The benefits of index telephone consultations in patients referred on the two-week wait colorectal cancer pathway.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic led to hospitals in the UK substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the use of virtual two-week wait (2-ww) lower gastrointestinal (LGI) clinic appointments, conducted using telephone calls at a district general hospital in England. METHODS: Patients undergoing index outpatient 2-ww LGI clinic assessment between 1 June 2019 and 31 October 2019 (FtF group) and 1 June 2020 and 31 October 2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets was assessed. Environmental and financial impact analyses were performed. RESULTS: In total, 1,531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety-two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9,288 miles, 0.7 metric tonnes of CO2 emissions and £7,482.97. Taxpayers saved £80,242.00 from VCs. No formal complaints were received from patients or staff in the VC group. CONCLUSION: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits.

Index telephone two-week wait lower gastrointestinal clinics as a substitute to face to face outpatient appointments during the COVID-19 pandemic

Purpose/Background: The COVID-19 pandemic led to hospitals in the United Kingdom substituting face-to- face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the impact of virtual two-week wait (2-ww) lower gastrointestinal (LGI) consultations on stakeholders at a district general hospital in England. Methods/Interventions: Patients undergoing index outpatient 2-ww LGI clinic assessment between 01/06/2019-31/ 10/2019 (FtF group) and 01/06/2020-31/ 10/2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets (WTT) was assessed. Environmental and financial impact analyses were performed. Results/Outcomes: In total, 1531 patients were analysed (median age = 70, male = 852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone;the remainder were seen FtF (n = 774, 50.6%). Ninety two (6%, VC = 44, FtF = 48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC);of these, 46 (71.9%, VC = 26, FtF = 20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p < 0.001). The cancer detection rates (p = 0.749), treatments received (p = 0.785) and median time to index treatment for CRC patients (p = 0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p < 0.001). VC appointments saved patients a total of 9288 miles, 0.7 metric tonnes of CO2 emissions and £7482.97. Taxpayers saved £80,242.00 from VCs. No adverse events or complaints were reported in the VC group. Conclusion/Discussion: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits for stakeholders. (Figure Presented).

Determining the appropriate use of Technology Enabled Care Services (TECS) to manage upper-limb trauma injuries during the COVID-19 pandemic: A multicentre retrospective observational study.

BACKGROUND: The COVID-19 pandemic created a unique opportunity to explore the use of Technology Enabled Care Services (TECS), which remains novel for many service providers. This study assesses the factors that affect adaptation to remote monitoring of patients after upper-limb trauma injury. A standardised risk-stratified screening tool is further developed here to support clinical staff in both the determination of appropriate use of TECS and the optimisation of patient care. OBJECTIVES: 1: To explore the patient and injury factors that determine the appropriate use of TECS for patients with upper-limb injury. 2: To use these findings to refine a standardised screening tool for the appropriate choice of follow-up format. METHODS: A retrospective review of patient management was undertaken across three NHS upper-limb trauma units during the first UK COVID-19 lockdown. Data were collected, and themes were analysed across a number of predetermined categories. This was underpinned by a review of contemporary policy guidance and literature. RESULTS: A total of 85% of patients were offered an appropriate format of follow-up; this was defined by the ability to achieve desired patient-clinician goals and lack of complications. Key factors in determining appropriate follow-up included extent of injury, mental health considerations, and the need for face-to-face (F2F) assessment and treatment. CONCLUSION: Study findings demonstrate consistency between units in the factors determining the appropriate use of TECS. The refined screening tool provides a risk-stratified, standardised approach to the choice of follow-up format, F2F or TECS. It is hoped that this will support future clinical decision-making processes to ensure optimal patient care.

Coronavirus information hub for people affected by terminal illness

IntroductionDuring the coronavirus pandemic, people affected by terminal illness had many questions, including what restrictions there were for visiting someone who was dying and who can attend a funeral.AimsCreate an online information hub for people affected by terminal illness throughout the coronavirus pandemic.Answer people’s questions and help them feel informed, reassured and supported.Keep the information up-to-date, accurate and relevant for our audience.MethodStreamline our content development process so that we could respond quickly to our audience’s needs.Use website analytics and a feedback survey to assess the impact of the content and look at improvements we could make.ResultsWe created 26 pages covering a range of coronavirus-specific content.We had 697,687 website users of this content between 1 March 2020 and 31 October 2021.We had 176 survey responses. They told us that we offered the right information, helped them make better decisions and supported them emotionally.Examples of responses:‘It’s the first and maybe only place I found honest feedback to my questions about how to talk to, treat, watch out for a loved one who I believe is dying who I may not be able to be with.’‘Just knowing that some people are out there with empathy for the situation, who are not afraid to answer what they can.’‘It explained everything very clearly and in one place – I’ve been searching the internet for these answers to no avail.’ConclusionMarie Curie supported people affected by terminal illness during the coronavirus pandemic by providing useful online information.ImpactPeople affected by terminal illness were better informed about coronavirus rules – this helped them to make decisions. They also felt reassured and emotionally supported by our information.

Development of a COVID-19 impact assessment for national drug abuse treatment clinical trials network

The COVID-19 Impact Assessment was developed by Emmes' National Drug Abuse Treatment Clinical Trials Network's Data and Statistics Center along with National Institute on Drug Abuse's Center for Clinical Trials Network. With numerous clinical trials investigating treatments for substance use disorder set to initiate data collection in 2020 and 2021, the COVID-19 pandemic presented novel and unanticipated challenges to study implementation. Specifically, it presented potential for disrupting a wide range of factors that could impact trial operations (study visit planning, clinic closures, public health measures, transportation and childcare issues, changes in clinical practice, and economic factors) and outcomes (social isolation, changes in medical and/or psychiatric functioning, changes in substance use patterns including substance used, quantity and frequency). Several National Drug Abuse Treatment Clinical Trials Network clinical trials were in protocol development stage when the pandemic hit. Initially, different protocol teams began compiling questions and assessments within their respective studies in anticipation of the need to assess the prevalence of COVID-19 within the study population as well as the potential impacts of the pandemic. Center for Clinical Trials Network and National Institute on Drug Abuse Data and Statistics Center identified the opportunity to streamline assessment by creating a standardized form that could be used across all trials, which would allow for cross-study harmonization and data analysis. Items for the assessment were drawn from publicly available survey repositories including the CDC Community Survey Online Question Bank, PhenX Toolkit, and the National Institutes of Health Office of Behavioral and Social Sciences Research, and were identified in reference to five primary domains of particular relevance to National Institute on Drug Abuse's vulnerable population of individuals with substance use disorder: (1) personal exposure and illness related to COVID-19 (10 items);(2) mental health and healthcare impact (32 items);(3) knowledge and beliefs about COVID-19 (7 items);(4) social distancing regulations, behavior, and beliefs (37 items);and (5) employment and economic impact and housing stability (9 items). Through an iterative process, stakeholders from Data and Statistics Center, Center for Clinical Trials Network, and Clinical Trials Network determined which items should be retained for inclusion, removed, or added, or considered priority for inclusion during the COVID-19 pandemic, until consensus was reached. While the COVID-19 illness and exposure and Mental Health and treatment impact were considered higher priority, the inclusion of modules or (select items) in trial assessments is at the discretion of the lead investigative team. These may be considered a menu of options for investigators to choose from, so that constructs included are assessed in a harmonized manner across trials. Data from the COVID-19 impact assessment can inform how COVID-19 related illness, changes in mental health functioning and/or treatment access (including substance use treatment medications and psychosocial supports) may impact the operations and outcomes of treatments for substance use disorder in Clinical Trials Network trials that are conducted during the COVID-19 era. Since the development of the form, five National Drug Abuse Treatment Clinical Trials Network trials that are in pre-implementation stage (beginning recruitment as early as January 2021) have elected to include the form either in its entirety or select domains, predominantly choosing to include the mental health and healthcare impact and personal exposure and illness modules.

Electronic data capture system modifications to capture COVID-19-related data in the national drug abuse treatment clinical trial network

The COVID-19 public health emergency created significant challenges for the safe conduct of clinical trials. The Clinical Trials Network conducts multi-site substance use treatment studies, of which several are in an active recruitment phase. Investigators within the Clinical Trials Network collaborate with the Clinical Coordinating Center and Data and Statistics Center, both at the Emmes Company, to effectively manage these trials and ensure data quality. In March 2020, the US Food and Drug Administration issued guidance for the conduct of clinical trials during the pandemic;notably, the Food and Drug Administration recommended capturing reasons for missing data, protocol deviations, or modified study procedures as related to COVID-19. The Clinical Coordinating Center and Data and Statistics Center worked with investigators to evaluate and modify study protocols to allow for flexibility in the collection of study assessments (e.g. off-site/home visits and telehealth visits) while ensuring the safety of participants and research staff and maintaining the integrity of trial data. In addition, an interdisciplinary team within the Clinical Coordinating Center and Data and Statistics Center reviewed the Food and Drug Administration guidance, identified changes to case report forms, and proposed these to investigators and sponsor for buy-in and approval. Namely, an existing case report form that previously captured missed visits was expanded to collect relevant information for all visits. The modified case report form is expected to be completed for all visits and was adapted to capture whether a visit occurred outside the prescribed visitwindow, if a visit was missed, and if not, where the visit occurred: in clinic, via telemedicine, and/or offsite. Furthermore, if any portion of the visit occurred at an offsite location, follow-up questions capture the location of urine sample collection, which is often the basis of primary outcome, and the location of medication dispensing/administration. Another change included the addition of COVID-19 response options to case report forms collecting data that have potential to be missing or otherwise impacted by COVID-19. To capture the nuances among (1) active COVID-19 infection, (2) lockdown-related isolation/quarantine, or (3) other COVID-19 factors including fears of exposure, we proposed a set of three response options for impacted forms: ''COVID-19: Illness,'' ''COVID-19: Public health measures,'' and ''COVID-19: Other.'' Likewise, to assess the impact on study procedures and assessments, a question was added to evaluate if a protocol deviation was related to COVID-19. Finally, the Data and Statistics Center included automated data queries for operational concerns related to visit flexibility. For example, if a participant's visit occurred entirely offsite, the system issues an automated query if any incongruous visit data point is indicated as being collected in clinic or via telemedicine (e.g. biospecimen). The interdisciplinary collaboration among the Clinical Coordinating Center, Data and Statistics Center, and investigators allowed for timely updates to the electronic data capture system to capture COVID-19-related data across Clinical Trials Network trials in a harmonized fashion and brought the Clinical Trials Network into compliance with Food and Drug Administration guidance. These data will also allow statisticians to conduct sensitivity analyses to assess the impact of COVID-19 on trial outcomes. This, along with the reasons for missing data, protocol deviations, and assessment changes due to COVID-19 will be included in final study reports of these trials.

A Multi-Center Retrospective Review of COVID-19 Outcomes in Patients with Lymphoid Malignancy

Background: Early reports suggested that cancer patients have a 1.7-fold increased risk of contracting SARS-CoV-2 and higher rates of severe events and mortality compared with general population. Patients with hematologic malignancies may have worse COVID-19 outcomes, due to an impaired humoral immune response from their underlying malignancy and concurrent anticancer therapy. In this multi-center, retrospective, observational study, we evaluate the associations of COVID-19 outcomes with patient and lymphoma disease characteristics. Methods: EMRs at 10 study centers across the USA identified 519 patients with a diagnosis of lymphoma, CLL, or other lymphoid malignancies, who had a documented positive result of SARS-CoV-2 PCR or nucleocapsid antibody testing. Descriptive statistics were used to summarize the demographic and clinical characteristics. Logistic regression was used to evaluate the associations of individual characteristics with COVID-19 outcomes, adjusted for center (NYU vs. other). The interactions between each of the variables was also included in these models;since the interactions were generally small and non-significant, only the main effect of center was included. Two-sided p-values ≤0.05 were considered significant;there were no adjustments for multiple variables or endpoints. Each analysis was based on complete data for that analysis. Results: Tables 1 and 2 provide demographic and clinical characteristics, respectively, of the 519 patients. The mean age was 61.9 years, with 296 (57%) male and 374 (72%) white patients. NYU had the largest cohort (318 patients), with the remaining centers contributing a range of 3 to 69 patients (median 14). Logistic regression models for the association of each COVID-19 outcome with individual clinical and patient characteristics included adjustments for the center (NYU/other). While center effects were statistically significant, center by covariate interaction effects were not and are not included in the final models. The odds ratio (OR) estimates and p-values for each patient and CLL/lymphoma clinical variable are shown in Tables 3 and 4, respectively. The risks of experiencing a severe event, death, and hospital admission increased with age;for each 10 years of age increase, the ORs were 1.58 for experiencing severe events, 1.78 for death, and 1.65 for hospital admission. The risks of poor outcome were higher in males than in females (OR 1.93 for severe events, 1.85 for death, and 1.47 for hospital admission). Patients with Charlson Comorbidity Index (CCI) >5 had a higher risk of severe events (OR 2.46), mortality (3.30) and hospital admission (2.73) compared to patients with CCI ≤5. Compared to patients with HL, patients with aggressive NHL had a higher risk of severe events (OR 4.05), mortality (4.68) and hospital admission (4.65). Patients with CLL similarly had a higher risk of severe events (OR 4.64), mortality (4.65) and hospital admission (5.93) compared to HL patients. Patients with indolent NHL had a higher risk of hospital admission (OR 3.95) but not a higher risk of mortality compared to HL. Patients in remission at the time of COVID-19 diagnosis had a lower risk of severe events (OR 0.42), mortality (0.36) and hospital admission (0.40) relative to those who were not in remission. Patients who received cytotoxic chemotherapy within 28 days of their COVID-19 diagnosis had a higher risk of severe events (OR 2.54), mortality (2.79), and hospital admission (2.31). Patients who received an anti-CD20 monoclonal antibody within 6 months of COVID-19 diagnosis had a higher risk of severe events (OR 2.60), mortality (2.17) and hospital admission (3.28). Conclusions: In addition to demographic and comorbidity risk factors identified in previous studies, our study shows that patients with aggressive NHL and CLL, or patients who have received recent cytotoxic chemotherapy or anti-CD20 mAB, may be at risk for poor COVID-19 outcome. The difference in risk between NHL and HL patients is likely associated with young age of HL patients but may also be related o differences in underlying innate and adaptive immune defects. Patients at high risk for poor outcome should be a priority for studies of monoclonal antibody prophylaxis. If defects in humoral immunity are at the root of poor outcome, this may be compounded by poor response to vaccination. Multivariate analysis of this data will be completed in advance of the meeting. [Formula presented] Disclosures: Olszewski: Celldex Therapeutics: Research Funding;PrecisionBio: Research Funding;TG Therapeutics: Research Funding;Acrotech Pharma: Research Funding;Genentech, Inc.: Research Funding;Genmab: Research Funding. Barta: Daiichi Sankyo: Honoraria;Seagen: Honoraria;Acrotech: Honoraria;Kyowa Kirin: Honoraria. Hernandez-Ilizaliturri: AbbVie: Other: Advisory Boards;Incyte: Other: Advisory Boards;Celgene: Other: Advisory Boards;BMS: Other: Advisory Boards;Pharmacyclics: Other: Advisory Boards;Amgen: Other: Advisory Boards;Kite: Other: Advisory Boards;Gilead: Other: Advisory Boards;Epyzime: Other: Advisory Boards. Leslie: Janssen: Consultancy, Speakers Bureau;Merck: Consultancy;Abbvie: Consultancy, Honoraria;Epizyme: Consultancy, Honoraria, Speakers Bureau;PCYC/Janssen: Consultancy, Honoraria, Speakers Bureau;Seagen: Consultancy, Honoraria, Speakers Bureau;TG Therapeutics: Consultancy, Honoraria, Speakers Bureau;Celgene/BMS: Consultancy, Honoraria, Speakers Bureau;Kite, a Gilead Company: Consultancy, Honoraria, Speakers Bureau;ADC Therapeutics: Consultancy;BeiGene: Consultancy, Honoraria, Speakers Bureau;Karyopharm Therapeutics: Honoraria, Speakers Bureau;AstraZeneca: Consultancy, Honoraria, Speakers Bureau;Pharmacyclics: Consultancy, Honoraria, Speakers Bureau. Diefenbach: Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding;Merck Sharp & Dohme: Consultancy, Honoraria, Research Funding;Morphosys: Consultancy, Honoraria, Research Funding;Genentech, Inc./ F. Hoffmann-La Roche Ltd: Consultancy, Honoraria, Research Funding;Perlmutter Cancer Center at NYU Langone Health: Current Employment;Incyte: Research Funding;AbbVie: Research Funding;Trillium: Research Funding;IGM Biosciences: Research Funding;IMab: Research Funding;Janssen: Consultancy, Honoraria, Research Funding;Gilead: Current equity holder in publicly-traded company;MEI: Consultancy, Research Funding;Celgene: Research Funding;Seattle Genetics: Consultancy, Honoraria, Research Funding.

Changes in sexual behavior during COVID-19 among men who have sex with men in a sexual network study

Background As part of an ongoing sexual network study, we assessed the impact of COVID-19 on sexual behavior of men who have sex with men (MSM). Methods The Columbus, Ohio arm of the multi-site Network Epidemiology of Syphilis Transmission (NEST) study is following 241 MSM over two years. Participants attend quarterly visits with behavioral surveys and HIV/STI testing. In April 2020, we implemented an additional survey to measure the impact of COVID-19 on sexual behavior. Our analysis compared participants' reported sexual behavior during two periods: April-July 2020 (T1) and August-December 2020 (T2). Results Of the 200 participants who completed at least one COVID-19 survey in either time period, 10 (5%) self-reported a previous COVID-19 diagnosis. We compared behaviors reported by 174 respondents who submitted surveys in both time periods. During T1, about half (46%) said they felt more anxious about sex since COVID-19;anxiety was similar during T2 (43%). Many reported engaging in online sexual activities, though we saw no meaningful differences by time period for starting or increasing chatting on hookup apps (T1=30%, T2=30%), sexting (T1=30%, T2=25%), or video chat sex (T1=16%, T2=14%). Watching pornography was reported more often in T1 than T2 (53% vs. 42%). Nearly a third of respondents (30%) in T1 reported that they were not having sex;this decreased to 17% in T2. Compared to prepandemic behavior, in T1 a majority of participants (74%) said they were less likely to have sex with a new partner, compared to 61% during T2. Conclusion During COVID-19, nearly half of MSM reported feeling more anxious about sex, and many turned to online activities in lieu of in-person sex. However, when comparing the early months of the pandemic to later months of 2020, more participants are resuming in-person sex, and willingness to have sex with new partners also rose.

EU food system strengths and vulnerabilities during COVID-19. (Special Issue:Covid-19 pandemic impacts on agri-food systems.)

The performance of the EU food system during the early stages of the Covid-19 pandemic is examined in this article. The preliminary evidence from the early lockdown period in March to June 2020 supports the view that, apart from some experiences of empty supermarket shelves in the very first days of lockdown caused by hoarding by consumers, the EU food system has been remarkably resilient. EU farmers, processors and retailers have maintained food supplies to EU consumers and adjusted to the shift in demand caused by the lockdowns in the food service sector. Farm prices fell after lockdowns were introduced but, with some notable exceptions, such as flowers, the fall in prices has been limited. Consumer food prices, on the contrary, increased but this seems to have been a temporary phenomenon. The response to the pandemic has revealed the limitations in the EU's crisis response mechanism particularly where market support may be needed. The argument of some EU leaders that local food systems should be supported as a way of increasing the resilience of the food system to future shocks does not have empirical support. Policies in the future should support firms in building more robust and resilient supply chains and not undermine food security built on misconceptions about how supply chains performed during the Covid-19 pandemic.

Color recognition of design object of manual decoration element based on convolution neural network under the impact of COVID-19

The popularity of covid-19 has led to the introduction of the policy of controlling the flow of personnel, which has a certain impact on the color recognition of the design objects of hand decorative elements. In the past, the research on convolution neural network design and color recognition is still in the traditional method, and the field of computer vision is not really combined with the traditional decorative fabric. This paper proposes a solution based on deep learning. Color learning and main color recognition can be processed as a whole. By introducing convolution neural network, the scheme can learn color features directly from the image itself, and the process of artificial design features is omitted. While simplifying the process of model building and training, the potential information association can be obtained, so as to obtain better recognition effect. In addition, due to the deep depth of the network, this paper uses the initial optimization module to avoid the performance degradation and over fitting in the training process. This method has an important reference value for the color design of modern hand decoration, and can promote the development of hand decoration during the popularity of covid-19. © 2020 - IOS Press and the authors. All rights reserved.