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(Wolverhampton Intellectual Repository and E-Theses)
WIRE is an open access repository for the research publications and other outputs from postgraduate students and staff at the University of Wolverhampton.
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The impact of the Coronavirus infectious disease (COVID-19) pandemic on the provision of Inflammatory Bowel Disease (IBD) antenatal care and outcomes of pregnancies in women with IBDBackground The impact of COVID-19 on pregnant Inflammatory Bowel Disease (IBD) patients is currently unknown. Reconfiguration of services during the pandemic may negatively affect medical and obstetric care. We aimed to examine the impacts on IBD antenatal care and pregnancy outcomes. Methods Retrospective data were recorded in consecutive patients attending for IBD antenatal care including outpatient appointments, infusion unit visits and advice line encounters. Results We included 244 pregnant women with IBD, of which 75 (30.7%) were on biologics in whom the treatment was stopped in 29.3% at a median 28 weeks gestation. In addition 9% of patients were on corticosteroids and 21.5% continued on thiopurines. The care provided during 460 patient encounters was not affected by the pandemic in 94.1% but 68.2% were performed via telephone (compared to 3% pre-pandemic practice; p<0.0001). One-hundred-ten women delivered 111 alive babies (mean 38.2 weeks gestation, mean birthweight 3324grams) with 12 (11.0%) giving birth before week 37. Birth occurred by vaginal delivery in 72 (56.4%) and by caesarean section in 48 (43.6%) cases. Thirty three were elective (12 for IBD indications) and 15 emergency caesarean sections. Breast feeding rates were low (38.6%). Amongst 244 pregnant women with IBD 1 suspected COVID-19 infection was recorded. Conclusion IBD antenatal care adjustments during the COVID-19 pandemic have not negatively affected patient care. Despite high levels of immunosuppression only a single COVID-19 infection occurred. Adverse pregnancy outcomes were infrequent.
Longitudinal complications associated with PEG: rate and severity of 30-day and 1-year complications experienced by patients after primary PEG insertionBackground and Aims Percutaneous Endoscopic Gastrostomy (PEG) feeding is utilised in patients with exceptionally poor oral intake but is associated with both short and long-term complications. This study reviews longitudinal PEG complications and compares key subgroups. Methods Single-centre retrospective observational study of all patients receiving PEG insertion between January 2016 and December 2018. Results 306 patients met the inclusion criteria. The mean age at insertion was 67 years. The majority were cared for in their own home (80.4%) by themselves or family (74.9%). 127 PEG tubes were inserted for dysphagia and 165 prophylactically prior to treatment for head and neck cancer. In the first 30 days 16.7% experienced a complication. The most frequently reported was peristomal pain (9.2%). In the first year, 35.6% experienced at least one complication, 12.4% two complications and 6.6% three complications and 6.5% required inpatient treatment for their complication. The most common was pain (14.4%) followed by site weeping, site infection and external overgranulation. Patients with dysphagia took longer to develop complications, had fewer complications and took longer to require management by members of the secondary care team than those with head and neck cancer. Discounting peristomal pain, there was no difference in total complications between patients caring for themselves when compared to those receiving professional input. Conclusion One third of patients will experience a complication related to their PEG tube over 1 year, but the majority are managed in an outpatient setting. This study has implications for planning support services and consenting and counselling patients pre-PEG-insertion.
Impact of Covid-19 on water sector projects and practicesThe COVID-19 pandemic has negatively affected world economies. The water industry was adversely affected, with unprecedented slow down and changes to ways of working. However, the pandemic also accelerated positive digital transformation. A qualitative research approach was adopted to analyze data collected from 12 interviewees representing six water sector organizations. The paper provides insight into the impact of COVID-19 on the delivery of water sector projects and how organizational practices have adapted from business as usual.