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Introduction: Telemedicine has been a useful tool in the virtual management of patients with sleep disorders during the COVID-19 pandemic. Given the detrimental effects of chronic, untreated obstructive sleep apnea (OSA) on patient health, it is important that patients receive timely care. This study investigates whether the use of telemedicine is associated with delays in care or different rates of patient follow-up after drug-induced sleep endoscopy (DISE). Method(s): We performed a retrospective review of 166 patients who underwent DISE during 4-month periods of March-June 2019 and March-June 2021. The efficiency of telemedicine vs inpatient appointments following DISE was assessed using the time from DISE to the patient's first postop visit and the time from that postop visit to surgical intervention, referral to another specialty, or clinic follow-up. Additional variables of interest included patient demographics, characteristics of their OSA (sleep study results, Epworth score, positive airway pressure use), and the type of further care received (clinic follow-up, referral to another specialty, or surgery). Result(s): There was a significant increase in the rate of initial post-DISE telemedicine visits during the COVID-19 pandemic, with 39.7% of visits being telemedicine (P<.001) compared with 13.0% of visits pre-pandemic. The use of telemedicine was not associated with significant delays in obtaining initial post-DISE appointments, further surgical interventions, specialist referrals, or clinic follow-ups. There were no significant differences in follow-up rates between inperson or telemedicine appointments. In addition, there were no significant differences in telemedicine usage among patients of various demographics or with different severities of OSA compared with in-person appointments. Conclusion(s): Telemedicine appointments are an efficient alternative to in-person appointments following DISE for the management of OSA. In this setting, telemedicine was not associated with any significant delays in patient care or decreased follow-up rates, even among various patient demographics.
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Rationale:The West Midlands in the UK, which includes the City of Birmingham, was disproportionately affected during COVID-19 pandemic first wave. This was thought to be due to a number of factors relating to population demographics and density. At the initial peak, there were more than 700 inpatients at University Hospitals Birmingham NHS Foundation Trust (UHB), one of the largest NHS trusts in the UK (2700 beds and more than 21000 members of staff). The UHB tertiary Sarcoidosis Service looks after over 500 people with the condition. In March 2020 individuals felt to be at very high risk of severe COVID-19 were identified as clinically extremely vulnerable by NHS England and advised to shield March-July 2020. Though not initially specified, those with sarcoidosis were included on the national register following specialist consensus discussion. The aim was to assess whether patients receiving immunosuppression therapy for sarcoidosis (corticosteroids, diseasemodifying agents or biological agents) received and followed guidance to shield, alongside assessing the impact and unintended consequences of this guidance (diagnosis of COVID-19 and psychological impact). Methods:Sarcoidosis patients receiving immunosuppression therapy were identified from existing clinical databases and contacted to complete a telephone interview. Electronic medical records were reviewed to confirm the diagnosis of sarcoidosis and organ system involvement, treatments, co-morbidities, ethnicity and BMI. Results:A total of 115 patients on immunosuppression during the study period were identified. The mean age was 57 and mean BMI was 29. Pulmonary involvement was a feature in 92%, extrapulmonary systemic involvement in 46%. Half the patients (53%) were white British and 37% from Black and Ethnic minorities. Interviews were completed by 76 of the 109 patients. There were 6 deaths, one from confirmed COVID-19. Shielding letters were received by 70, although 75 in total shielded, 16 of whom stopped before government guidance to do so was announced. Symptoms consistent with COVID-19 were experienced by 3 patients none were eligible for a swab at that time. Most interviewed felt they had received enough information in the context of general uncertainty regarding COVID-19, however, some reported confusion as to when to stop shielding. Many spoke of the difficulties of shielding;they felt lonely and isolated. Some people felt fearful that they received the information too late, delaying onset of shielding. Conclusion:Shielding may have helped protect those with sarcoidosis, with few reported cases and one COVID-19 death. This is countered by a not insubstantial impact on fitness and mental health.
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The Covid-19 epidemic has resulted in many workers having prolonged periods away from work, opening an opportunity to clarify the effect of occupational exposures on workers with equivocal diagnoses, and the effectiveness of previous relocation of workers with confirmed occupational asthma. However, investigations have been confounded by many clinics and physiology departments not running during the epidemic. We report a cluster of cases from an office building where previous investigations including two workplace visits with the ventilation engineer and a workplace challenge had been equivocal, but where prolonged periods away from work clarified the occupational cause for the symptoms. The index case was an intelligence officer (forensic computing) who developed cough and recurrent episodes of 'bronchitis' and voice change within weeks of moving into a large air-conditioned office with air supply delivered from the suspended floor and separate cooling delivered through the ceiling. Oasys ABC analysis of serial PEF records showed one positive timepoint (outside the 95% CI for days off work) in the evening after work but a negative ABC score and normal diurnal variation. A second record showed similar results (one late positive timepoint) making it highly likely that the changes were associated with work. Figure 1 shows the mean 2-hourly PEF on workdays (crosses) and days away from work (squares). The lower grey line shows the 95% CI for days away from work from the Oasys plotter. The mean of 11 workdays between 1830-20.30 is significantly lower than the 16 days away from work. At least two others working nearby were affected, a computer programmer had similar work-related symptoms and a data information officer more obviously asthmatic symptoms. The building has been closed during the epidemic and all substantially improved and are currently repeating PEF measurements, which are the only physiological tests readily available at present. The nature of the disease in the index case remains unclear. The PEF changes could be the very earliest indication of occupational asthma, could be due to hypersensitivity pneumonitis, which usually results in bigger PEF changes, or could represent occupational upper airways disease, but the late fall in PEF is unusual.
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S110 Figure 1
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AIMS: To report long-term outcomes of patients treated with stereotactic ablative radiotherapy (SABR) for early stage, peripherally located non-small cell lung cancer. MATERIALS AND METHODS: Data were collected retrospectively between September 2009 and May 2019. Electronic medical records were reviewed for baseline characteristics, treatment details and outcomes. All patients were treated according to local protocol based on the national UK SABR Consortium guidelines. Risk-adapted treatment schedules were used depending on the size and the location of the tumour (54 Gy in three fractions, 55 Gy in five fractions, 60 Gy in eight fractions or 50 Gy in 10 fractions). Overall survival outcomes were evaluated using the Kaplan-Meier method. RESULTS: In total, 412 patients were included in the analysis. The median age was 76 years (range 48-93 years). Histological confirmation was obtained in 233 cases (56.6%). The median overall survival for all patients was 42.3 months (95% confidence interval 37.3-47.3 months), with 3- and 5-year overall survival of 52.8% and 37.3%, respectively. For biopsy-proven patients (56.6%), 3- and 5-year overall survival was 57.3% and 40.1%, respectively. With respect to overall survival, univariate and multivariate analysis revealed no significant difference in survival by technique (volume-modulated arc therapy versus conformal; three-dimensional computed tomography versus four-dimensional computed tomography), tumour location, smoking status at first contact, pre-treatment tumour stage or pre-treatment standardised uptake value. Survival was poorer for patients who received the 50 Gy in 10 fractions schedule. Treatment was very well tolerated with very low rates of grade 3-4 toxicity (1%). CONCLUSIONS: SABR for peripherally located, medically inoperable non-small cell lung cancer can be safely and effectively implemented in a non-academic institution with appropriate equipment and training. Overall survival outcomes and toxicity rates are comparable with internationally published studies. Patients treated with 50 Gy in 10 fractions had a poorer survival outcome.