shyh poh teo

Sinopharm (BBIBP-CorV) is an inactivated whole-virus COVID-19 vaccine. The phase 3 trial showed an efficacy of up to 78% in preventing symptomatic COVID-19 infections. However, there have been questions raised regarding in its efficacy in older people. In this paper, several lessons are highlighted from this. Firstly, there is a need to take into account the heterogeneity of COVID-19 vaccine studies, such as representation of older people; and whether the results are generalizable to the target population of immunization programmes. Secondly, for older people, antibody responses alone may not indicate the level of protection afforded by vaccines, as cell mediated immunity is a better marker of immunity. Finally, suggestions are given to improve the immune response in older people, such as heterologous vaccination and booster doses.

Cutaneous reactions reported post COVID-19 trials range from acute and immediate to delayed reactions. The suspected trigger for hypersensitivity reactions is the inactive ingredients, such as polyethylene glycol in mRNA vaccines and polysorbate 80 in AstraZeneca. Localised or injection- site reactions are generally self-limiting and occur within seven days. Younger and female patients were more likely to report injection-site reactions, and most cutaneous reactions after the second dose occurred sooner than after the first dose. Delayed large local reactions or ‘COVID arm’ have been reported after seven days post vaccination and generally resolve within two weeks. However, there were cases reported four days post-AstraZeneca vaccination. Other dermatological reactions, such as pityriasis rosea- like eruptions and flares of existing cutaneous conditions were seen in mRNA and AstraZeneca recipients but not in Sinopharm. Risk stratifying vaccine recipients into low, medium or high risk of developing severe allergic reactions may be done using screening questions. Skin testing may be considered for the high risk category but negative skin testing does not rule out a subsequent allergic response. Delayed cutaneous reactions may be misdiagnosed as cellulitis and administered unnecessary antibiotics.

Vaccine safety surveillance is important to identify and manage adverse events following immunisation (AEFI) and avoid vaccine hesitancy. Currently, COVID-19 vaccines are administered to large numbers of people to try and curb the pandemic. In this paper, quantitative methods for causality assessment of AEFI are described. Qualitative methods for causality assessment involve an expert panel reviewing each AEFI report to determine whether the AEFI can be attributed to the vaccine. Each AEFI is determined to be classified as consistent, inconsistent, indeterminate or unclassifiable in terms of causality. Quantitative approaches can strengthen causality assessment outcomes. However, the potential for bias and errors should be considered for each safety signal identified. Vaccine and population specific factors may affect AEFI incidence, with a need to obtain background rates to frame safety signals identified into the local context. Several case scenarios from the vaccine safety surveillance in Brunei are used to illustrate the practical application of quantitative approaches for AEFI causality assessment (including comparison of AESI incidence to background rates and disproportionality analysis), which complement the traditional qualitative methods.

To identify the type of referrals received by vestibular physiotherapists for vertigo and assess whether medical review for these patients would be appropriate.

We performed a retrospective review of referral forms, vestibular assessment forms, and vertigo clinic letters of patients referred for vertigo or vestibular physiotherapy input between July 1, 2013, to December 31, 2013.

We studied 29 patients with a median age of 63 years. A diagnosis was provided in 65.5% of the referrals. Of 14 patients with possible benign paroxysmal positional vertigo (BPPV), Dix-Hallpike had been performed only for 4 patients. Almost half were seen for the medical review in the Vertigo Clinic due to the concerns of possible alternative non-vestibular diagnosis, medication issues, or syncope. Alternative diagnoses identified medically included orthostatic hypotension, stroke, vestibular migraine, medication-induced bradycardia, and phobic postural vertigo. Medication changes in vertigo clinic included treatment for heart failure, migraine, and medication optimization.

Medical review is appropriate for some patients referred for vestibular physiotherapy. A medical opinion should be sought by vestibular physiotherapists if there is uncertainty or concerns that the referred patients did not have straightforward vestibular problems, or there were possible alternative diagnoses, concerns with medications, or syncope.

Lower limb amputee patients tend to have multiple co-morbidities and are at risk of developing complications during early rehabilitation for lower limb amputees. These complications are associated with worse outcomes and interruption in rehabilitation, requiring a transfer from the rehabilitation ward to acute medical or surgical care. This study aims to describe the circumstances of patients transferred from early lower limb amputee rehabilitation ward to regional hospitals, and identify areas of potential improvement in management.
The present study is a retrospective study of electronic records for patients admitted or transferred to Hutt Hospital from vascular surgery wards for early lower limb amputee rehabilitation between 1st January 2009 and 31st December 2011. The data collected was identified through a multidisciplinary discussion to determine appropriate standards of care for amputee patients. This included patient demographics, comorbidities, cognitive and physical function, as well as complications during rehabilitation.
There were 42 lower limb amputations with median age of patients 71.5 years. Dysvascularity was the most common cause (57.1%) for amputation. Patient care was inappropriately stepped-down to a rehabilitation ward, including one in six amputees who were not haemodynamically stable, and one-quarter of patients with hypoglycaemia. Handover between allied health staff and comprehensive assessment, particularly of the contralateral limb should be improved. Complications during rehabilitation involved 71.4% patients, the most common non-wound issues were decubitus ulcers, chest infections and delirium. A quarter of the patients, initially living at home were discharged to residential care. The median length of hospital stay was 44.5 days.
Amputee patients have multiple co-morbidities and a high risk of complications. The areas of improvement identified included transfer of care between allied health professionals, appropriateness of step-down transfer to rehabilitation, assessment of the contra-lateral limb and standardisation of care. Education of healthcare professionals and systematic transfer of care should be implemented for patients transferred for early rehabilitation for lower limb amputees.