ABSTRACT
Background: DT combination has shown efficacy in the adjuvant setting for BRAF-mutated melanoma (BMM) patients (pts) in clinical trials. Previous reports from DESCRIBE-AD resulted in promising overall survival (OS) rates at 12 months. Methods: An observational retrospective study was carried out in 25 GEM sites in Spain. Histologically confirmed and resected BMM pts previously treated with DT according to standard clinical practice in the adjuvant setting were included. Only surgical resection was allowed as a prior treatment to DT. DT discontinuation rate and time to treatment discontinuation were the primary objective. Secondary objectives included safety and efficacy of the combination. Here, we report 3-year results for OS. Results: From 10/2020 to 03/2021, 65 pts were included. Median age was 58 years, 55% were male and 60%, 25%, and 14% had an ECOG PS 0/1/Uk respectively, one patient presented ECOG 3. Allocation of stage IIIA, IIIB and IIIC according to TNM AJCC 7th edition was 29%, 26% and 32%, respectively. There were 3 pts diagnosed at stage I/II but considered of risk, and 2 pts with stage IV but completely resected, all considered for adjuvant DT. Ulceration was present in 40%, Breslow ≥2 mm in 71%, and nodes were microscopically and macroscopically affected in 39% and 22% of pts, respectively. Only 9.2% of pts discontinued DT prematurely due to toxicity and 21.2% had dose reductions to manage toxicity. After a median follow-up of 36.2 m (range: 13-51.1), the overall OS rate at 3-years was 83.5% (95% CI: 74.5-93.5). According to AJCC 7 stage at diagnosis, the 3-years OS rate was 95.2% (95% CI: 86.6-100), 75% (56-100), and 76.8% (60.7-97.2) for stage I-II-IIIA, IIIB, and IIIC-IV respectively. Throughout the study period 11 (16.9%) pts died, of which 10 died due to disease progression and one due to COVID-19 infection. Conclusions: Adjuvant treatment with DT for melanoma achieved good treatment compliance and has proven efficacy in the real world. Adjuvant DT has a clinical impact in survival in line with previous clinical trial COMBI-AD. Editorial acknowledgement: We acknowledge Mfar Clinical Research staff for their assistance in the development of this . Legal entity responsible for the study: Grupo Español Multidisciplinar en Melanoma (GEM). Funding: Grupo Español Multidisciplinar en Melanoma (GEM) as Sponsor with Industry partner NOVARTIS. Disclosure: P. Cerezuela-Fuentes: Financial Interests, Personal, Other, Consultancy, conference,congress attendance/infrastructure: BMS, MSD, Pierre Fabre, Roche, Sanofi, SunPharma. J. Martín-Liberal: Financial Interests, Personal, Other, Lecture fees: Astellas, MSD;Financial Interests, Personal, Other, Lecture fees, advisory fees: Bristol Myers Squibb, Novartis, Pierre Fabre, Pfizer, Roche, Sanofi;Non-Financial Interests, Personal, Member, membership or affiliation: ASCO, ESMO, SEOM, GEM, EORTC, SOGUG, GEIS. L.A. Fernández-Morales: Financial Interests, Personal, Invited Speaker, Speak at sponsored meetings: BMS, MSD, Pierre-Fabre, Roche;Financial Interests, Personal, Other, Speak at sponsored meetings and advisory role: Novartis. J. Medina Martinez: Financial Interests, Personal, Other, Speaker, consultancy or advisory role or similar activity: Novartis, Roche, Pierre Fabre, BMS, MSD, Sanofi. M. Quindós: Financial Interests, Personal, Other, speaker, consultancy and advisory: AstraZeneca, GSK, Merck Sharp & Dohme, Novartis, PharmaMar, Roche, Bristol Myers Squibb, Pierre Fabre;Financial Interests, Institutional, Other, Clinical trials: Merck Sharp & Dohme, Roche, Bristol Myers Squibb. A. García Castaño: Non-Financial Interests, Advisory Role: Bristol, MSD, Novartis. T. Puértolas: Financial Interests, Personal, Invited Speaker, Speaker and advisory role: BMS, Novartis;Financial Interests, Personal, Invited Speaker: Roche, MSD, Sun-Pharma;Financial Interests, Personal, Other, Speaker and advisory role: Pierre-Fabre;Financial Interests, Personal, Advisory Role: Sanofi;Financial Interests, Institutional, Other, Clinical trial: Roche, BMS, Apexi en Inc, Aduro Biotech, Alkermes Inc;Non-Financial Interests, Institutional, Other, congresses inscriptions: Lilly, Sun-Pharma, Novartis, Roche, MSD;Non-Financial Interests, Institutional, Leadership Role, Vocal: GEM (Grupo Español Multidisciplinar de Melanoma);Non-Financial Interests, Institutional, Affiliate: SEOM (Sociedad Española de Oncología Médica), GEM (Grupo Español Multidisciplinar de Melanoma). P. Ayala de Miguel: Financial Interests, Personal, Invited Speaker, Public speaking: Novartis, Merck Sharp & Dohme, Sanofi, Pierre-Fabré. B. Campos: Financial Interests, Personal, Other, Speaker or advisory role: Roche, BMS, Sanofi, Novartis, Pierre-Fabre, Sun Pharma;Financial Interests, Personal, Other, Speaker role: AstraZeneca, Merck, ROVI, Leo Pharma. E. Espinosa: Financial Interests, Personal, Advisory Role, Advisory: BMS, MSD;Financial Interests, Personal, Other, Advisory, educational activities: Novartis;Financial Interests, Personal, Invited Speaker, Advisory, educational activities: Pierre Fabre;Financial Interests, Personal, Funding, Funding for translational investigation: Roche;Non-Financial Interests, Personal, Member, Vicepresident: Grupo Español Multidisciplinario de Melanoma. A. Rodríguez-Lescure: Financial Interests, Personal, Advisory Role: Pfizer, Novartis, ROCHE, AstraZeneca, Daiichi Sankyo, Seagen;Financial Interests, Personal, Invited Speaker, Public speaking: Pierre-Fabre;Financial Interests, Institutional, Research Grant, Grant for Clinical Trials: BMS, Lilly, Roche, Novartis, Amgen, Pzifer, Zimeworks, AstraZeneca, G1 Therapeutics, Bayer. L. Espasa Font: Financial Interests, Personal, Full or part-time Employment: Novartis. G. Belaustegui Ferrández: Financial Interests, Personal, Full or part-time Employment: Novartis. All other authors have declared no conflicts of interest.
ABSTRACT
The COVID-19 pandemic caused a rapid expansion of telemedicine use in the outpatient setting. Although studies have proposed several workflows for implementing telemedicine visits, most have not considered integrating the traditional role of medical assistants and nurses in virtual office visits. We report the experience of implementing telemedicine visits in a large university-based primary care office in the United States during the pandemic, with particular emphasis on integrating “virtual rooming” into the telemedicine workflow. This chapter describes the implementation of a virtual rooming model, including a discussion on facilitators, challenges, and suggestions for best practices. We examine these issues from the point of view of primary care providers, medical assistants (MAs)/licensed vocational nurses (LVNs), and office administration staff. Since telemedicine is likely here to stay, there is a need to develop, refine, and test effective and efficient workflows to integrate these visits seamlessly into office workflows without compromising the quality of patient care. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
Marginalized ethnic groups commonly experience discrimination, and these experiences are increasingly linked to adverse health outcomes. Research indicates that the psychosocial stress of discrimination is negatively associated with cardiovascular health. We report a study of the role of U.S. acculturation in this link via an examination of the relation of discrimination with cardiovascular responses to a psychosocial evaluative stressor in a sample of Latino, East Asian, and European American young adults and explored the role of U.S. acculturation and ethnicity in that association. Participants (n = 158, Mage = 20.49, 58% Females, 53.8% Latinos, 14.6% European Americans, 12.7% East Asians) from a larger study on stress reactivity self-reported on experiences of discrimination, U.S. acculturation (rating scale, nativity) and ethnicity. We obtained measures of heart rate variability (HRV), as indexed by root mean-squared successive differences (RMSSD) and high-frequency HRV (HFHRV). Relevant to this study, participants engaged in a 3-minute standing baseline, and then took part in the 5-minute speech task of the Trier Social Stress Test (TSST). Results indicated that discrimination, parental nativity, and quadratic time interacted to influence the RMSSD trajectory during the TSST. Specifically, those reporting higher levels of discrimination and had at least one U.S. born parent exhibited a decrease in RMSSD (? = 0.18, RSE = 0.08, z = 2.30, p = .021, 95%CI [0.03, 0.33]). We also found that during the TSST, East Asians surprisingly exhibited significantly lower HFHRV, as compared with European Americans (? = -233.78, RSE = 86.93, z = -2.69, p = 0.007, 95%CI [-404.17, -63.40]), while Latinos were not significantly different from European Americans in HFHRV (? = -15.00, RSE = 92.99, z = -0.16, p = .872, 95%CI [-197.26, 167.26]). Furthermore, higher discrimination was associated with lower HFHRV (? = -12.68, RSE = 4.20, z = -3.02, p = 0.003, 95%CI [-20.92, -4.45]). Taken together, these findings suggest that perceiving higher levels of discrimination can play a role in the ability to physiologically regulate during stress, and that U.S. acculturation may also contribute. It also suggests the importance of considering ethnicity, as the cardiovascular health of those of various marginalized ethnic groups may be differentially affected. Paper Session 34 - Current state of the art of COVID-19 research Saturday 15:45-16:45.
ABSTRACT
The article discusses the challenges of assisting violence against women (VAW) at the beginning of the SARS-CoV-2/Covid-19 crisis. Key informants from public support services in the city of Sao Paulo were interviewed and emphasized how the health-crisis intensified the violence synergy co-produced by increasing social vulnerability. The results indicate a contradictory programmatic response to the unprecedented psychosocial context marked by a sharp reduction in family income and a rise in alcohol and drug abuse. With government officials individualizing the VAW without offering sufficient support programs to maintain the distance/isolation necessary to prevent SARSCoV-2/Covid-19, women's demand for services have decreased despite the fact that the complaints have increased. Service users were increasingly deprived of the access to remote communication, while professionals were using personal cells and resources to attend them, without ethical confidentiality protocols. The foreseen challenges include expanding the intersectoral network and mental health services. © 2020.