The United States Food and Drug Administration recently issued emergency use authorization for 2 mRNA vaccines for preventing COVID-19 disease caused by SARS-CoV-2 virus infections. BNT162b2 from Pfizer-BioNTech and mRNA-1273 by Moderna are planned for use in mass-immunization programs to curb the pandemic. A brief overview of COVID-19 mRNA vaccines is provided, describing the SARS-CoV-2 RNA, how mRNA vaccines work and the advantages of mRNA over other vaccine platforms. The Pfizer-BioNTech collaboration journey to short-list mRNA vaccine candidates and finally selecting BNT162b2 based on safety data is outlined, followed by the Phase 3 study of BNT162b2 demonstrating 95% efficacy in preventing COVID-19 infections. Studies regarding mRNA-1273 (Moderna) are described, including extended immunogenicity data up to 119 days. The Phase 3 COVE study of mRNA-1273 eventually showed vaccine efficacy of 94.5%. Recommendations for future mRNA vaccine development are provided, including ongoing safety surveillance, evaluation in under-represented groups in previous studies and improving mRNA vaccine thermostability. Finally, further logistical considerations are required for manufacturing, storing, distribution and implementing mass vaccination programs to curb the pandemic.

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a global pandemic and significant loss of life. Older people are vulnerable to SARS-CoV-2 infections and complications; thus, they are a priority group to receive COVID-19 vaccines. This review discusses considerations for COVID-19 vaccines for older adults. The general concepts of vaccine effectiveness in older adults are described, particularly immune senescence and vaccine development approaches to improve immunogenicity. The types of COVID-19 vaccine platforms are also described before reviewing the available, although limited, evidence from phase 3 COVID-19 vaccine trials relevant to older adults. The BNT162b2 vaccine by Pfizer-BioNTech and mRNA-1273 vaccine from Moderna demonstrated high efficacy and immunogenicity, which were also observed in older people. While the ChAdOx1 nCoV-19 vaccine (AZD1222) by AstraZeneca demonstrated some efficacy in older people, the vaccine dose requires clarification through further studies. Finally, the Ad26.COV2.S vaccine by Janssen Pharmaceuticals shows promise as a single-dose vaccine with a potential durability of response.

tion. 4) An observational study showed a poor prognosis for functional recovery among older patients hospitalized for acute medical illness and discharged with a new or additional disability. Identifying these patients early enables clinicians to provide intensive rehabilitation interventions, caregiver support, or consideration of palliative care. 5) For example, before surgical intervention, identifying frailty may facilitate early rehabilitation to improve the likelihood of recovery. It may also be appropriate to counsel frail patients against surgery or offer palliation if there is a high risk of complications, including dependence and mortality. This paper provides an overview of frailty and frailty screening tools and suggests an approach that incorporates a frailty scale in preoperative assessments for older surgical patients to identify those who may benefit from early intervention and rehabilitation. FRAILTY The Asia-Pacific Clinical Practice Guideline indicates that frailty can be identified through three approaches, namely the Fried

The increasing survival rate from the intensive care unit (ICU) has led to the recognition that survivors may develop long-term impairments in terms of cognitive, psychiatric and physical domains. This post-ICU syndrome (PICS) as well as the debilitating effects on family members (PICS-F) is usually under-recognised by clinicians. In this paper, two cases of PICS illustrate the different impairments that may occur in ICU survivors. The PICS risk factors for each domains and the interactions between risk factors are described. In terms of diagnostic evaluation, there is limited evidence-based or validated tools to assist with screening for PICS.Clinicians should be aware to monitor and look out for the symptoms based on the cognitive, psychiatric and physical domains. It is recommended to use the Montreal Cognitive Assessment (MoCA) to screen for cognition, as it is more sensitive and can evaluate executive function. Mood disorders should be screened. For mobile patients, the 6-minute walk test should be performed. Prevention of PICS can be achieved through the ABCDEF bundle described in the paper. Finally, for ICU patients, it is recommended to involve family members in the care of patients and to use a tactful communication approach to reduce the risk of PICS-F.

Background: Effective pain management is a fundamental human right. However, global disparities in pain management practices exist across health settings. This study explored healthcare practitioners' views on pain management in the acute care hospital setting. Methods: The focus groups included clinical specialties most likely to encounter patients with 'difficult to manage pain', namely those in the Geriatrics and Palliative Care Unit (2 doctors and 3 nurses), Critical Care Unit (7 doctors), and the Pain Management Team (3 doctors and 2 nurses). The transcripts were analyzed using a qualitative thematic analysis. Results: The data analysis revealed four themes. Theme 1, 'Being too safe' described the presence of apprehensive attitudes among patients and healthcare practitioners that limits the appropriate use of diverse and tailored pain medications in acute care hospital settings. Theme 2, 'Working as a team' described the need for collaborative approaches to achieve hospital-wide evidence-based pain management. Theme 3, 'Adaptation for local and cultural preferences' explored how pain was perceived through cultural lenses and suggested strategies to tailor pain management to local and cultural preferences. Finally, Theme 4, 'Driving acute pain management forward' listed clinician solutions for improving pain management in acute care hospital settings toward a pain-free hospital initiative. Conclusion: Despite advances in pain medicine and pain teaching strategies, effective pain management is proportionate to both clinical and cultural preferences. Future studies should investigate the standardization of global pain management tools and guidelines to fit the local culture and context.