ABSTRACT
Background and aim: Covid-19 has had a devastating global impact and resulted in over 4.4 million directly attributed deaths. The UK entered lockdown in March 2020, redistributing its medical workforce and resources. Early estimations suggested at least 4700 extra cancer deaths at 5 years if there was a 3-month delay to surgery. Delays to diagnosis and treatment for esophagogastric (EG) cancers can be particularly detrimental to survival. The aim of this study is to assess the impact of Covid-19 on new cancer referrals to a centralised UK EG cancer centre, including presentation, decision making and treatment. Methods: Patients with EG cancer referred to a tertiary, high-volume centre between March 2019 and March 2021 were reviewed. Patients were stratified into Pre-covid (March 2019-March 2020) and Covid (March 2020- 2021) cohorts. Number of new referrals, clinical stage, treatment decision, and time to treatment were compared for gastric adenocarcinoma (GA), esophagogastric-junction adenocarcinoma (EGJA), esophageal adenocarcinoma (EA) and esophageal SCC (ESCC). Results: There was an 11% reduction in new cancer referrals (485 vs 431). GA, EGJA and EA did not have significant change in treatment intent, although there was a significant increase in the decision for definitive nonsurgical treatment of EA (P = 0.046). GA and EA patients had a small, but significant increase in average clinical stage at presentation (P < 0.05). There was no increase in time to treatment for GA, EGJA and EA. A significantly higher proportion of ESCC patients were given curative intent treatment in the Covid-19 cohort (P = 0.0006) however, this was accompanied with an increased time to treatment (35.8 days vs 27.9 days P = 0.0198). Conclusion: This high-volume centre has seen a reduction in new cancer referrals since the first UK lockdown. This was associated with a small, but significant, increase in clinical stage of GA and EA at presentation. This may represent an early indication of excess esophagogastric cancer deaths due to the impact of Covid-19. This data also confirms initial results showing that oncological decisions were not compromised, although Covid-19 remains a dynamic challenge.
ABSTRACT
Background: Early childhood development (ECD) is increasingly being recognised as vital for the care and education of our children, particularly in countries such as South Africa where vast social disparities have a significant influence on development and well-being. Aim: This study aimed to explore and develop understandings of quality in early childhood care and education in a particular setting. Setting: The setting of this community research project is a small rural town in the Eastern Cape of South Africa. The project is facilitated by a non-governmental organisation affiliated with a university in the Eastern Cape of South Africa, working with participants from two neighbourhood hubs. This study coincided with the onset of the COVID-19 pandemic. Methods: Located in a social constructionist paradigm, the research methodology may be described as participatory, polyphonic and appreciative. Responses from simple, positively constructed questions, framed by dimensions of an ecological systems model, were interrogated through a multilayered process of content analysis. Results: Analysis of the data led to a range of themes and evidence of significant role players, around quality ECD. These were developed into two simple frameworks, capturing conceptual and contextual aspects of quality ECD: ‘Quality Early Childhood Development’ and ‘Circles of Care and Education’. Conclusion: The juxtaposition of the conceptual and contextual frames is offered as a simple, yet comprehensive, tool to scaffold ongoing research and support further development of quality ECD practice. © 2022. The Authors.
ABSTRACT
In May 2020, a cluster of 7 COVID-19 cases was identified in a rural Amish community in Ohio, USA, which led to an increase of access to testing. Real time RT-PCR testing was positive for SARS-CoV-2 in 23 out of 30 additional residents. Among the 30 persons with laboratory-confirmed COVID-19, the mean age was 46 years (range: 12-86 years), and 21 (70[%]) were male. Eight of those persons reported having underlying medical conditions. Symptoms most commonly reported included fatigue, headache, cough, myalgia and chills. None had travelled recently, and 24 (80[%]) at the time of testing reported contact with a person who was sick, usually at a social or religious event. Rapid and sustained transmission of SARS-CoV-2 in the said community was associated with multiple social gatherings, where some community members were interviewed and revealed concerns about having to follow critical mitigation strategies, including social distancing and mask wearing. The reduction of ongoing community transmission would entail the cooperation among state and county health department staff members and community leaders. The development, delivery, and promotion of culturally responsive health education messages to prevent SARS-CoV-2 transmission and timely and convenient access to testing services must be ensured as well.
ABSTRACT
BACKGROUND: The COVID-19 pandemic continues to have a significant impact on the provision of medical care. Planning to ensure there is capability to treat those that become ill with the virus has led to an almost complete moratorium on elective work. This study evaluates the impact of COVID-19 on cancer, in particular surgical intervention, in patients with esophago-gastric cancer at a high-volume tertiary center. METHODS: All patients undergoing potential management for esophago-gastric cancer from 12 March to 22 May 2020 had their outcomes reviewed. Multi-disciplinary team (MDT) decisions, volume of cases, and outcomes following resection were evaluated. RESULTS: Overall 191 patients were discussed by the MDT, with a 12% fall from the same period in 2019, including a fall in new referrals from 120 to 83 (P = 0.0322). The majority of patients (80%) had no deviation from the pre-COVID-19 pathway. Sixteen patients had reduced staging investigations, 4 had potential changes to their treatment only, and 10 had a deviation from both investigation and potential treatment. Only one patient had palliation rather than potentially curative treatment. Overall 19 patients underwent surgical resection. Eight patients (41%) developed complications with two (11%) graded Clavien-Dindo 3 or greater. Two patients developed COVID-19 within a month of surgery, one spending 4 weeks in critical care due to respiratory complications; both recovered. Twelve patients underwent endoscopic resections with no complications. CONCLUSION: Care must be taken not to compromise cancer treatment and outcomes during the COVID-19 pandemic. Excellent results can be achieved through meticulous logistical planning, good communication, and maintaining high-level clinical care.