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Objective: To review notification of incidents that occurred during the COVID-19 pandemic. Methods: This is a cross-sectional, exploratory descriptive quantitative study. A total of 1,466 notifications to risk management of a private hospital were analyzed from September 2020 to September 2021. Descriptive statistical analysis was used, applying Pearson's chi-square test or the likelihood ratio test. The margin of error used was 5%. Results: Communication failure (358 -24.5%), probe and catheter use failure (232 -15.9%) and article and equipment use failure (132 -9.1%) were identified as prevalent incidents. The notifiable circumstance totaled 55.9% of reports, and, of these, 33.4% were communication failure. Adverse events were 416 (28.6%), and fall was related to mild damage (43.9%), health care-associated infections, to moderate harm (31%), and medication use failure (50%), to severe harm and death. Conclusion: Communication failure was the most reported risk circumstance, followed by medication use failure as an adverse event with severe harm. The nursing unit showed the possibility of a greater number of adverse events, while in Intensive Care Units, the degree of harm from adverse events was higher.
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We investigated the prevalence of body image dissatisfaction (BID) and associated factors among professors and undergraduate students in Brazil during the COVID-19 pandemic. Using Stunkard's Figure Rating Scale, BID was analyzed in a sample of 2,220 adults. The independent variables were sociodemographic, lifestyle, mental health symptoms, COVID-19-related factors, disordered eating, experience of weight stigma, and weight change concerns. We used a multinomial logistic regression analysis. The overall prevalence of BID was 82.5% (69.0% due to excess weight), with more professors dissatisfied by excess weight than undergraduate students (78.9% vs. 61.2%, p < 0.001). In the adjusted model, being a young adult (PR, 1.201, 95% CI: 1.128;1.279), married or in a stable union (PR, 1.088, 95% CI: 1.027;1.152), reporting of binge eating episode (PR, 1.120, 95% CI: 1.068;1.173), concern about weight gain (PR, 1.394, 95% CI: 1.310;1,483), and experience of excess weight stigma (PR, 1.193, 95% CI: 1.141;1.248) increased the prevalence of BID due to excess weight. While males (PR, 1.578, 95% CI: 1.328;1.875), moderate to severe depressive symptoms (PR, 1.217, 95% CI: 1.011;1.465), the concern of losing weight (PR, 1.494, 95% CI: 1.221;1.830), and experience of low weight stigma (PR, 2.620, 95% CI: 2.093;3.280) increased the prevalence of BID due to low weight. Different factors associated with BID were observed between students and professors. Bearing in mind the complexity of body image, it is essential to consider different public health interventions and the COVID-19 pandemic's influence on reducing BID among Brazilian adults, especially susceptible groups. Copyright © 2023 de Magalhães Cunha, Pereira, Souto, de Sá, da Silva, de Brito and de Santana.
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Background: COVID-19 is an acute respiratory illness caused by a novel human coronavirus. Due to the accelerated spread of the virus, health authorities have advocated social distancing. Homeless people have difficulties meeting this requirement due to a lack of access to fundamental rights such as housing, education, and health. The epistemological bases of nursing theories contribute to under-pinning the care provided to these people. Objective: To reflect on the health care of the homeless population during the COVID-19 pandemic in light of five nursing theories. Main topics under analysis: The theories of Nightingale, Roy, Horta, Peplau, and Henderson have care approaches focused on the basic needs of homeless people who require immediate interventions due to the COVID-19 pandemic. Conclusion: Nursing theories provide scientific support to caring for the homeless population based on physical, biological, and social aspects through intersectoral partnerships that can promote care during and after the pandemic. © 2022, Escola Superior de Enfermagem de Coimbra. All rights reserved.
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Objetivo: Esta revisao narrativa tem como objetivo resumir a literatura sobre associacoes entre o Grupo sanguineo ABO e COVID-19. Metodologia: Foram selecionados 147 artigos pesquisados entre os anos de 2012 a 2022, usando multiplas combinacoes de palavras chaves nas bases de dados PubMed. Resultados: Dos 147 artigos;40 abordaram sobre grupo ABO e infeccoes;10 sobre a suscetibilidade a infeccao por SARS-CoV-2;25 sobre a gravidade da COVID-19 entre os grupos sanguineos;30 sobre a relacao genetica com suscetibilidade e gravidade;6 abordando a ligacao com o tipo sanguineo ABO e COVID-19 mostrando mecanismos e contribuicoes para a interpretacao de associacoes vistas;14 que relataram a iniciacao da proteina S e interacao das celulas hospedeiras com SARS-CoV-2;e 10 mostrando a relacao do grupo sanguineo ABO e risco cardiovascular em pacientes com COVID-19. Discussao: O grupo sanguineo ABO e conhecido por ser um fator que influencia a suscetibilidade a doencas infecciosas, e muitos estudos tem descrito associacoes entre tipos sanguineos ABO e infeccao e gravidade por COVID-19, com achados conflitantes. O tipo sanguineo O esta associado principalmente a taxas mais baixas de infeccao por SARS-CoV-2, enquanto o tipo sanguineo A e frequentemente descrito como um fator de risco. Embora os resultados sobre o risco de desfechos graves sao mais variaveis, o tipo sanguineo A e o mais associado a gravidade e mortalidade por COVID-19, enquanto muitos estudos descrevem o tipo sanguineo O como fator protetor para a progressao da doenca. Alem disso, associacoes geneticas com tanto o risco de infeccao quanto a gravidade da doenca foram relatados para o locus ABO. Alguns mecanismos subjacentes foram hipotetizados para explicar as associacoes relatadas, com dados experimentais incipientes. Tres hipoteses sao sugeridas: SARS-CoV-2 poderia transportar estruturas semelhantes a ABO(H) em suas glicoproteinas do envelope viral e seriam transmitidos assimetricamente devido a um efeito protetor dos anticorpos ABO. Os antigenos ABH poderiam facilitar a interacao do SARS-CoV-2 com as celulas do hospedeiro e a associacao de tipos sanguineos nao O com maiores riscos de eventos tromboembolicos poderia conferir aos pacientes com COVID-19 com tipo sanguineo O, um risco menor de desfechos graves. Os mecanismos hipoteticos afetariam distintos aspectos da historia natural do COVID-19, com distintas implicacoes potenciais para a transmissao da doenca e seu manejo. Conclusao: um levantamento da literatura de estudos epidemiologicos sugere que a ABO tipo sanguineo pode ser um fator de influencia para a infeccao por SARS-CoV-2 e gravidade da COVID-19. Embora os resultados sejam conflitantes e bastante variavel, o tipo sanguineo O esta associado principalmente ao menor risco de SARS-CoV-2 infeccao, enquanto o tipo sanguineo A, com maior risco. Apesar disso, ha poucos dados experimentais sobre este assunto, mais estudos sao necessarios para elucidar os mecanismos subjacentes as associacoes relatadas, que e fundamental para uma compreensao mais profunda da relacao entre o grupo sanguineo ABO e COVID-19 e se pode ou nao ser traduzido em estrategias de prevencao ou tratamento desta doenca. Copyright © 2022
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Objective. To analyze the vocal self-perception of individuals who wore face masks for essential activities and those who wore them for professional and essential activities during the coronavirus disease pandemic.Materials and Methods. This was an observational, descriptive, cross-sectional study. The study included 468 individuals who were stratified into two groups: the Working Group, comprising individuals who wore face masks for professional and essential activities during the pandemic;and the Essential Activities Group, with indi-viduals who wore face masks only for essential activities during the pandemic. The outcome measures tested were self-perception of vocal fatigue, vocal tract discomfort, vocal effort, speech intelligibility, auditory feedback, and coordination between speech and breathing. Descriptive and inferential statistics were performed. Results. Face masks increased the perception of vocal effort, difficulty in speech intelligibility, auditory feed-back, and difficulty in coordinating speech and breathing, irrespective of usage. Individuals who wore face masks for professional and essential activities had a greater perception of symptoms of vocal fatigue and discomfort, vocal effort, difficulties in speech intelligibility, and in coordinating speech and breathing.Conclusion. Use of face masks increases the perception of vocal symptoms and discomfort, especially in indi-viduals who wore it for professional and essential activities.
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Objective: to analyze the perceptions of academics and supervisors about the strategic action “O Brasil Conta Comigo”(Brazil counts on me). Method: cross-sectional study conducted in Mato Grosso do Sul-Brazil, from December 2020 to March 2021, in two stages: 1) Exploratory (quantitative), via analysis of reports of the 33 supervisors and 90 academics convened, application of an online questionnaire;2) In-depth (qualitative), using the remote focus group technique, with convenience sampling. Descriptive and content analysis was performed. Results: the reasons for joining and remaining with the action (scholarship, internship hours, and social responsibility), the pedagogical aspects (training, evaluation, and support from educational institutions, and management), and the contributions of the action (assistance and professional training) were identified. Conclusion: the general perceptions of the recruits are positive. Pedagogical aspects related to the evaluation of academics and support from higher education institutions should be reviewed, for more assertive actions in times of health crisis. © 2022, Universidade Federal do Parana. All rights reserved.
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As the use of smartphones in Brazil has advanced in recent years, instant messaging platforms such as WhatsApp and Telegram became part of Brazilians' lives and communication. However, the use of these platforms is not limited to exchanging messages between two users but also serves as a platform for group discussions and content dissemination. This study focuses on YouTube videos shared by politically oriented public groups on WhatsApp and Telegram during the COVID-19 pandemic in Brazil. Specifically, we analyze the information disseminated by political groups about the pandemic and the main events that took place during the same period, highlighting the main differences between the platforms. Our investigation shows a relevant political bias in the content shared in public groups in Brazil, with predominantly right-oriented content in messaging apps. A significant overlap of popular videos between these platforms was also found. On YouTube, we found the main categories of videos and examined the narrative that these videos give us from the perspective of WhatsApp and Telegram users. © 2022 ACM.
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In 2020 there was the impact of a pandemic that changed the routine of many countries, including Brazil, causing most governments to decide to implement measures of social isolation. As a result, only essential services remained in place (sectors such as health, transport, food). Thus, for many areas it was necessary to adopt the Home Office. The objective of this work is to raise general aspects about the new professional routines and seek information on factors that facilitate the adaptation process to the Home Office modality. An exploratory, quantitative research was carried out through a questionnaire with closed questions. As a result, it was possible to validate the investment in employee training to meet current needs. Faced with uncertain scenarios, this study can help organizations of any nature in situations of need for continuous isolation and social distancing, in order to reduce the problems faced during the pandemic.
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Introduction: Reflect on care is to recognize it in the ontological perspective of its existence, so that health and law professionals can develop a human and empathic practice, beyond the technique. Objective: To reflect on the care of the judicialization of health in the current scenario of COVID-19, from the thinking Merleau-Pontyano. Methods: This is a theoretical-reflective analysis, held in May 2021, constructed from readings on care from the perspective of the judicialization of health during the period of COVID-19, available in scientific articles in electronic databases LILACS, MEDLINE, IBECS and BDENF, and based on the concept of care proposed by the philosopher Merleau-Ponty in his literary works phenomenologicals. Results: It is expected to strengthen the interdisciplinarity of the legal field with health, through the reflection on the notion of intersubjectivity of Merleau-Ponty, as a reference for research and actions aimed at human care, broadening the look beyond technicality and in order to mobilize the feeling of human dignity. Conclusion: In times of pandemic, the effective solution to the current problem is the attentive listening of individuals on the care and attention received both in medical care and in the judicial sphere, in order to meet their expectations and remedy much of the pr oblems arising from poor public service provision, and thus contribute to the reduction of the demand for judicialization and to the well-being of the human being, through dignified treatment and care. © 2022, Editorial Ciencias Medicas. All rights reserved.
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Airports are dynamic places and a significant number of people walk around it daily and use the aircraft as a way of transport. It is considered efficient, safe and time is saved these days by shortening distances between cities, states and countries, for work or leisure. The study aims to understand the perception of the airport health team about communication regarding the new coronavirus. It consists of a descriptive study with a qualitative approach and as a data collection technique, the phenomenological interview. The method suggested by Amedeo Giorgi and the analysis took place in the light of the Merleau-Ponty framework. As a result, the category communication and intersubjectivity of care at the airport and aircraft emerged. It is concluded that the deponents point out that objective, clear and safe communication is important during the health problems calls, whether for clinical, traumatic cases as well as infectious and contagious diseases.
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Bioinformatics tools for online sequence analysis of variants have been used worldwide for the phylogenetic approach of SARS-Cov-2 and their variants. The purpose of this work is to contribute to the settlement of the SARS-CoV-2 genetic of the South America pandemic, presenting the ORF1a-1b evaluation. We proposed and reviewed two online bioinformatics pipelines for viral phylodynamic and phylogeographic analysis with an interactive visualization platform. The phylodynamics evaluation of South America shows a strong viral capacity to evoke immunity and an impressive multiplicity of variants in rapid expansion with mutations of potential importance, including ORF 1a-1b. They showed stately vital for infection and lethality, spreading and raising your frequency in South America from 1% to 20-30% in one year of pandemic occurrence. © 2021 IEEE.
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Introduction The coronavirus disease 2019 (COVID-19) was first known by its respiratory symptoms. Neurological complications are increasingly seen and described. Our case emphasizes the difficulties of differential diagnosis between encephalitis and post-traumatic stress disorder (PTSD) in SARS-COV2 patients. Case report A healthy 62 years old man tested positive for COVID-19 during a travel procedure. He was admitted to hospital because of a sudden drop of oxygen saturation from 99% to 89% with pulmonary CT scan showing a parenchymal bilateral ground-glass lesions and consolidative opacities of about 50% of lung while the patient remained asymptomatic. After he has been discharged from hospital he developed isolated executive disorders. Post COVID-19 encephalitis or PTSD were questioning. Discussion and conclusion Our patient had an acute hypoxemia which is well known to be associated with executive disorders such as in acute respiratory distress. But these signs appeared after the COVID-19 came negative hence the executive disorders were likely to be related to direct brain infection or to a non-infectious condition like the PTSD. Functional neuroimaging is then the gold standard to rule out a brain damage.
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The numbers of COVID-19 increase daily, both confirmed cases and deaths. All over the world, shock waves are felt with impacts on economies in general and the financial sector in particular. Aiming to assess the relationship between confirmed cases and deaths and the behaviour of stock markets, the authors perform a dynamic analysis, based on the Pearson correlation coefficient, for 10 of the most affected countries in the world. As expected, they find evidence that the number of COVID-19 cases had a negative effect on stock markets, and that the current second wave is penalizing them. They also find that deaths have a more relevant impact than the number of confirmed cases. © 2021, IGI Global.
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Objectives: Assess payer perceptions of COVID-19 pandemic’s impact on health systems, focusing on HTA, pricing, reimbursement and market access (PRMA) of new, branded medicines in the EU4 and UK. Methods: In June 2021, MME Advisors conducted a virtual, national payer / advisor board with representatives from France (2), Germany (2), Italy (1), Spain (1), and the UK (2) - to discuss key topics within the pandemic’s context, such as: • Disruption to healthcare systems • HTA impact: backlog, re-prioritization, framework • PRMA impact: net price pressure, conditional pricing/RWE and time to market • Differences and similarities within oncology, rare diseases, ATMPs and general medicines Results: Unlike the significant disruptions seen during the height of the pandemic in 2020, payers saw impact ranging from moderate (Italy) to high (Spain) as of June 2021. Disruption by disease state varied: oncology was highly disrupted everywhere but Germany. Most payers did not anticipate shifts in long term priorities or budget cuts to healthcare post pandemic. HTA impact was minimal, with no need to re-prioritize by therapy area or alter plans to adjust frameworks. Likelihood of stricter HTA criteria varied with payers in Italy anticipating more scrutiny for oncology and in Germany for rare diseases/ATMPs. While time to market was expected to remain mostly stable, delays anticipated in Spain. Majority of payers anticipated increasing pressure on drugs’ net prices;however, they were divided on increases in conditional pricing/RWE. Conclusions: Perceived COVID-19 impact varied by country based on infrastructure and adaptability. Germany less impacted, whereas in other markets (e.g., Spain) COVID-19 seemed to have accelerated changes, rather than drive PRMA policy. Given the importance of healthcare, overall budget cuts were not anticipated, although the need to deploy funds to diverse areas (e.g., healthcare worker salaries, hospital capacity) could complicate future scenarios, especially for high-cost therapies. Therefore, continued monitoring is warranted.
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An important task in combating COVID-19 involves the quick and correct diagnosis of patients, which is not only critical to the patient’s prognosis, but can also help to optimize the configuration of hospital resources. This work aims to classify chest radiographic images to help the diagnosis and prognosis of patients with COVID-19. In comparison to images of healthy lungs, chest images infected by COVID-19 present geometrical deformations, like the formation of filaments. Therefore, fractal dimension is applied here to characterize the levels of complexity of COVID-19 images. Moreover, real data often contains complex patterns beyond physical features. Complex networks are suitable tools for characterizing data patterns due to their ability to capture the spatial, topological and functional relationship between the data. Therefore, a complex network-based high-level data classification technique, capable of capturing data patterns, is modified and applied to chest radiographic image classification. Experimental results show that the proposed method can obtain high classification precision on X-ray images. Still in this work, a comparative study between the proposed method and the state-of-the-art classification techniques is also carried out. The results show that the performance of the proposed method is competitive. We hope that the present work generates relevant contributions to combat COVID-19. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Introduction The Brazilian vectorial 'control' is characterized by the intensive use of pesticides (agrotoxics), such as organo-chlorines, organophosphates, carbamates, pyrethroids, benzoy-lureas;some of them banned worldwide or restricted by international agreements. Continuous exposure to these neuro-toxic and/or carcinogenic products has resulted in damage to the health of Endemic Workers, leading to a process of illness and deaths. Thus, because they have chronic diseases and are immunocompromised, due to exposure to agrotoxics, this population is more susceptible to COVID-19, a situation that is aggravated by workplaces and working conditions, which place them at risk, due to frequent circulation and the need for entry into residences. Method This descriptive study was part of a multicenter research with Endemic Workers from the State of Rio de Janeiro, Brazil. To investigate the work during the pandemic we used an online questionnaire, structured with open and closed questions. Results Preliminary results from the 140 responses to the questionnaire demonstrate that: 78% of the Endemic Workers reported diagnosed disease and from these, 70% had comor-bidities. The most frequent are hypertension (49%), diabetes (22%), respiratory problems (22%) and malfunction of the liver and kidneys (17%). Although 88% did not have a diagnosis of COVID-19, 64% reported having co-workers and/or family members with COVID-19. Regarding remote work: 2% reported working at home, 29% were working in scale and/or alternate time and 53% were working full time. Workers who stayed the longest time in remote work (five months) represented only 8%, with 31% remaining in full time presential work during the period in which isolation and detachment measures began in Brazil. Conclusion Protective measures of the health of these workers and assisting this population to prevent the transmission of SARS-Cov-2, are necessary to implement health protection policies, including other exposures at work, such as agrotoxics.
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Objective: Coronavirus disease 2019 (COVID-19) pandemic may have indirect consequences in ST-segment elevation myocardial infarction (STEMI) outcomes due to difficulties in healthcare access, but also due to reperfusion delays. The objective of this study was to evaluate the performance indicators in STEMI during the early phase of the lockdown following the COVID-19 pandemic. Methods: The patient delay and the system delay were evaluated in 312 patients with suspected STEMI, in the period of the first State of Emergency in Portugal, through a survey called Moment COVID implemented within 18th March to 2 May 2020, in 18 national centers of Interventional Cardiology where PPCI is carried out 24/7. These patients were compared with a historical cohort of 267 patients from the 5th year after integration of SFL Initiative in Portugal (Moment 2015) in which the same survey was applied. Patients with late presentation of STEMI (>12 hours of symptoms onset) were excluded from this analysis. Results: In Moment COVID there was a trend towards a longer patient delay (incremental median 20 min;p=0.059) and a significant longer system-delay (incremental median 17 min;p=0.033) compared to the historical cohort of Moment 2015. Consequently, times to revascularization tended to be longer (incremental median 26 min;p=0.074). Indeed, in Moment COVID patients were less compliant with the times recommended by the European guidelines: door-to-balloon time <60 min was achieved in 47.6% of patients compared to 57.0% (p=0.052) in Moment 2015 and system-delay <90 min in 13.9% compared to 21.8% (p=0.033). Conclusion: These results from a multicentric national analysis demonstrated a trend to longer time from symptom onset to request healthcare system assistance and a significantly longer time from first medical contact to revascularization among patients with STEMI during COVID-19 pandemic. This delay for treatment could negatively impact the STEMI prognosis at the long-term.
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Introduction: As a result of the coronavirus disease 2019 (COVID-19) pandemic the year 2020 brought major changes on the delivery of health care and face to face physician patient communication was significantly reduced and the practice of remote telehealth care using computer technology is assuming a standard of care particularly with COVID-19 patients with attempts to reduce viral spread. Objective: To describe the clinical practice experience using telemedicine towards COVID-19 and the respective clinical outcomes. Methods: We performed a pilot open-label non-randomized controlled clinical trial. The patients were divided into four groups according severity of symptoms: (1) asymptomatic (2) mild symptoms (3) moderate symptoms and (4) severe symptoms and were followed up for five days counted from the beginning of the symptoms. A drug intervention was performed in group 3 for which the protocol followed as suggested by the International Pulmonology Societys consensus for adults with moderate symptoms: first day (attack phase) hydroxychloroquine sulfate 400 mg 12/12h second to fifth day (maintenance phase) 200 mg (half pill) 12/12h. The medication was associated with azithromycin 500mg once a day for five days. For children with moderate symptoms were used: hydroxychloroquine sulfate 6.5 mg/kg/dose every 12 hours in the first day and 3.25 mg/kg/dose every 12 hours from day 2 to 5. The therapeutic response was telemonitored. Group 4 patients were directly oriented to seek hospital care. During the use of the drugs, the patients were telemonitored daily. Results: One hundred eighty-seven patients were seen with mean age of 37,6 years (about 15,6). The most frequent symptom was cough (57,6%) followed by malaise (60,3%) fever (41,1%) headache (56,0%) muscle pain (51,1%). Of all the patients that sought telemedicine service in our center 23% were asymptomatic despite contact with people with probable diagnostic of COVID-19 29,4% reported mild symptoms 43,9% moderate symptoms and 3,7% severe symptoms. It was possible to observe in patients treated their symptoms of COVID-19 (group 3) with hydroxychloroquine and azithromycin for five days presented statistically better improvement of the symptoms when compared to those that did not follow the protocol (p = 0.039). Three patients were hospitalized and discharged after recovery. Conclusions: Our study showed that patients with COVID-19 who had delivery of health care through telemedicine initiated in early stages of the disease presented satisfactory clinical response, reducing the need of face-to-face consultations and hospitalizations. Our results indicate that the use of telemedicine with diagnosis and drug treatment protocols is a safe and effective strategy to reduce overload of health services and the exposure of healthcare providers and the general population to infected patients in a pandemic situation.
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COVID-19 , Fever , Myalgia , HeadacheABSTRACT
Introduction: There are currently no predictive biomarkers for long-term survival after neoadjuvant chemoimmunotherapy. However, the identification of non-small lung cancer (NSCLC) patients who obtain long-term benefit from chemoimmunotherapy is essential to optimize therapies. Methods: Using samples from NADIM clinical trial (NCT03081689), in which resectable stage IIIA NSCLC patients were treated with neoadjuvant chemo-immunotherapy with nivolumab, we have evaluated the capacity of ctDNA levels before treatment initiation to predict overall survival (OS) and progression-free survival (PFS) by calculating Harrell’s C-statistic and we compare its predictive value with classical survival surrogates as the pathological response and clinical response assessed according to RECIST criteria v.1.1. The ctDNA was analyzed by NGS, using the Oncomine Pan-Cancer Cell-Free Assay™ (Thermo Fisher Scientific®). To explore the prognostic value of the amount of ctDNA at baseline, for each positive plasma sample, we calculated the sum of the mutant allele frequency (MAF) for all detected mutations. Patients who died from COVID19 were excluded from this analysis. Results: In our study, clinical responses based on RECIST criteria were not predictive for OS or PFS. On the contrary, in the multivariate analysis, patients with low ctDNA levels (<1% MAF), in the baseline sample, had significantly improved PFS and OS than patients in whom the opposite situation occurred (adjusted HR: 0.22;95%CI: 0.06-0.75;P=0.016 and adjusted HR: 0.04;95%CI: 0.00-0.45;P=0.008 for PFS and OS, respectively). The adjusted C-statistic (c) to predict PFS for ctDNA was 0.68 (95%CI: 0.51-0.84), which was superior to that of RECIST criteria (c=0.61;95%CI: 0.45-0.78) and similar to that of pathological response (c=0.68;95%CI: 0.52-0.84). Similarly, baseline ctDNA levels predicted OS (c=0.85;95%CI: 0.72-0.99) better than RECIST criteria (c=0.68;95%CI: 0.44-0.93). Conclusion: Pre-treatment ctDNA levels predicted more accurately long-term survival than radiological assessments in NADIM study and might be useful for the design of new clinical trials.