ABSTRACT
Introduction/BackgroundHigher risk of COVID 19 infection reported in patients with cancer. There are limited studies comparing the available vaccines in cancer patients.MethodologyStudy was conducted to 370 patients with breast and gynecological cancer. Data collected on comorbidities, cancer diagnosis, stage and treatment, COVID 19 infection, severity, timing of infection to chemotherapy, COVID 19 vaccination status, and vaccine side effects.ResultsBy March 15th 2022, 40.3% of study population had received COVID 19 vaccine, 52.2% not yet & 7.6% were refusing it. Commonest vaccine received in chemotherapy group was Sinovac 56%, Pfizer & AstraZeneca 18.7% for each, while sputnik & Johnson 1.3%, 5.3% respectively.Highest COVID 19 vaccine refusal was in elderly 71.4% P. < 0.01. Higher education patients were more likely to refuse vaccination P. < 0.03.Gynecological malignancy cases were twice higher refusal rate to COVID vaccine compared to the breast cancer cases 13.5% vs 6.1% P. <0.01.Multivariate analysis showed that CTH treatment increased risk of COVID 19 infection P. <0.001, Odds Ratio 4.6, 95% CI (2.3, 9.4).Injection site pain reported by 66.7%, fever, flu like symptoms were reported in 20.8% 12.5% respectively. Vaccine side effects reported with AstraZeneca & Pfizer 41.7%, 37.5%, respectively, while 16.7% of cases received Sinovac reported any side effects P. < 0.001.Gynecological cancer cases were at a higher risk to develop side effects post COVID 19 vaccination 29.2%, P. < 0.01 with odds ratio 3.54 and 95% CI (1.2, 10.1). 90% of reported severe COVID 19 infection were diagnosed with advanced malignancy P. <0.05.ConclusionHigher vaccination refusal reported among elder patient with advanced stage gynecological cancers. Patients with cancer have increased risk to COVID 19 infection. There are no major safety concerns to receive COVID19 vaccination during CTH.
ABSTRACT
BACKGROUND: Guidance documents are a valuable resource to clinicians to guide evidenced-based decision making. The quality of guidelines in anaesthesia and across other specialties has been demonstrated to be poor. COVID-19 presented an urgent need for immediate guidance for anaesthetists as frontline clinicians. The aim of this study was to evaluate the quality of COVID-19 guidance documents using the internationally validated Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. METHODS: A search was conducted in Ovid EMBASE and Ovid MEDLINE to identify all COVID-19 anaesthesia guidance documents from 2020-2021. Thirty-eight guidance documents were selected for analysis by 4 independent appraisers using the AGREE II instrument, across its 6 domains and 23 items. A scoring threshold for high quality was agreed by the working group via consensus. RESULTS: Overall, the body of COVID-19 guidance documents achieved poor scores using AGREE II. Only 5% of documents met the high-quality criteria. Markers of quality included international and multi-institutional collaboration. Document title ('guideline' vs 'consensus statement'/ 'recommendations') did not yield any differences in domain scores and overall quality ratings. Compared with recent general anaesthesia guidelines, COVID-19 guidelines performed significantly worse. CONCLUSIONS: COVID-19 guidance documents published during the first two years of the pandemic lacked rigour and appropriate quality. This raises concern about their trustworthiness for use in clinical practice. Enhanced systems are required to ensure the integrity of rapidly formulated guidance.
Subject(s)
Anesthesia , COVID-19 , Humans , ConsensusABSTRACT
Guidance documents are a valuable resource to clinicians to guide evidenced-based decision making. The quality of guidelines in anaesthesia and across other specialties has been demonstrated to be poor. COVID-19 presented an urgent need for immediate guidance for anaesthetists as frontline clinicians. The aim of this study was to evaluate the quality of COVID-19 guidance documents using the internationally validated Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. A search was conducted in Ovid EMBASE and Ovid MEDLINE to identify all COVID-19 anaesthesia guidance documents from 2020-2021. Thirty-eight guidance documents were selected for analysis by 4 independent appraisers using the AGREE II instrument, across its 6 domains and 23 items. A scoring threshold for high quality was agreed by the working group via consensus. Overall, the body of COVID-19 guidance documents achieved poor scores using AGREE II. Only 5% of documents met the high-quality criteria. Markers of quality included international and multi-institutional collaboration. Document title (‘guideline’ vs ‘consensus statement’/’recommendations’) did not yield any differences in domain scores and overall quality ratings. Compared with recent general anaesthesia guidelines, COVID-19 guidelines performed significantly worse. COVID-19 guidance documents published during the first two years of the pandemic lacked rigour and appropriate quality. This raises concern about their trustworthiness for use in clinical practice. Enhanced systems are required to ensure the integrity of rapidly formulated guidance.
ABSTRACT
We conducted this meta-analysis to address the outcomes in cancer patients after oncologic surgery during COVID-19 pandemic. The primary endpoint was the COVID-19-related mortality rate. Higher body mass index was significantly and negatively associated with higher all-cause mortality and in-hospital COVID-19 infection rates. Male sex, preoperative respiratory disease, and smoking history were positively and significantly associated with increased all-cause mortality rates. Furthermore, male sex was positively and significantly associated with the COVID-19 infection rate.
Subject(s)
COVID-19 , Neoplasms , COVID-19/complications , Humans , Male , Medical Oncology , Neoplasms/complications , Neoplasms/mortality , Pandemics , Risk Factors , SARS-CoV-2 , Sex Factors , Smoking/adverse effectsABSTRACT
As New York State quickly became the epicenter of the COVID-19 pandemic, innovative strategies to provide care for the COVID-19 negative patients with urgent or immediately life threatening cardiovascular conditions became imperative. To date, there has not been a focused analysis of patients undergoing cardiothoracic surgery in the United States during the COVID-19 pandemic. Therefore, we seek to summarize the selection, screening, exposure/conversion, and recovery of patients undergoing cardiac surgery during the peak of the COVID-19 pandemic. We retrospectively reviewed a prospectively maintained institutional database for patients undergoing urgent or emergency cardiac surgery from March 16, 2020 to May 15, 2020, encompassing the peak of the COVID-19 pandemic. All patients were operated on in a single institution in New York City. Preoperative demographics, imaging studies, intraoperative findings, and postoperative outcomes were reviewed. Between March 16, 2020 and May 15, 2020, a total of 54 adult patients underwent cardiac surgery. Five patients required reoperative sternotomy and cardiopulmonary bypass was utilized in 81% of cases. Median age was 64.3 (56.0; 75.3) years. Two patients converted to COVID-19 positive during the admission. There was one operative mortality (1.9%) associated with an acute perioperative COVID-19 infection. Median length of hospital stay was 5 days (4.0; 8.0) and 46 patients were discharged to home. There was 100% postoperative follow up and no patient had COVID-19 conversion following discharge. The delivery of cardiac surgical care was safely maintained in the midst of a global pandemic. The outcomes demonstrated herein suggest that with proper infection control, isolation, and patient selection, results similar to those observed in non-COVID series can be replicated.