ABSTRACT
Background: ConCure-SM is a mixed-methods research project for developing and testing an advance care planning (ACP) intervention for people with progressive multiple sclerosis (pwPMS) in Italy. It consists of a booklet to be used during the ACP conversation (the focus of this presentation) and a training program for neurologists and other MS healthcare professionals (HPs). Aims: To assess the acceptability and comprehensibility of the ConCure-SM booklet. Methods: An inter-disciplinary panel translated and adapted to the Italian legislation and to the MS context a booklet developed by the National ACP programme for New Zealand. The booklet was then probed via individual cognitive interviews with pwPMS and caregivers, and a focus group meeting (FGM) with MS HPs. Two weeks before the interview/ FGM, held on digital platform due to the COVID-19 pandemic, participants received the booklet and were invited to browse it. Results: Between September-January 2021 we conducted 13 interviews which lasted between 36 and 80 minutes. Participants were 10 pwPMS and 3 caregivers (2 spouse, one daughter);8 were men, median age was 54 years. Data saturation was achieved after 11 interviews were analyzed. Twelve HPs participated in the FGM (7 neurologists, 3 psychologists, one nurse and one physiotherapist), which lasted 1.45 min. Thematic analysis (performed by LDP, SV, and LG) identified 4 overarching themes: comprehensibility and clarity;content acceptability and emotional impact;images and layout;suggestions for improvement. Interviews revealed that the booklet was useful and informative, though pwPMS found it emotionally taxing. The FGM was well participated;few experiential data on ACP emerged, lack of training and time constraint emerging as major reasons. Conclusions: Cognitive debriefing was key to refine the ConCure-SM booklet. Interview and FGM results corroborated use of the booklet within the ACP conversation, and the challenge of appraisal as a standalone tool.
ABSTRACT
Background: Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection and a diagnosis of cancer are at high risk of severe symptomatic disease (COVID-19) and death. We performed a systematic review and meta-analysis of published studies, to estimate the case-fatality rate (CFR) of patients with solid or hematological tumors and SARS-CoV-2 infection. Methods: A systematic search of PubMed library up to 31 January, 2021, was performed in order to identify publications reporting the CFR among adult patients with solid or hematological tumors and SARS-CoV-2 infection. CFR was defined as the rate of deaths among SARS-CoV-2-positive cancer patients. Moreover, we separately assessed the CFR among patients with lung and breast cancer. Studies with at least 10 patients were included. The CFR was assessed through a random effect model, and 95% confidence intervals (CI) were calculated. The Higgins I2 index was computed to assess the heterogeneity between studies. Results: The systematic search of the literaturereturned 1,727studies. 1,551 were excluded on the basis of the title, 29 based on the abstract, and 3 were duplicates. A total of 144 studies were selected, including 35,725 patients with solid or hematological tumors and SARS-CoV-2 infection. In total, 46 and 32 studies reported the CFR among COVID-19 patients with lung (total N = 1,555) and breast (total N = 1.398) cancer, respectively. Overall, the CFR was 25.5% (95% CI 23.1%-28.1%, Egger test p < 0.001). A sensitivity analysis, after excluding studies with less than 100 patients, showed a CFR of 22.1% (95% CI 19.4%-25.2%). The CFR among patients with lung cancer and SARSCoV2 infection was 33.4% (95% CI 28.1%-39.6%) when including all studies and 26.3% (95% CI 17.6%-39.2%) at the sensitivity analysis after excluding studies with less than 100 patients. The CFR among patients with breast cancer and SARS-CoV2 infection was 13.7% (95% CI 9.1%-20.7%) when including all studies and 13.0% (95% CI 7.6%-22.1%) at the sensitivity analysis after excluding studies with less than 100 patients. Conclusions: One year after the outbreak of the pandemic, this large metaanalysis reports the impact of SARS-CoV-2 infection in patients with cancer. This population experienced a high probability of mortality, with a comparatively higher CFR in patients with lung cancer, and a comparatively lower CFR in patients with breast cancer. Patients with an underlying diagnosis of cancer require special attention with aggressive preventive measures that also include early access to COVID-19 vaccination.
ABSTRACT
Introduction: The COVID-19 pandemic has impacted stroke care and highlighted health care disparities. We aimed to determine if stroke alert (SA) volume, stroke alert mimic (SAM) volume, utilization of reperfusion therapies, and socioeconomic and race ethnic determinants of clinical outcome were impacted by the pandemic. Methods: Data was obtained from our Institutional Review Board approved SA database from February 2019-June 2019 and February 2020-June 2020 to capture the impact of the stay at home orders enacted at the end of March 2020 and the increase of COVID-19 cases in Florida in June 2020. Regression analysis was used to identify differences in volumes of SA, reperfusion therapy, SAM, and clinical factors (NIHSS, age, sex, race, ethnicity, insurance status, and rural region). Results: A total of 1171 SA were included, median age 66 (interquartile range 55-76), 50% woman, 23% Black, 68% Non-Hispanic White, 1% Hispanic, 8% unknown;52% of the SA were SAM. SA volumes, thrombolysis and endovascular therapy use was unchanged. The volume of SAM did not differ between time intervals, but SAM were more likely to be older (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.02 - 1.04), White (OR 1.80, 95% CI 1.09 -2.99), uninsured (OR 2.19, 95% CI 1.35 - 3.46), arrive by EMS (OR 1.77, 95% CI 1.31- 2.40), and have a higher NIHSS (OR 1.02, 95% CI 1.003 - 1.034). SAM secondary to migraine, intoxication, medication toxicity, or psychiatric disease were less likely to occur in April 2020 (OR 0.37, CI 0.15- 0.96) and in patients from rural regions (OR 0.42, CI 0.19 - 0.95). They were more likely to occur in older patients (OR 1.06, CI 1.05-1.07) and men (OR 2.31, CI 1.62 - 3.31). SAM secondary to seizure were more likely to occur in April 2020 (OR 2.46, CI 1.06- 0.96) and Whites (OR 2.22, CI 1.16 -4.26). SAM from medical ornon-cerebrovascular or epileptic neurologic disease were unchanged. Conclusions: Significant changes in the frequency of SAM subtypes occurred in close proximity tostay-at-home orders. Our findings suggest that a proportion of Blacks and Hispanics were notaccessing healthcare for stroke like symptoms during the stay-at-home orders. Thus, patienteducation on how to access healthcare in vulnerable populations should be included withimplementation of stay at home orders.
ABSTRACT
Novel coronavirus SARS-CoV-2 has created unprecedented healthcare challenges. Neurologic deficits are often an important presenting symptom. To date, the only reported post-infectious COVID-19 manifestations of neurologic disease include cognitive deficits and dysfunction of the peripheral nervous system. Here we report that seizure can also be a post-COVID-19 or "long-COVID" complication. We present a 71-year-old man with hypertension, diabetes mellitus, and COVID-19 diagnosed by RT-PCR who initially presented with posterior circulation stroke-like symptoms, which completely resolved after emergent thrombolysis. Six days later, the patient returned with seizure activity, supported by radiographic and electroencephalographic studies. Notably, he was negative for SARS-CoV-2, and no other provoking factor was uncovered after a comprehensive work-up. To our knowledge, this is the first report of post-infectious seizures after a case of COVID-19, highlighting the potential importance of monitoring for neurologic symptoms in COVID-19 patients, even after convalescence.