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There is a paucity of information concerning normative reference ranges on standardized measures of profession-wide competencies for the purpose of conducting formative assessments. The present study draws from a convenience sample to provide developmental (first/second half of training year) normative data for use in formative assessments of individual trainees and program-level quality improvement processes. Data reveal the anticipated pattern of competency scores generally improving across any given training year, with the strongest gains in competencies tied to assessment, supervision, and advocacy. A secondary aim, which emerged after study launch, was to evaluate whether training disruptions due an infectious viral pandemic (COVID-19) exerted demonstrable impacts at the aggregate level on trainee competency development. This sample of doctoral trainees evidenced no pandemic-associated suppression of Competency attainment. Rather, this sample of trainees evidenced growth in focal competencies tied to policy creation, systems-change, management structure, and leadership. Training implications are discussed.
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Background: Post-acute COVID-19 syndrome is recognised as a complex systematic disease. There is limited information on asthma-like symptoms following acute COVID-19. Objective(s): We estimated prevalence and persistence of asthma-like symptoms at 3 and 12 months after acute COVID-19 as compared to a control population. Method(s): Community-based COVID-19 patients from the first pandemic wave in Bergen, Norway, were included in a longitudinal clinical study. At 3- and 12-months, 158 and 89 patients, respectively, also participated in an additional sub-study, which was harmonised with clinical follow-up of the community-based RHINESSA population (control) with 235 participants. The European Community Respiratory Heath Survey structured questionnaire on general characteristics, asthma and respiratory symptoms, was administered to both groups. The prevalence of respiratory symptoms in acute COVID-19 patients at two time points post infection was estimated, using logistic regression adjusted for sex, age and smoking. Result(s): In the COVID-19 patients, symptoms in the last 3 days were more common after 12 than after 3 months: wheeze 11.2% vs 3.2%, waking up with shortness of breath (SOB) 5.6% vs 0.6%, and night cough 10.1% vs 3.2%. A year after the infection, COVID-19 cases reported more asthma-like symptoms than the control population: waking up with SOB (odds ratio [OR], 95% confidence interval [CI]: 2.50, 1.10-5.68);wheeze in the last 3 days (OR, 95%CI: 5.00, 1.10-22.8);and waking up with cough in the last 3 days (OR, 95%CI: 1.80, 0.60-5.37). Conclusion(s): Our findings indicated that asthma-like symptoms persisted one year after acute COVID-19.
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To map the public information about COVID-19 vaccines and vaccine trials in Europe, we have compiled an inventory of online communication materials from official sources (e.g., governments, public agencies, and NGOs) via directed online research. While information for the general public was abundant across Europe, we found a large variation in number, type and target audiences among countries. Little or no information was found for population groups that are typically underrepresented in vaccine clinical trials. Materials about clinical trials and trial participation were also limited.Interestingly, higher number of media materials was not reflected in higher national vaccination rates.
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Objectives: This is a protocol for a Cochrane Review (qualitative). The objectives are as follows:. This is a protocol for a Cochrane Review (qualitative). The review aims to explore the factors associated with a person’s decision to take part in a pandemic or epidemic vaccine trial.
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The outbreak of the COVID-19 pandemic in late 2019 has so far caused more than 6 million deaths worldwide according to WHO. Currently, there is only one FDA-approved novel antiviral drug therapy (Paxlovid, Pfizer) for treatment of critically ill patients from COVID-19 infection. However, there is a need for a great diversity of antiviral therapies because of the constant mutations of the virus and the possibility of other similar viruses causing similar symptoms in patients. By utilizing natural products from medicinal plants, it is possible to provide a drug, or drug leads for a future novel antiviral therapy. Currently, we are testing isolated and characterized natural products (some novel and some already elucidated) from water lily (Nuphar lutea) and eagle fern (Pteridium aquilinum) on the SARS-CoV-2 virus where we are working on developing a good pipeline to test these compounds in vitro. So far, we have tested the effect of the compounds on inhibition of cell entry using a pseudovirus system and HEK293-FT cells transiently transfected with SARS-CoV-2 receptors ACE-2 and TMPRSS2. Some of the compounds showed a slightly inhibitory effect. Next steps will be to establish a cell line with stable expression of ACE-2 and TMPRSS2 and confirm the results in cells with endogenous expression of these receptors. We will proceed working with different variants of the hospital isolates of the virus within the next months, where we will further analyse the potential effect of these compounds on viral replication. The goal is to determine and understand the mechanism of inhibitory action of the natural products on the virus. In conclusion, we are at an early stage of researching the abundant possibilities of antiviral effects of these natural products on SARS-CoV-2.
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Objective: To compare patient satisfaction and preference for future telemedicine following in-person and virtual visits (telephone and video) in an ambulatory neurology practice. Background: During the COVID-19 pandemic, care shifted from exclusively telemedicine to hybrid models with in-person, video, and telephone visits. We sought to understand how patient satisfaction and visit preferences have changed. Design/Methods: Patients who completed a virtual visit in March 2020 (early pandemic, exclusive telemedicine), May 2020 (mid pandemic, in-person optional), and March 2021 (late pandemic, hybrid model) were contacted by telephone. Assenting patients were assessed for visit satisfaction (% reporting “all needs met”) and desire for future telemedicine (% reporting “definitely interested”). Results: 3,991 ambulatory visits were performed (1,004 early;478 mid;2,509 late);1,725 patients (43%) assented to post-visit feedback;mean age 45.8±24.4 years, 42% male, 79% white, and 56% with Medicare/Medicaid insurance. Patient satisfaction significantly increased (73% early, 79% mid, 81% late pandemic, p=0.008). Interest in telemedicine also increased for patients completing telephone visits (40% early, 50% mid, 59% late, p=0.027) and video visits (52% early, 59% mid, 62% late, p=0.035). Patients reporting “all needs met” were younger (44 years vs 51, p<0.001). There was no difference in satisfaction by race (p=0.09), sex (p=0.82), or insurance (p=0.82). However, white patients were more interested in future telemedicine (p=0.037). Multivariable analysis showed that older, male, black patients, with Medicare/Medicaid insurance were less likely to complete a video visit early pandemic. Male sex was no longer a predictor late pandemic whereas older patients were 2% less likely (for each 1 year older), black patients 45% less likely, and patients with Medicare/Medicaid 54% less likely to complete a video visit. Conclusions: Patients, especially younger ones, have become more satisfied and more interested in hybrid care models. Barriers to conducting video visits persist including for older, black patients with Medicare or Medicaid insurance.
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Objective: To compare patient satisfaction and preference for future telemedicine visit following in-person and virtual visits (telephone and video) based on distance from a neurology ambulatory clinic. Background: Due to the COVID-19 pandemic, ambulatory neurology shifted to both in-person and telemedicine visits. Understanding how patient satisfaction and visit preferences differ by distance traveled can inform care post-pandemic. Design/Methods: Patients who completed a virtual visit in March 2020 (early pandemic) and virtual or in-person visit in March 2021 (late pandemic) were contacted by telephone within 3 months. Assenting patients completed quantitative assessment of satisfaction and desire for future telemedicine visit. Distance was measured “as-the-crow-flies” between patients' home and clinic zip-codes. Patients were stratified into groups: >60mi, 60-30mi, 30-15mi, and <15mi away. Results: 3,610 ambulatory visits were performed (1,101 early, 2,509 late);1,235 patients (34%) assented to feedback. Of these, 57% were in-person, 18% video, and 23% telephone. In general, >70% of patients reported “all needs met” regardless of visit type. Patient satisfaction was significantly greater with in-person visits for intermediate distances (60-15mi) and with telemedicine visits for the closest (<15mi) and farthest distances (>60mi, p<0.048). Satisfaction with in-person visits exceeded video and telephone visits only for patients at 30-15mi (89%, 76%, and 69% respectively;p<0.011). In the late pandemic, patients desired future virtual visits significantly less following in-person visits compared to video and telephone at all distances (p<0.037). Satisfaction did not change from early to late pandemic;however, desire for future virtual visits significantly increased for telephone visits (29-39% early to 58-71% late, p<0.05) and remained high for video (50-67% early and 54-67% late, P>0.05). Conclusions: Patients have become more receptive to telemedicine and in particular to telephone visits. Satisfaction with virtual visits is comparable to in-person visits at all distances and is particularly high for patients traveling the longest and shortest distances.
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The response to the health crisis caused by the COVID-19 pandemic has resulted in an employment crisis. On the one hand, an unprecedented number of employees have been laid off. On the other hand, how the work of those who are still employed is organized has undergone upheavals, particularly in terms of the professional temporalities to which they have been subjected. The upheavals caused by the pandemic have led to an increased blurring of the boundaries between social time, i.e., time spent on work and time spent not working, as many have found themselves having to reconcile their work and family obligations. These upheavals are taking place in a pre-existing context characterized by a deterioration of working conditions caused by the intensification and extensification of work. The authors examine the extent to which existing labour law is a useful bulwark against the changes in working time that have been observed during the pandemic and that are likely to be perpetuated.
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Introduction: Coronavirus disease 2019 (COVID-19) adversely affects patients with cancer, underscoring the critical need for vaccination. However, the safety of COVID-19 vaccines in patients with solid tumors receiving systemic therapy is inadequately studied. Research Question or Hypothesis: Are COVID-19 vaccines safe in patients with solid tumors receiving systemic therapy? Study Design: Retrospective review of electronic medical records. Methods: Recipients of COVID-19 vaccines between January 1, 2021 and April 30, 2021, while on systemic therapy for solid tumors, were identified. Data were collected from the electronic clinic notes, and adverse events (AEs) were graded according to Common Terminology Criteria for Adverse Events, version 5.0. Results: The analysis included 185 patients;the median age was 71 years, and 55% were female. The most common chemotherapy, immunotherapy, and targeted therapy administered were Oxaliplatin (9%) and taxane-based (13.5%) regimens, anti-programmed death 1 agents (17%), and Osimertinib (3%), respectively. Patients received the following vaccines: BNT162b2 from Pfizer (96/185, 52%), mRNA-1273 from Moderna (79/185, 43%), and JNJ-78436735 from Johnson & Johnson (10/185, 5%). At least one AE was observed in 35 patients (19%);the total number of AEs was 56: 48 grade 1 (86%) and 8 grade 2 (14%). Most adverse events occurred after the second dose (33, 59%). The most frequent grade 1 AEs included injection site pain (7,14.6%), fever (7,14.6%), fatigue (7,14.6%), chills (5,10.4%). The most frequent grade 2 AE was fatigue (3, 37.5%). Therapy was delayed because of AEs in 3 patients (1.6%). The following table summarizes the data: Conclusion: COVID-19 vaccines caused infrequent and mild AEs in patients with solid tumors receiving systemic therapies.
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[Figure: see text].
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Background: Rituximab is increasingly used as disease modifying treatment (DMT) in patients with multiple sclerosis (MS). Data are limited, but rituximab and other anti-CD-20-antibody treatments are known to reduce humoral vaccine response and to enhance risk of severe COVID-19 disease. Objective: To assess humoral immune response in MS patients treated with rituximab after full vaccination. Methods: All adult MS patients treated with rituximab at Haukeland University Hospital, Bergen, Norway, received a written invitation to provide a blood sample before COVID-19- immunization and 3-12 weeks after full immunization (2 doses of vaccine or confirmed COVID-19 disease and 1 dose). Baseline information on MS treatment and vaccine dates were obtained from the patients journal, The Norwegian Registry of Immunization (SYSVAK) and patient questionnaire. Humoral immune response was assessed by SARS-CoV-2 RBD IgG response by the Bergen Covid-19 Research group. Results: 352 patients were invited. By july 10th 2021, 249 patients had submitted a written concent and 93 patients had completed covid-19 vaccination and given a blood sample for humoral immunity analysis 3-12 weeks after immunization. Out of 93, a total of 63 patients (67.7%) presented low or not detectable humoral immune response. Conlusions: More than 2/3 of MS-patients receiving treatment with rituximab have low or not detectable humoral immunity to mRNA vaccines against covid-19. The final results will be compared to a group of health care workers vaccinated in Haukeland University Hospital and possible predictors of vaccine response including age, time from last dose of rituximab and cumulative dose of rituximab will be analyzed and presented.