ABSTRACT
Background: To mitigate the risks of chemotherapy associated neutropenia, during the COVID-19 pandemic, all genitourinary (GU) cancer patients treated with chemotherapy at the Princess Margaret Cancer Centre (PMCC) were offered primary prophylaxis with GCSF. We hypothesize that this reduced rates of febrile neutropenia, hospitalizations, healthcare costs and improved overall outcomes, compared to GU cancer patients treated with chemotherapy without GCSF in the 2 years prior to the pandemic. Method(s): We performed a retrospective review of GU cancer patients, receiving curative or palliative intent chemotherapy, with or without primary GCSF prophylaxis between January 2018 and June 2022. GCSF was given either as a single dose or as consecutive doses post chemotherapy. Main outcomes were incidence of febrile neutropenia, hospitalization, health care expenditures as well as disease specific outcomes. Result(s): Overall, 248 patients with prostate cancer (44%), urothelial cancers (33%) germ cell (21%), and rare GU cancers (4%) were identified. Median age was 70 (range 19-91), 92% were male, 65% were ECOG 0/1. Treatment intent was neoadjuvant (13%), adjuvant (20%), or palliative (67%). Main regimens used were docetaxel, cabazitaxel, carboplatin, cisplatin/ etoposide, gemcitabine/cisplatin and BEP. Median follow-up was 10.5 months (0.23-52.3 months). A total of 206/248 received primary GCSF prophylaxis. During chemotherapy, the median white blood cell levels were higher in the GCSF group compared to the non-GCSF group (14.1+/-10+/-9/L vs 2.90+/-10+/-9/L, p<0.0001);and neutropenia rates were markedly lower (2% vs. 93%, P=,0.0001). Hospital admission rates were significantly lower in G-CSF users compared to nonusers (19% vs. 69%, P,0.0001). Symptomatic disease progression 13% was the leading cause of admission in the G-CSF group. Infectious causes such as UTI, pneumonia, COVID-19, and sepsis were seen in only 12% of the G-CSF group compared to 31% in the non-users. G-CSF was generally well tolerated with just 0.97% discontinuing G-CSF. Conclusion(s): During the COVID-19 pandemic, primary prophylactic G-CSF use in GU cancer patients, undergoing chemotherapy significantly lowered rates of both febrile neutropenia and hospitalizations and could be a cost-effective strategy in this patient population that warrants further study.
ABSTRACT
In the midst the COVID-19 pandemic, and given the imminence of oxygen shortages in Colombia, the Knowledge Management and Transfer Network, made up of 19 scientific societies, health institutions, and universities, generates an update to the document led by the Colombian Association of Critical Medicine and includes new evidence-informed guidelines for the rational management of oxygen therapy, as well as basic and advanced devices for oxygen therapy. The recommendations refer to five topics: goal-oriented rational use of oxygen, standardization of follow-up and dose adjustment, effective use of oxygen therapy devices, rational use of invasive mechanical ventilation, and rational use of extracorporeal oxygenation membrane therapy. When exercising their judgment, it is expected that professionals and care teams will take into account these guidelines to make rational and safe use of oxygen therapy and its basic and advanced devices, together with the individual needs and preferences of the people who are under their care. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
ABSTRACT
Objective: To offer a novel opportunity for students of backgrounds underrepresented in neurology to engage in remote paid neurology education and research amidst the COVID-19 pandemic. Background: Neurologic disorders disproportionately burden female, American Indian, Black, Latino and lower socioeconomic status populations. Concomitantly, there is stark underrepresentation of these communities in the neurology workforce demonstrating a need for effective efforts to recruit students from underrepresented backgrounds into neurology. Design/Methods: We recruited high school and undergraduate students from backgrounds underrepresented in neurology to participate in a paid remote neurology education and research program. Proposed activities included mentored neurology research, didactic sessions, and individualized support. Results: The program's 31 students predominantly identified as female 68%, Black or Latino 68%, immigrant 39%, and first-generation students 61% living across underserved communities in Massachusetts 96%. Mentored research occurred in teams across 11 neurology labs spanning basic, translational, clinical, and health services research covering a variety of neurologic conditions. Didactic sessions exposed participants to career development, discovery, innovation, and leadership topics led by neurology professionals. Individualized support facilitated understanding of students' professional aspirations and challenges to better support their goals. Following program completion, 90% of students indicated interest in pursuing a career in neurology compared to 21% at the start of the program, with most participants planning to pursue graduate or professional studies 90% and work in healthcare 84%. Conclusions: Offering a structured opportunity for students of backgrounds underrepresented in neurology to engage in remote paid neurology education and research was feasible despite the challenges brought by the COVID-19 pandemic. This program provides a framework to develop effective education and research programs that engage students from backgrounds underrepresented in neurology. While short-term outcomes are encouraging, longer-term efforts are needed to continue to diversify the neurology workforce and advance equity.
ABSTRACT
In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.