Search

Introduction Due to lockdown measures associated with the COVID 19 pandemic (1), there were substantial changes to healthcare delivery, including the suspension of face-to-face medical appointments, expansion of telehealth and changes to medication protocols.(2) It is important to learn from the successes and challenges of this period to ensure we adapt and improve how we support people to take medicines in the future. Aim We sought to conduct a systematic review to explore the different approaches used to deliver medicines management services for people living with long term conditions (LTCs) during the pandemic and identify strategies that could be integrated into standard care. Methods We conducted a systematic review across 3 large databases: MEDLINE (OVID), EMBASE (OVID) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Our research question and search strategy was developed using the PICO framework (Population: adults with LTCs, Intervention: medicines management during the COVID 19 pandemic; no comparison group. Outcome: any aspect relating to medicines management. Search terms relating to ‘long term conditions’, ‘medication management’ and ‘COVID-19’ were used. One reviewer (LM) screened all titles, abstracts, and full texts. We included studies discussing medication management of LTCs, in patients of all ages and healthcare settings, throughout the pandemic. Primary literature sources, feasibility studies and case studies, were included. We excluded studies solely focusing on disease monitoring, or the treatment of COVID/ ‘long Covid’. One reviewer performed a thematic analysis, synthesising the findings into themes and sub-themes, which were discussed with a further reviewer (CT). A critical appraisal was performed using the Critical Appraisal Skills Programme checklists. Results The search returned 2365 results. After deduplication, articles were removed at the title (n=1070) abstract (n=813) and full text (n=232) stages. 31 studies were included. Studies were conducted in India (n=6), US (n=5), international (n=4), France (n=2), Italy (n=2), and one each from China, Japan, Jordan, Mexico, Morocco, Nigeria, Romania, Saudi Arabia, Spain, UK, UK and US, and location not specified. Most studies (n=17) employed subjective methods of data collection (surveys/ questionnaires). We identified 6 themes. These were: changes in consultation type, for instance using teleconsultations and smartphone apps to monitor glucose control and diabetic management. Studies described temporary changes to treatment protocols e.g., using oral chemotherapy to reduce the need for in-person appointments and reduce the infection risk associated with intravenous administration. Control of certain conditions for example epilepsy was reduced in some studies. Patients missed doses due to drug shortages associated with disruptions in the medication supply chain, particularly in low-income countries. Finally, we identified prescribing trend changes in certain classes of medicines (e.g. reduced biologic usage due to immunosuppression risk) and an increase in patients self-medicating conditions including anxiety and depression, with associated safety risks. Conclusion This review suggested that certain medical conditions such as diabetes and hypertension were more suited to remote monitoring with technological interventions such as smartphone apps. While other conditions e.g., cancer and epilepsy, demonstrated a greater need for in-person care. Countries of lower socioeconomic status were disproportionately affected by the pandemic. References 1. World Health Organisation (2020). WHO Director General's opening remarks at the media briefing on COVID 19 11 March 2020. Retrieved 22/11, 2021, from https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. 2. Onyeaka, H., et al. (2021). COVID 19 pandemic: A review of the global lockdown and its far reaching effects. Science Progress 104(2): 003685042110198.

Europe’s national, supranational, and international governance structures produce parallel and often overlapping systems of rights protection. After more than sixty years’ experience with the European Convention on Human Rights, the advent in 2009 of the Charter of Fundamental Rights added new complexity to the human rights system. Examined here are the three dimensions of rights protection in this multi-layered system and the challenges resulting from this complexity, including: (1) uncertainty and confusion over the scope and level of rights protection, (2) general lack of uniformity in the recognition and enforcement of rights from one country to the next, and (3) questions over who has the last word on the protection of rights in Europe. Assessed in the conclusion are how and to what extent the unique interactions of national courts, the European Court of Human Rights, and the Court of Justice of the European Union affect outcomes such as the protection of fundamental rights.

The catalytic activity of a set of mono- and bimetallic Rh(I) and Ir(I) complexes bearing carbene-linker-carbene (CXC) bis-triazolylidene ligands (with X = O, N) coordinated in a bridging or chelating fashion was evaluated in the hydrothiolation of alkynes. The hydrothiolation of 1-hexyne with thiophenol in the absence of an external base or other additives was selected as a model reaction. All rhodium complexes are highly selective catalysts towards Markovnikov product formation and display superior activity compared to the related iridium derivatives. DFT calculations were carried out to rationalize the reaction mechanism and selectivity of this process. Neutral dinuclear [Rh2Cl2(cod)2(μ-COC)] was found to be the most effective catalyst for this transformation. Its applicability was further studied towards the hydrothiolation of different alkyl and aryl alkynes using predominantly aryl thiols and proved to be one of the most active and selective catalysts towards the α-vinyl sulfide product to date., L. C. T. and D. I. B. acknowledge the National Research Foundation, South Africa (NRF 115642; NRF 94784; NRF 100119; NRF 111705), and Sasol Technology R&D Pty. Ltd. (South Africa) for financial support (D. I. B.). I. F. is grateful to the Spanish Ministerio de Economía y Competitividad and FEDER (Grants CTQ2016-78205-P, PID2019-106184GB-I00 and CTQ2016-81797-REDC). G. G.-B gratefully acknowledges MICIU/AEI/FEDER “Una manera de hacer Europa” (PGC2018-093382-B-I00 and RTI2018-098903-J-I00) for financial support.

Background:Lupus nephritis (LN) is an autoimmune disease characterized by inflammation of the kidneys as a result of systemic lupus erythematosus (SLE). Approximately 50% of SLE patients will develop LN, which is considered to be one of the most severe manifestations of SLE and the leading cause of morbidity and mortality in SLE. While there is ample existing evidence on disease experience and PROs used in extra-renal SLE, little research has been done in LN. Qualitative interviews with patients can help identify concepts that are both important and relevant to the patient. In order to effectively evaluate treatment benefit, it is critical that PRO measures used to assess such concepts and define clinical trial endpoints are fit for purpose and have strong evidence of content validity in the specific context of use.Objectives:The objective of this study was to understand the patient experience of LN and to identify and characterize the signs and symptoms of LN and their impact on health-related quality of life (HRQoL) through the development of a disease-specific conceptual model. This model was then used to evaluate the content validity of existing PRO measures available for use in LN.Methods:A structured literature search was conducted in Medline, Embase and PsycINFO to identify qualitative research articles documenting the patient experience of LN. PRO measures developed or commonly used to assess patient experiences of LN were also identified. Semi-structured concept elicitation interviews were conducted with 15 adult patients in the US with a clinician-confirmed diagnosis of LN (defined in accordance with established clinical guidelines). Supplementary qualitative data were also collected from a review of publicly available online blogs/forums. Findings were used to inform the development of a conceptual model detailing the impact of LN signs, symptoms and HRQoL and evaluate the validity of existing measures used within LN.Results:Searches revealed a paucity of qualitative research conducted with LN patients, supporting the need for prospective research in LN. Consistent with existing literature in SLE, the core signs and symptoms identified from the qualitative literature review, interviews and blog/forum review included joint pain, fatigue, joint stiffness, swelling (particularly in the extremities) and skin rashes. LN patients also reported urinary frequency, urgency, foamy urine and blood in their urine. Disease impact on physical functioning, activities of daily living, emotions, social life, work/finances and sleep were reported. PRO measures commonly used to evaluate patient experiences in LN included the SF-36, LupusQOL, LupusPRO, SLE Symptom Checklist, KDQoL and KSQ. Conceptual mapping of instruments against the newly developed conceptual model (Figure 1) highlighted that no single measure provides a comprehensive assessment of all symptoms/impact important to LN patients. Furthermore, items are largely focused on impact of symptoms with few items on symptom severity.Figure 1.Conceptual model of lupus nephritis symptoms and associated impactsConclusion:The presentation of signs and symptoms in LN patients appears similar to those reported in extra-renal SLE populations, with the addition of swelling and urinary symptoms. Qualitative research with LN patients guided the development of a comprehensive LN conceptual model outlining the disease experience from the patients’ perspective. These insights can be useful to inform PRO measurement strategies for clinical trials in LN.Acknowledgments:With thanks to Dr. Betty Diamond and Dr. David Wofsy for their collaboration and helpful insightsDisclosure of Interests:Pamela Berry Employee of: Janssen, Kate Burrows Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Rebecca Hall Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract., Adam Gater Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Helena Bradley Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Amy Ward Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Chloe Tolley Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Patricia Delong Employee of: Janssen, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC

Study Objective To assess associations between perioperative non-opioid pain control adjuncts and postoperative opioid use. Design Survey and retrospective chart review of patients who underwent a minimally invasive hysterectomy or laparoscopic adnexal surgery at a single academic institution between October 2017 and October 2018. Patients underwent a structured telephone interview 5-7 days after discharge and a chart review one month later. The primary outcome was morphine milligram equivalent (MME) use after discharge. Setting N/A Patients or Participants Of 352 patients enrolled, 124 met inclusion and exclusion criteria, including 87 who underwent minimally invasive hysterectomy and 42 laparoscopic adnexal surgery. Ten of these participants did not consent to a medical record review. Interventions The perioperative non-opioid adjuncts examined include preoperative administration of celecoxib, gabapentin, pregabalin, and/or acetaminophen; intraoperative application of bupivacaine topically to the diaphragm; and postoperative ketorolac. Surgeons treated patients at their own discretion. Measurements and Main Results The median MME used after minimally invasive hysterectomy and laparoscopic adnexal surgery was 8 and 8.2 respectively, with 42% of participants not receiving, not filling or not using their opioid prescription at all. The median proportion of MME used to MME prescribed was 10% for hysterectomy and 20% for adnexal surgeries. Of these patients, 33.3% received at least one preoperative medication, 18% had intraoperative bupivacaine, and 71% received postoperative ketorolac. There were no statistically significant differences in MME use between those who did or did not receive any of the perioperative non-opioid adjuncts, though there was a trend toward lower MME use with post-operative ketorolac (6.35 vs 23.4 MME, p 0.056). Conclusion Some patients do not require post-operative opioid medications after a minimally invasive hysterectomy or adnexal surgery and most use only a small fraction of the amount prescribed. Perioperative adjunct therapies did not demonstrate statistically significant reductions in opioid use, though small numbers and lack of standardization limit the evaluation.

In Europe's multilayered constitutional arrangements, the work of national courts is increasingly influenced by directives and regulations of the European Council and Commission and decisions of the Court of Justice of the European Union and the European Court of Human Rights or Strasbourg Court as it is generally identified. Examined in this article are the recent efforts by courts in Germany, France, Italy, and the United Kingdom to keep pace with developments in European human rights law, especially the decisions of the Strasbourg Court, dealing with asylum and immigration. By focusing on recent decisions dealing with asylum and immigration issues, this article reveals the variety of approaches taken by courts in Europe to harmonize national law with international human rights law and concludes that the decisions that contributed most to the expansion of judicial power in this domestic policy area were those invoking principles of European human rights law to bolster the protection of rights that were ...

This article examines the work of the Joint Committee on Human Rights (JCHR) and assesses its effectiveness in safeguarding fundamental rights in the United Kingdom. In 2001, Parliament created the JCHR to scrutinize legislation for compliance with the Human Rights Act 1998 and the UK's international human rights commitments. Data on the impact of JCHR reports on the work of Parliament and courts are collected and used to evaluate the efficacy of parliamentary scrutiny committees devoted to human rights. Is the use of a human rights scrutiny committee an effective mechanism of rights review? Since the success of the ‘Commonwealth model of constitutionalism’ ultimately depends on the effectiveness of parliaments in safeguarding rights, the extent to which the JCHR's work influences the drafting of proposed bills; contributes to more informed parliamentary debate; and, ultimately, prevents bills with rights problems from becoming law, is likely to interest scholars and reformers alike.

This article seeks to offer an alternative to traditional understandings of how doctrine can inform the ways that medical professionals and others care for people who suffer. Placing traditional christological reflections in conversation with an aesthetically generated christology, I consider how the beauty of encounter can shape us. First, I consider how encounters in general can shape us, and then I reflect in particular upon how encounters with Christ, as construed by Hans Urs Von Balthasar, can shape us. I suggest that personal encounters shape us by forcing us to cross stories with others and by affecting us at the level of personal desire. Then, I articulate how an encounter with Christ – especially with Christ's questioning, liberating gaze as described by Von Balthasar – can motivate people to approach others with this same gaze. Lastly, I focus upon how caregivers can embody Christ's gaze at the bedside in acknowledgement, intimacy, communion and respectful silence with those who suffer.