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Latest COVID News

Coronavirus Disease 2019: Considerations for Health Technology Assessment From the National Centre for Pharmacoeconomics Review Group.

Leahy J, Hickey C, McConnell D, Cassidy O, Trela-Larsen, L, Barry M, Tilson L, McCullagh L. Value in Health 2020. https://doi.org/10.1016/j.jval.2020.09.003

It is expected that the COVID-19 pandemic will leave large deficits in the budgets of many jurisdictions. Funding for other treatments, in particular new treatments, may become more constrained than previously expected. Therefore, a robust health technology assessment (HTA) system is vital. Many clinical trials carried out during the pandemic may have been temporarily halted, while others may have had to change their protocols. Even trials that continue as normal may experience external changes as other aspects of the healthcare service may not be available to the patients in the trial, or the patients themselves may contract COVID-19. Consequently, many limitations are likely to arise in the provision of robust HTAs, which could have profound consequences on the availability of new treatments. With that in mind, the NCPE Review Group discuss the effect of the COVID-19 pandemic on HTA and make some recommendations to Applicants submitting HTAs to the NCPE.

Fatigue management found to be key factor impacting surgical practice during pandemic 

The shift in the national focus and allocation of resources to the management of COVID19 has led to significant changes to surgical practice including the delay of elective surgery. School of Medicine PhD candidate Dale Whelehan and associate professor Prof. Paul Ridgway conducted a qualitative thematic analysis to explore the implications of such changes on surgeons. Fourteen surgeons were interviewed eliciting significant themes included ‘impacts’ on a variety of constructs such as performance, self-reported fatigue and wellbeing. 

Training themes elucidated included the effects of the cancellation of elective admissions on reduced operative exposure for trainees. Senior surgical staff were particularly focused on increased complexity in patient management. New policy requirements such as personal protective equipment use and novel rotas have had implications for aspects of work engagement. The pandemic and subsequent national restrictions imposed has afforded opportunities for improved well-being but also resulted in greater solitude in surgeons. Rhetoric surrounding fatigue management and virus control dominates the conversation on the relationship between COVID-19 and surgery. Tipping the balance back to parity of fatigue management with service delivery in surgery will be key for sustainability of the surgical workforce.

For full paper: https://doi.org/10.1016/j.surge.2020.07.006

Anatomical education offers a lesson in adaptation

New paper, co-authored by TCD teaching fellow Dr Deirdre Scully, describes how anatomical education has effectively adapted its methods during the COVID-19 pandemic. 

https://anatomypubs.onlinelibrary.wiley.com/doi/full/10.1002/ase.1967

Inspiring précis of research-led response to COVID

The newly launched School of Medicine e-brochure is a fascinating insight into the extraordinary efforts of School of Medicine academic clinicians and researchers to tackle Covid-19. The articles reflect the energy and ingenuity of its research-led approach to the crisis, aligned with the cutting edge clinical activities of its TCD hospital partner network. 

Link to brochure

The effects of COVID-19 crisis on mental health of children and adolescents

Researchers in the School of Medicine are tracking effects of the COVID-19 crisis on the mental health of children and adolescents in Ireland. Dr Ian Kelleher, TCD Psychiatry and Lucena Clinic, is analysing data from both secondary and tertiary mental health services to help understand the effects of the crisis on young people’s mental health, including changes in self-harm or suicidal behaviour.

Dr Kelleher said, “There is potential for the COVID-19 crisis to have both negative and positive effects on young people’s mental health. Anxiety, especially health anxiety, might be expected to increase during the crisis. Beyond that, challenges like reduced ability to exercise, financial pressures, reduced peer contact, and changes in routine, especially sleep routines, might all impact negatively on mood. At the same time, crises can increase societal and family cohesion, and some research even suggests that in times of crisis, such as wars, suicide rates may decline".

Dr Kelleher added, "With the COVID crisis, we’ve really entered uncharted territory, which is why research is so important – we need to rely on data, not guesses or anecdote. This study will provide us with important information on the effects of the crisis on young people’s mental health, and this information will allow us to effectively plan our responses in mental health services”.

Photo caption. Dr Ian Kelleher, TCD Psychiatry

Tele-rehabilitation During COVID19- building better and safer ways to deliver care.

centre

Academic Unit of Neurology

PI – Dr. Dara Meldrum, Physiotherapist and Senior Research Fellow

Co-Investigators – Dr. Deirdre Murray, Prof. Orla Hardiman

Collaborators:  ADAPT Centre TCD

Funded by
centre
Currently, during the COVID19 crisis, patients are understandably reluctant to come to hospital for out-patient treatment and hospitals are endeavouring to reduce face to face contact where possible to reduce transmission. Many out-patient appointments are curtailed or cancelled but patients still need rehabilitation. VertiGenius will help solve these problems.
VertiGenius is a mobile health application that digitally delivers rehabilitation programmes to patients with dizziness, vertigo and imbalance at home. VertiGenius connects the patient to the clinic, and educates and empowers the patient. It is in the final stages of development at the Academic Unit of Neurology at the School of Medicine and at the ADAPT centre in TCD.

It has been conceived, designed, built and tested by a team of Physiotherapists, Doctors, Computer Scientists and Electronic Engineers and is supported by Enterprise Ireland.

Background

35% of adults have balance impairment; dizziness and vertigo are prevalent in 20% and a combination of both results in a 12-fold risk of falling which is associated with high morbidity and significant mortality. Across jurisdictions of UK/Ireland, US and Australia a first episode of vertigo equates to 1.6 million per year, 80% of whom will consult a medical professional and 80% of whom will have a recurrence. Dizziness and imbalance can be rehabilitated effectively with physical exercise, a specialist form of treatment known as vestibular rehabilitation, but at present access to this treatment and expert capacity is low leading to an impaired population that is under-served. During vestibular rehabilitation, physiotherapists prescribe exercises for patients to do at home. VertiGenius is a mobile health application, which aims to educate, deliver, measure and track vestibular rehabilitation in the home and is combined with expert assessment and prescription from the physiotherapist. It combines an inertial sensor placed behind the ear like a hearing aid paired via Bluetooth to a Smartphone app.  The sensor measures head movement, a crucial parameter in exercises for dizziness and imbalance.


   

The prescribing physiotherapist evaluates each patient individually and then sets up a series of personalised exercises to be carried out by the patient with an aim of reducing their vertigo symptoms and improving balance and walking.

When the patient is carrying out the prescribed exercises, VertiGenius coaches them to follow the prescription and records the compliance with the prescribed exercises and symptom burden.

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The physiotherapist can remotely view the exercise history (and symptoms) of the patient to aid the continued management. VertiGenius is developed and ready for clinical testing. The head sensor is currently being validated against a gold standard of head velocity measurement. A clinical study will commence when the head sensor is satisfactorily validated and will test the usability, tolerability and effects of the VertiGenius in a group of patients who are referred for vestibular or balance rehabilitation. Following an initial face to face assessment, the patient will use the application at home for the duration of their therapy and outcomes will be measured pre and post treatment. We hope to launch VertiGenius as early as is feasible to help combat the now massively reduced face to face access to rehabilitation during the COVID19 crisis for those with balance impairment, dizziness, vertigo, frailty and falls.

How is the Irish health system responding to Covid-19?

Researchers in the School of Medicine are engaged in rapid learning about the effects of the Covid-19 crisis on the Irish health system and the responsiveness of our health service in dealing with unprecedented demand. Recently Steve Thomas, Sarah Barry and Sara Burke from Centre for Health Policy and Management, Catherine Darker from Public Health & Primary Care, Ann Nolan from the Centre for Global Health and Kevin Kelleher from the HSE published a blog post charting Ireland's response to the pandemic so far on the University of Cambridge's Core Blog. 

Centre for Health Policy and Management staff have also contributed to the new WHO Health System Response Monitor Covid-19 specific page which was launched in mid-April to monitor the policy responses to the pandemic.

TCD Research team launches revolutionary GP data tracker to tackle Covid-19

https://www.businesspost.ie/health/gp-data-tracker-could-play-key-role-in-fight-against-covid-19-3584b96f?utm_source=DNA+Audience&utm_campaign=54e1a65925-EMAIL_CAMPAIGN_2020_04_22_07_10&utm_medium=email&utm_term=0_ec8856c1a0-54e1a65925-231173873

Nature Paper on Child Immunity Responses to COVID19 from TCD Child Health team

https://www.nature.com/articles/s41390-020-0881-y

TBSI/TTMI Covid-19 research hub is important initiative

The newly launched Trinity College Dublin COVID-19 Research Hub is welcomed by the School of Medicine as a critical and important initiative addressing the COVID-19 Pandemic.

The dedicated COVID-19 Research Hub, initially funded by the philanthropy of a €2.4 million donation from AIB, creates a dynamic partnership in translational immunology research by merging the synergies of TCD’s two foremost Heath Research centres – Trinity Biomedical Sciences Institute (TBSI) & Trinity Translational Medicine Institute (TTMI), working alongside academic clinicians and consultant colleagues at St. James's Hospital. Prof Aideen Long, School of Medicine and Director of TTMI will co-direct the hub with Prof Kingston Mills, director of TBSI. At the heart of this concept and underpinning the success of the research venture will be the involvement of our clinician academics and consultant colleagues at the front line at our partner teaching hospitals. Prof Clíona Ní Cheallaigh, consultant in infectious diseases, Prof Niall Conlon, consultant immunologist and Prof Colm Bergin, consultant physician in infectious diseases, will lead from St. James's Hospital. Many of the School of Medicine’s research Professors are affiliated across TBSI and TTMI, including Padraic Fallon, Professor of Translational Immunology, who is addressing biomarkers in COVID-19 patients for disease prognosis.

Prof Michael Gill, Head of School of Medicine, said: "I am delighted that the School of Medicine will be central to this exciting COVID-19 Research Hub. The multi-disciplinary nature of the initiative, with TCD researchers and clinicians in our teaching hospitals, will generate a unique synergy which will deliver advances in basic and translational research to impact on controlling the COVID-19 pandemic. I very much look forward to what will emerge.”

World Health Organization (WHO) daily confirmed COVID 19 cases map

The World Health Organization (WHO) publishes a dashboard of live updates on confirmed COVID 19 cases reported by comparative world region. The dashboard which represents the pattern of activity by country can be searched by number of confirmed cases, by population, by median age, by hospital beds per 1000, by cases per 1000 and deaths per 1000 is available to view here.

SFI COVID-19 Rapid Response Funding Call still open.

While the HRB/IRC COVID-19 Rapid Response Funding Call closes on April 9th 2020, the SFI COVID-19 Rapid Response Funding Call will remain open until further notice. Closure of the call will be based on the status of the COVID-19 crisis, the portfolio of awards made and the availability of funding. SFI will accept applications at any time while the call remains open. A fast-track review process will be employed, that will prioritise applications considered to have the greatest and most immediate impact. These applications will be reviewed immediately with awards issued as soon as possible thereafter for successful applications. Call Document here.

EIT Health 2021 call: invitation for additional proposals on pandemic response

The EIT Health 2021 call has been extended and now has a deadline of 8th July 2020 for projects relating to either COVID 19 or pandemic response more generally. The innovation category of this call offers up to €3m in funding over 3 years. Projects would start in Jan 2021.

Department of Health Latest Irish updates on COVID-19 (Coronavirus)

The latest information on how Ireland is responding to cases of COVID-19. The link the most up to date daily statistics patients diagnosed with COVID-19 issued by The Health Protection Surveillance Centre.

Clinical Research Facility to join ‘solidarity trial’ to jumpstart search for COVID-19 treatment

The Wellcome - HRB Clinical Research Facility at St. James Hospital is primed to join the WHO “Solidarity Trial an international clinical trial which will compare four treatment options against standard of care, to assess their relative effectiveness against COVID-19. By enrolling patients in multiple countries, the Solidarity trial aims to rapidly discover whether any of the drugs slow disease progression or improve survival. Other drugs can be added based on emerging evidence.

Until there is sufficient evidence, WHO cautions against physicians and medical associations recommending or administering these unproven treatments to patients with COVID-19 or people self-medicating with them. WHO is concerned by reports of individuals self-medicating with chloroquine and causing themselves serious harm. WHO guidance on compassionate use can be found here.