Government advice was supporting discharge from hospital wherever possible (NHS England and NHS Improvement, 2020). When asked, more than four in five people say they would prefer to die at home (Hoare, Morris, Kelly, et al., 2015). Patients receiving care from specialist palliative care teams tend to do better than those without (Higginson & Evans, 2010). Aims To expedite the discharge of patients at end-of-life from hospital and prevent unnecessary hospital admission for those in the community so that more people achieve their preferred place of death (PPD) with the provision of a dedicated palliative care service. Methods March-May 2020: consultations with fast track continuing care (FTCC), model planning, internal consultation, workforce transformation. May-July 2020: recruitment, service launch. July-March 2021: continuous service provision. We worked closely alongside FTCC to support patients either in hospital that wished to come home but needed a package of care or, patients that were deteriorating at home and required end-of-life care. An initial assessment by a registered nurse from the Hospice Outreach Discharge Support (HODS) team meant more timely referral into extended palliative community services including provision of specialist equipment and access to other hospice services e.g. bereavement support. It also focuses on the completion of EPaCCS and ReSPECT forms identifying PPD. Results Number of patients treated by HODS May 20 - March 21 = 195. 64% (124) died at home. 23% (44) remained well enough to be discharged to domiciliary care agency. 10% (20) admitted to hospital. 3% (6) admitted to nursing home. Average length of stay on HODS = 10 days PPD achieved = 95.87% [4] Conclusion The creation of HODS allows more people at end-of-life to remain in their PPD and with greater access to support services preventing carer burnout and unnecessary admission to hospital.

14.
BMJ Supportive and Palliative Care ; 11:A52, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032498

RESUMO

Background During the first three months of the COVID-19 crisis in Highlands, the local palliative care helpline was put on pause to allow out-of-hours practitioners to cope with increasing demand on acute services. An enhanced helpline was introduced in August 2020. Aim To provide improved support and advice to members of the community with palliative care needs, at home or in residential care, using existing resources more effectively. Method A partnership was established with NHS Highland and Highland Hospice to staff an out-of-hours enhanced Palliative Care Helpline (PCH) seven nights/week. Shielding nursing staff working with the NHS who had previous knowledge and experience in palliative care were invited to work remotely alongside nursing staff in the Highland Hospice. Staff involved were consulted and supported with three online induction sessions. Results During the six-month pilot, 470 calls were made to the Palliative Care Helpline of which 55% were put through to the PCH nurse. The data from the pilot period was compared to pre-pilot data. Calls were more likely to be dealt with by giving advice (to patients, families and care staff) resulting in reduced home visits and fewer hospital admissions. Qualitative feedback from out-of-hours practitioners was positive. The assessment and triaging of the patients by the PCH nurses was felt to be 'often better', and 'Far more timely for patients' Far fewer OOHs home visits/contacts required'. Conclusion A palliative care helpline staffed by nurses with palliative care experience can provide additional support to palliative patients in the community resulting in fewer house visits and hospital admissions.

15.
BMJ Supportive and Palliative Care ; 11:A50-A51, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032497

RESUMO

Dementia is a far-reaching disease and it is estimated that approximately 850,000 people are living with dementia in the UK;this is estimated to increase to over 1 million by the year 2025 (Prince, Knapp, Guerchet, et al., 2014). Caring for people with dementia is demanding and this care is often provided by unpaid carers in the home (National Institute for Health Research, 2016). So often people are uncertain about what the future could hold following diagnosis and how to support a person with dementia. Due to this in 2017, St Giles Hospice in collaboration with Green Square Accord launched a four-week carers' course which was designed to support unpaid carers in the community who support people living with dementia. The course covers a range of topics, including looking after yourself and activities for people with dementia, eating and drinking and infections in dementia, dementia related behaviours and planning for the future including end-of-life. Prior to 2020 this four-week course was face-to-face and was group based. When the COVID-19 pandemic hit the service had to act quickly to ensure the much-needed support for these carers did not disappear. The carers' course was adapted to provide support via a one-to-one basis either via video consultation or through a telephone call. This ensured that carers were not isolated and had access to specialist support and signposting to other services. Data captured showed that 100% of participants found that the topics covered were relevant to their situations, 92% of participants found that sessions fulfilled their expectations and that 100% were given opportunity to ask questions. Over 80 carers have been supported through the adaptation of the service so far.

16.
BMJ Supportive and Palliative Care ; 11:A47, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032495

RESUMO

Background Palliative care services have responded rapidly and innovatively to the challenges of the COVID-19 pandemic (Dunleavy, Preston, Bajwah, et al., 2021;Etkind, Bone, Lovell, et al., 2020). Digital health interventions (DHI) have the potential to improve service provision (Finucane, O'Donnell, Lugton, et al., 2021;Bush, Perez, Baum, et al., 2018), with increasing evidence supporting the use of video consultations in palliative care as a safe and effective adjunct to face-to-face patient contact (Sutherland, Strickland, Wee, 2020). Aim To evaluate the extent to which two digital health interventions were adapted by one hospice in response to the COVID-19 pandemic. Method An electronic health record system was already in use (SystmOne) at the hospice and these new digital health interventions were incorporated in response to the pandemic:•Video consultations.•'Authority to Administer' (ATA) electronic charts on SystmOne, authorising administration of injectable medications by community nurses for people at end-of-life being cared for at home. These were in addition to paper community drug charts, usually completed by GPs, community or hospice prescribers. Results•Video consultations: From none (pre-pandemic) to a monthly average of 68 in early 2020, nearly doubling to an average of 132 in early 2021.•ATAs increased from a monthly average of five (mid 2020) to 27 (first quarter, 2021).•35% of ATAs (49 out of 144 in a 42 week period) were completed at weekends or late evening, with likely patient benefit as delays awaiting completion by urgent care prescribers were potentially avoided. Conclusion Digital health interventions are firmly embedded in the day to day provision of palliative care services. As well as using NHS approved software such as accuRx for secure video consultations, staff have also innovated in using this technology to communicate more effectively with patients, such as sending clinic letters, symptom assessment questionnaires, patient information leaflets and text summaries of medication changes directly to patient devices. There is huge scope to incorporate digital health interventions further within palliative care to meet the changing needs of local communities.

17.
BMJ Supportive and Palliative Care ; 11:A46, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032492

RESUMO

Background Income generation plays a crucial part in funding charities and with only 1/3rd funding received for our hospice, would it be sustainable to still have the current structure with the world in lockdown? Aim To revaluate our current structure, implement changes to meet the changing face of fundraising, analysing data to influence and drive our income generation decisions going forwards whilst ensuring our systems and processes digital transformed the way we operate. Methods May-June 2020: Evaluation of all current roles within Fundraising, Lottery, Grants and Legacies across two sites. August -September 2020: Full consultation with all staff members. October 2020 - staff receive confirmation of roles although still remain on furlough through pandemic;New supporter care team roles advertised and roles begin to work with the digital transformation plan. Results Cost savings of 100k when income received in to the hospice was uncertain and our fundraising events had been diminished due to lockdown, rising COVID-19 cases and furloughed staff across many industries. Changed direction of resources into new Supporter Care team (SCT) whose aims was to ensure our data was fit for the future and could influence our decisions going forwards. Invested in a standalone role for legacy giving, an income stream that many hospices don't invest enough resource into (Remember A Charity, 2019. UK legacy fundraising market 2019;Remember A Charity, Legacy Foresight, the Institute of Legacy Management, and Smee & Ford). Conclusion Restructure is working well, new SCT fully trained on database allowing data to become more focused and relevant to our needs therefore subsequent mailings are donor specific allowing us to understand and map our donor journey. Fifteen months later the UK is still not back to full capacity after COVID-19 therefore the reduced fundraising team is currently adequate based on demands and income streams. A surge in wills during last 18 months has already seen an increase in supporter communication and a new legacy strategy is being implemented as a result of this consultation.

18.
BMJ Supportive and Palliative Care ; 11:A42, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032484

RESUMO

Background Farleigh Hospice provides palliative and end-oflife care to the people of Mid Essex (population c. 400,000), with a dedicated inpatient unit (IPU) and community services. Problem The first wave of the COVID-19 pandemic catalysed organisational change with creation of 'Locality Care Teams' and the upskilling of non-clinical members of staff. Subsequently, the IPU closed and staff were reassigned to Locality Care Teams in November 2021, mobilising the workforce to care for more patients. However, there was a resulting potential for some patient and carer needs to go unmet. Intervention A community-based nurse-led 'Virtual Ward' was created in mid-December at rapid pace, to support people to die at home. A detailed SOP was developed, specifying the purpose of the Virtual Ward, eligibility criteria, and referral, assessment and discharge processes. This information was disseminated to all teams. Data were collected throughout the time of IPU closure. Outcome Within a short time, the virtual ward was well-utilised (mean 8.6 admissions per month). Referrals to the Virtual Ward were largely appropriate with mean length of stay seven days, median three days. 80% of patients admitted to the Virtual Ward died as expected while under its care;none were admitted to acute care services. Informal feedback has been positive from referrers, patients and family caregivers. Learning The temporary closure of the IPU could have caused patient and carer needs to go unmet. Instead, the rapid set up of the Virtual Ward, alongside the reassignment of IPU staff and arrangements with other regional hospices, has enabled the local population's end-of-life care needs to be well met. During the pandemic the greatest need for palliative care services has been in the community (Etkind, Bone, Lovell, et al., 2020;Costantini, Sleeman, Peruselli, 2020). Farleigh Hospice's reconfiguration of services has proven to be effective and responsive. There is a need for more robust data collection to evaluate outcomes particularly with regard to patient and family caregiver feedback.

19.
BMJ Supportive and Palliative Care ; 11:A38-A39, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032476

RESUMO

Background In response to the COVID-19 pandemic, the hospice moved to digital approaches. Whilst tele-rehabilitation has shown benefits for various chronic health conditions (Bhatt, Patel, Anderson, et al., 2019;Zanaboni, Hoaas, Lien, et al., 2017;Hwang, Bruning, Morris, et al., 2017), there is a gap in the literature on telehealth interventions for palliative rehabilitation. Aim To evaluate digital delivery of a palliative rehabilitation programme and obtain perceptions of users and staff. Methods All members of the Fatigue and Breathlessness (FAB) follow-on group (n=19) were invited to complete a questionnaire on the experience of transitioning to Zoom sessions. Descriptive statistics were produced using the statistical software package, Stata (Version 15;StataCorp, 2017). Qualitative data were analysed using an inductive thematic analysis framework (Braun & Clarke, 2006). Three members of the rehabilitation team were interviewed about encountered benefits and challenges. Results Thirteen members completed the questionnaire (68%) and all were positive about the transformed sessions. Eight respondents (62%) felt that the Zoom sessions were 'no different' or 'better' than in-person sessions. No adverse events were reported. Themes from open-ended comments included patient-level effects such as maintained exercise and social contact when in isolation and removed travel requirements. At the service level, there was improved access but technological challenges. Most respondents (9, 69%) suggested keeping the option of Zoom for flexibility and 46% (6) wanted both staff-led and self-led elements. The rehabilitation team felt their rapid response and team working enabled efficient transition to Zoom. This included risk assessments, particularly for those living alone. With help, users quickly learned and the virtual delivery provided opportunities to try new activities. At times, staff found the 'silent audience' challenging. The rehabilitation team felt the approach may only work with groups with existing rapport. Conclusions The hospice rehabilitation team now provide concurrent sessions at home via Zoom and in the hospice. These access options provide choice, appear to be acceptable and offer flexibility around changing condition status and personal factors.

20.
BMJ Supportive and Palliative Care ; 11:A37-A38, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032473

RESUMO

Background In 2020 Highland Hospice faced the challenge of continuing the rehabilitation service delivered by our inpatient physiotherapist and occupational therapist. The service was originally delivered by admission to the unit for a five-day (Respiratory) or 10-day (Neurological) stay with intensive multi-disciplinary team rehabilitation. The team adapted the delivery of this service due to COVID-19 restrictions using the Zoom platform (licensed version). Aim To continue to provide ongoing rehabilitation for palliative care patients during COVID-19. Methods Referrals were received as usual from respiratory/ neuro nurses or consultant. Screening was carried out in a weekly meeting with the allied health professionals and doctors. Appropriate patients were contacted by telephone to schedule an initial assessment before setting up a Zoom call or home visit to set up technology. Patients were seen in person (if hearing or technology was an issue), or virtually for 6- 12 weeks. Results Of the eleven patients to date there were challenges for some but all participated and benefited. A survey was sent to participants. Three people responded. All three respondents said their goals were clear after the first session.•The respondents either mostly agreed/or agreed that their symptoms were better controlled.•Activity levels had increased.•Ability to cope was better.•Knowledge of helpful techniques was better and,•Quality of life was better after attending the service for the 6- 12 week period. Feedback from participants includes: 'The service was friendly and positive';'It helped me immensely';'a friend had been in respiratory crisis and I was able to help her while she waited for the ambulance - that felt good'. Conclusion Despite challenges, a virtual approach for palliative rehabilitation provided beneficial outcomes for patients who would not have been able to attend in person. This method will likely form a part of our services going forward.

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