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Objectives: At the beginning of the pandemic, it was believed that severe SARS-CoV2 infection would induce lifelong immunity and that reinfections would be unlikely. However, several cases of reinfection were documented in previously infected patient and the waning humoral immunity has raised significant concerns. Accordingly, long-term and durable vaccineinduce antibody protection against infection have also become a challenge, as several breakthroughs of COVID-19 have been identified in individuals partially or fully vaccinated. This study describes the incidence, the characteristics of severe COVID-19 infections requiring ECMO occurred after vaccination and the presence of side effects related to the vaccine. Method(s): EuroECMO COVID is a prospective, multicenter, observational study, developed by the EuroELSO, based on data from patients aged >=16 years who received ECMO support for refractory COVID-19 during the pandemic in 204 centers. The analysis investigates the survival of vaccinated patient, the associations between management-related variables, the incidence of vaccination during the different pandemic phases, the type of vaccines and the possible side effects. Result(s): Immunosuppressed patients are susceptible to reinfection even after being naturally infected or receiving a full vaccination. Ineffective antibody production, due to relatively ineffective vaccines, inadequate number of doses or the time after vaccination are involved in the pathogenesis of postvaccination infections. This population was found to have a partial immunity due to an inadequate number of doses and an overlapped time from vaccination and SARS-CoV2 incubation with PCR results after being vaccinated. Several manifestations of SARS-CoV2 infection are similar to vaccine-induce side effects and mild symptoms can be presented both as an adverse reaction after vaccination and a result of infection. In this subgroup no side effects were attributable to the vaccine. Conclusion(s): Vaccination does not entirely prevent SARS-CoV2 but will lead to less morbidity and mortality, as demonstrated by less need of ICU and ECMO care. In addition, the partial immunity for inadequate doses of vaccine or through the evolution of new variants demonstrated the importance of further analysis to differentiate the possible causes of waning humoral immunity.
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Background. The biological determinants of post-acute sequelae of SARS-CoV-2 infection (PASC), defined as the persistence or recurrence of symptoms not explained by an alternative medical diagnosis, are poorly understood. We assessed viral and immunological determinants during acute SARS-CoV-2 infection for an association with PASC at 4 to 8 months. Methods. From September 2020 to February 2022, symptomatic nonhospitalized individuals with laboratory-confirmed SARS-CoV-2 infection were identified within 5 days of symptom onset. We used anterior nasal biospecimens to measure the magnitude and duration of RNA and infectious viral shedding as well as blood samples to measure soluble markers of inflammation during the acute phase (first 28 days post-enrollment). PASC was defined as self-report of 1 or more COVID-19 attributed symptoms between 4 and 8 months after initial illness. We compared virologic and inflammatory markers, GFAP (a marker of neuronal damage) and neutralizing antibody levels from the acute phase between those with and without PASC using Mann-Whitney U tests or repeated measures mixed effects linear models. Results. Among 71 SARS-CoV-2-positive participants with a completed follow-up visit between 4 to 8 months, we included 69 with virologic data and 61 with inflammatory marker data. Median age was 37 (IQR: 29 to 48) Overall, 16/72 (23%) reported at least one qualifying PASC symptom. Report of PASC was associated with >9 days of RNA shedding (p=0.04);all participants stopped RNA shedding by day 20. During acute illness, those with subsequent PASC had increased levels of INF-alpha, INF-gamma, IP-10, IL-10, and MCP-1;these differences were greatest in the early period and normalized over 2 to 3 weeks post-illness onset. Compared to those without PASC, during the acute illness those with PASC had increased levels of GFAP and decreased levels of neutralizing antibodies but these differences were not statistically significant. Conclusion. We found indications that viral and immunological factors during acute illness may be associated with PASC, suggesting acute immunologic response to SARS-CoV-2 may have longer term effects and play a role in PASC. Further understanding of the clinically significance of these observations is needed.
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STATEMENT OF PROBLEM/QUESTION: Does providing residents with dedicated panel management time improve outpatient clinic follow-up rates? DESCRIPTION OF PROGRAM/INTERVENTION: Routine follow-up with primary care providers ensures that patients receive timely, evidencebased preventive care, resulting in improved longitudinal health outcomes. Unfortunately, due to the COVID-19 pandemic, there have been delays in routine care nationally, with reports of nearly 40% of people missing medical appointments in early 2020. In the resident primary care clinic at the Cleveland Veterans Affairs Medical Center (VAMC), we piloted an intervention to address this gap in care. Our clinic uses a Patient-Aligned Care Team (PACT) model, which is comprised of an interprofessional team of providers who care for a panel of patients. Using an EMR data collection tool, we aimed to identify patients without any future appointments scheduled and label them as “no future care” (NFC) within each panel. We proposed reducing NFC rates with a resident-based approach. Residents were given dedicated panel management time led by a Chief Resident to identify patients with NFC and consider how they might change their practice to minimize NFC rates in the future. They utilized members of their PACT team to reach out to patients and schedule follow-up appointments. MEASURES OF SUCCESS: Our primary outcome measure was NFC rates pre- and post-intervention for thirteen resident patient panels (average panel size 200 patients). Additionally, eleven residents completed a survey to assess the perceived educational benefit of this intervention. Resident respondents were queried as to their confidence in using the panel management tool and their interest in performing panel management activities in their future practice. FINDINGS TO DATE: Overall, the NFC rate among resident clinics improved, with 12 out of the 13 patient panels (92.3%) having a decreased NFC rate after the intervention. A paired-samples t-test was conducted to compare the NFC rate before and after resident panel management intervention. There was a significant difference in the rate, with an initial overall mean of 18.8% NFC rate per resident panel that decreased to an average of 16.2% patients who were NFC per panel (p<0.001). Resident response to this intervention was overwhelmingly positive, with 10 participants reporting increased confidence using the panel management tool and all 11 residents reporting interest in future panel management activities. KEY LESSONS FOR DISSEMINATION: In this pilot study we found that a resident-led approach can be effective for ensuring timely follow-up in primary care. This structured approach can be helpful for addressing the gaps in care that many patients have experienced as a result of the COVID-19 pandemic. Here we demonstrate that designated panel management time for residents can effectively decrease no future care rates for patients. This also provides the residents an educational benefit, with introduction to use of panel management tools and benefits of panel review.
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Purpose: Adjuvant radiation plays a significant role in reducing loco-regional recurrences in uterine cancers. Standard treatment consists of daily radiation for five weeks which can be challenging for patients and the healthcare system, especially during the COVID-19 pandemic. Hypofractionated radiotherapy has been evaluated and established in other pelvic malignancies. This study aims to evaluate the acute urinary and bowel toxicities, and patient reported outcomes following stereotactic hypofractionated adjuvant radiation for endometrial cancer. Materials and Methods: This is a prospective phase I/II trial in which patients with endometrial cancer planned for adjuvant radiation received 30Gy in 5 fractions, every other day or once weekly. Treatment was delivered at two centres with volumetric arc radiation therapy with a body-vacuum immobilization, bowel enema and 3D image-guidance. Toxicity assessment, outcomes and patient reported quality of life (QOL, EORTC core QLQ-C30 and endometrial EN24) were collected at baseline, fractions (F) 3 and 5, and at regular follow-up intervals. Higher scores represent better global QOL/health status or worse symptoms (scale 0 -100). Changes in QOL over time were investigated with linear mixed-effects models. A p-value threshold of 0.05 was used for statistical significance. A change in QOL score of > 10 points was considered clinically significant. Results: The median age of the 41 enrolled patients is 66 (range: 51 - 88). Histologies included 29 endometrioid adenocarcinoma, eight serous/clear cell, one carcinosarcoma, and three dedifferentiated. Thirty patients had Stage I disease while three had Stage 2 and eight Stage 3. Seven patients received sequential chemotherapy and 3 had additional vault brachytherapy. Median follow-up is nine months, with worst toxicity (GI or GU) of Grade 1 and 2 in 63% and 24% respectively. No patients have experienced a Grade 3 or higher toxicity. Patient-reported diarrhea and gastrointestinal domain scores were statistically significantly worse than baseline at F5 (mean paired difference = 27.2;8.7, p<.005) and six weeks (mean paired difference = 7.9;5.1, p<0.05), and returned to baseline levels at 12 weeks. The only clinically significant change (>10) from baseline was in diarrhea at F5. There were no significant changes in urinary domain, overall health and quality of life scores. No loco-regional recurrences have been found;three patients recurred distantly, of which two died of metastatic disease. Conclusions: Stereotactic hypofractionated radiation is feasible and well-tolerated with short-term follow-up. Longer follow-up and future randomized studies are needed to further evaluate this treatment.
ABSTRACT
Adjuvant radiation plays a significant role in reducing locoregional recurrences in uterine cancers. Standard treatment consists of daily radiation for 5 weeks which can be challenging for patients and the healthcare system, especially during the COVID pandemic. Hypofractionated radiotherapy has been evaluated and established in other pelvic malignancies. This study aims to evaluate the acute urinary and bowel toxicities, and patient reported outcomes following stereotactic hypofractionated adjuvant radiation for endometrial cancer. This is a prospective phase I/II trial in which patients with endometrial cancer planned for adjuvant radiation received 30 Gy in 5 fractions, every other day or once weekly. Treatment was delivered at two centers with volumetric arc radiation therapy with a body-vacuum immobilization, bowel enema and 3D image-guidance. Toxicity assessment, outcomes and patient reported quality of life (QOL, EORTC core QLQ-C30 and endometrial EN24) were collected at baseline, fractions (F) 3 and 5, and at regular follow-up intervals. Higher scores represent better global QOL/health status or worse symptoms (scale 0 – 100). Changes in QOL over time were investigated with linear mixed-effects models. A P -value threshold of 0.05 was used for statistical significance. A change in QOL score of ≥ 10 points was considered clinically significant. The median age of the 41 enrolled patients is 66 (range: 51 – 88). Histologies included 29 endometrioid adenocarcinoma, 8 serous/clear cell, 1 carcinosarcoma, and 3 dedifferentiated. Thirty patients had stage 1 disease while 3 had stage 2 and 8 stage 3. Seven patients received sequential chemotherapy and 3 had additional vault brachytherapy. Median follow-up is 9 months, with worst toxicity (GI or GU) of grade 1 and 2 in 63% and 24% respectively. No patients have experienced a grade 3 or higher toxicity. Patient-reported diarrhea and gastrointestinal domain scores were statistically significantly worse than baseline at F5 (mean paired difference = 27.2;8.7, P <.005) and 6 weeks (mean paired difference = 7.9;5.1, P < 0.05), and returned to baseline levels at 12 weeks (Table 1). The only clinically significant change (≥ 10) from baseline was in diarrhea at F5. There were no significant changes in urinary domain, overall health and quality of life scores. No locoregional recurrences have been found;3 patients recurred distantly, of which 2 died of metastatic disease. Stereotactic hypofractionated radiation for uterine cancers is feasible and well-tolerated with short-term follow-up. Longer follow-up and future randomized studies are needed to further evaluate this treatment. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)