ABSTRACT
This study explores the association between experiencing food insecurity and COVID-19 diagnosis in the United States, and what sociodemographic characteristics moderate this relationship. We analyzed a national sample of adults in the United States (n = 6,475). Multiple logistic regression results revealed respondents experiencing food insecurity had an approximately 3.0 times significantly higher odds of a positive COVID-19 diagnosis (odds ratio [OR] = 2.95, 95% confidence interval [CI] = 1.38-6.32, p < 0.01), which remained significant after adjusting for sociodemographics and COVID-19 mitigation behaviors (OR = 2.59, 95% CI = 1.09-6.18, p < 0.05). Age group had a significant moderating effect (OR = 42.55, 95% CI = 3.13-579.15, p < 0.01). Results indicate experiencing food insecurity is associated with contracting COVID-19.Copyright © 2022 Taylor & Francis Group, LLC.
ABSTRACT
Introduction/Aim: Post COVID conditions are highly heterogenous and pose significant challenges to healthcare systems. The aim of this study was to identify and characterise symptom clusters at 6-months following COVID illness. Method(s): Symptom burden was assessed in a COVID respiratory clinic 6-months following diagnosis. K-mean cluster analysis was utilised to identify clusters and validated assessment tools for dyspnoea [MMRC], mood [PHQ-4], fatigue [FSS] and pain [WPI]were used to characterise clusters. Result(s): 58 patients (median age 59 years, 31 males) attended 6-month follow up. Cluster 4 represented patients experiencing high symptom burden with high fatigue, pain, depression and anxiety scores. A high proportion of Cluster 2 reported no symptoms but had high dyspnoea scores. Results for PHQ-4, FSS and WPI are presented as means (95%confidence interval) Cluster (n) Symptoms MMRC >1 (n%) PHQ-4 FSS WPI 1(8) anosmia, headache, fatigue, memory, concentration 3(5.1) 1(1,2) 31(17,45) 5(-1,10) 2(42) Isolated Dyspnoea 15(25.9) 1(1,2) 22(18,26) 1(0,1) 3(3) fatigue, nasal congestion, chest pain 3(5.1) 5(-10,21) 36(-26,98) 7(-11,24) 4(4) high symptom burden 4(6.9) 7(0,13) 51(36,66) 12(2,21) Conclusion(s): This exploratory analysis identified 4 possible post COVID condition phenotypes with unique symptom profiles. Larger scale phenotyping may facilitate a streamlined and customised approach to managing this evolving chronic and highly heterogenous clinical condition.
ABSTRACT
Introduction/Aim: As health systems emerge through successive waves of COVID-19, focus shifts to the management of Post-COVID-19 conditions. The aim of this prospective observational study was to characterise and evaluate the respiratory sequelae affecting patients 6-months post-diagnosis of COVID-19. SIGNFICANT MODELLING PREDICTORS Outcome Predictors MMRC>= 1 Disease severity Moderate: OR 16.5 +/- 1.02 (SE) p = 0.006 Impaired DLCO (%predicted) Disease severity B=-1.51+/-0.67 (SE) p = 0.010 Impaired TLC (%predicted) D-Dimer B= -0.305 +/- 0.001 (SE), p = 0.05 TLC below LLN Diabetes B=-1.28 +/- 0.32 (SE), p = 0.044 Methods: Patients were evaluated for symptom burden and lung function at 6-months post-diagnosis of COVID-19 in an outpatient setting. Result(s): Fifty-eight (45 inpatients and 13 outpatients;median age 59 years, 28 females) patients attended 6-month clinic appointment. Whilst nearly half (28,48.3%) were asymptomatic at 6-months, 24 (41.3%) patients reported a modified medical research council dyspnoea scale (MMRC) >= 1 and 21 (36.2%) patient-reported fatigue (n= 21, 36.2%). Reduced TLC (n= 11/50, 22.0%) and DLCO (n = 12/51, 23.5%) were common at 6-months. Results of predictive modelling analyses are described in adjacent table. Conclusion(s): Patients presenting with increased disease severity are at risk of persistent dyspnoea and impaired diffusion capacity, 6-months following acute COVID-19 illness. Research guided management of this growing at risk cohort, while paramount, poses a formidable challenge to stretched healthcare systems.
ABSTRACT
Background: Physical activity has been shown to have a positive impact on cystic fibrosis (CF) symptoms and slows decline in lung function. Additionally, moderate-intensity activities have been shown to improve sputum expectoration and oxygen saturation in children with CF, improving symptoms [1]. This study assessed whether using fitness trackers and providing a daily step goal would increase physical activity in hospitalized children with CF. Method(s): This pre-post pilot study included participants aged 6 to 21 who were admitted to the hospital for a pulmonary exacerbation of CF between October 2020 and November 2021. Garmin vivosmart 4 wrist-based activity trackers were issued, and baseline datawere tracked and analyzed for the first 2 study days. Pre-goal number of steps was defined as average number of steps taken on those 2 days. On study day 3, a step goal and menu of activities designed to increase physical activity were shared with the participants. Steps after goal settingwere defined as average number of steps taken on study day 3 and beyond while hospitalized, excluding day of discharge. Data collected from the medical record and the activity tracker web-based profile included daily oxygen requirement, daily step count, sleep duration, overnight pulse oximetry levels, resting heart rate, calories expended, and intensity minutes. The primary outcome of change in daily steps and attainment of step goals was analyzed using descriptive statistical testing, means, and standard deviations. Outpatient data were collected for 3 months to observe adherence to goals after discharge. Result(s): Eight participants aged 6 to 18 completed the study. Hospital length of stay ranged from 4 to 14 days. Participants took an average of 1508 +/- 1078 steps before goal setting, which increased to an average of 3704 +/- 1555 steps after the intervention. Step goals were met 56% of the time, although these data were highly variable. During the first week after hospital discharge, participants took an average of 6303 +/- 1786 steps per day (Figure 1).(Figure Presented) Figure 1. During the intervention, patients met their step goal 56% of the time, although this was highly variable. Two patients met their goal 100% of the time (9- year-old boy, 7-year-old girl), two met it 0% of the time (18-year-old boy, 17-year-old girl), one met it 44% of the time (6-year-old boy), and the remaining three met it 67% of the time (10-year-old girl, 17-year-old girl, 14-year-old boy). Conclusion(s): This intervention shows promise, with daily number of steps doubling from baseline during the intervention period. There was great variability among participants, suggesting that the approach helps some more than others. Enrollment was initially planned for 20 patients, but the SARS-CoV-2 pandemic and changes to CF therapy reduced hospitalizations during the study period. Outpatient data were analyzed for only the first week after discharge because of poor adherence to wearing the device. Although our results showa positive impact, further research is needed to determine the effect such an intervention would have on a larger scale. Future directions of research include determining potential clinical benefit from increased activity during hospitalization and prolonged follow-up to assess long-term benefits of intervention.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
ABSTRACT
Background: Datopotamab deruxtecan (Dato-DXd) is an antibody-drug conjugate (ADC) consisting of a humanized anti-TROP2 IgG1 monoclonal antibody covalently linked to a highly potent topoisomerase I (Topo I) inhibitor payload via a stable, tumor-selective, tetrapeptide-based cleavable linker. Dato-DXd demonstrated compelling single-agent antitumor activity in heavily pretreated patients (pts) with metastatic triple-negative BC (Krop, SABCS 2021). This is the first report of results from the TROPION-PanTumor01 study in pts with unresectable or metastatic hormone receptor- positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-;including HER2-low and HER2-zero) BC. Method(s): TROPION-PanTumor01 (NCT03401385) is a phase 1, multicenter, open-label, 2-part doseescalation/expansion study evaluating Dato-DXd in previously treated pts with solid tumors. Based on previous clinical findings and exposure-response results from pts with NSCLC, Dato-DXd 6 mg/kg IV Q3W is being evaluated in pts with unresectable or metastatic HR+/HER2- BC that progressed on standard therapies. The primary objectives were safety and tolerability. Tumor responses, including ORR (complete response [CR] + partial response [PR]) and DCR (CR + PR + stable disease [SD]), were assessed per RECIST version 1.1 by blinded independent central review. Result(s): As of the April 29, 2022, data cutoff, 41 pts had received Dato-DXd (median follow-up, 10.9 mo [range, 7-13]);9 pts were ongoing. The primary cause of treatment discontinuation was disease progression (63% progressive disease [PD] or clinical progression). Median age was 57 y (range, 33- 75);54% had de novo metastatic disease. Pts were heavily pretreated (Table) with a median of 5 (range, 3-10) prior regimens in the advanced setting;95% had prior CDK4/6i (adjuvant/metastatic). Median time from initial treatment for metastatic disease to the first dose of Dato-DXd was 42.7 mo (range, 10.2-131.1). Treatment-emergent adverse events (TEAEs;all cause) were observed in 98% (any grade) and 41% (grade >=3) of pts. Most common TEAEs (any grade, grade >=3) were stomatitis (80%, 10%), nausea (56%, 0%), fatigue (46%, 2%), and alopecia (37%, 0%). Serious TEAEs were observed in 6 pts (15%);1 pt died due to dyspnea, which was not considered to be treatment related. Dose reductions occurred in 5 pts due to stomatitis (n=3), fatigue (n=2), keratitis (n=1), and decreased appetite (n=1) (>1 AE per pt);14 pts had treatment delayed due to stomatitis (n=8), retinopathy (n=1), dysphagia (n=1), fatigue (n=1), malaise (n=1), COVID-19 (n=1), cellulitis (n=1), urinary tract infection (n=1), decreased lymphocyte count (n=1), and nasal congestion (n=1;>1 AE per pt). Three pts discontinued treatment due to keratitis (n=1) and pneumonitis (n=2);1 case of pneumonitis was adjudicated as grade 2 drug-related interstitial lung disease. The ORR was 29% (11 confirmed PRs;1 pending confirmation), the DCR was 85% (35/41), and the clinical benefit rate (CR + PR + SD >=6 mo) was 41% (17/41). Conclusion(s): Dato-DXd demonstrated a manageable safety profile and encouraging antitumor activity, with high disease control in heavily pretreated pts, the majority having received prior CDK4/6i. Based on these findings, the TROPION-Breast01 (NCT05104866) randomized phase 3 study comparing 2L+ Dato-DXd vs investigator's choice chemotherapy is currently enrolling pts with HR+/HER2- BC.
ABSTRACT
Background Indications and practice of extracorporeal membrane oxygenation (ECMO) use in pregnant patients are known;however, there is minimal evidence outside of meta-analysis and case series that comprehensively documents the outcomes. This study systematically evaluates the outcomes of ECMO utilization for peripartum patients in the setting of respiratory and/or cardiovascular failure. Methods All peripartum patients from 2018 to 2021 from a single center were screened to see if ECMO was initiated in the setting of cardiac, pulmonary, or combined failure. 15 patients met inclusion criteria of requiring ECMO while pregnant or up until 6 weeks postpartum. The patient demographics;operative details;ECMO registry data;critical care characteristics;adverse events per the codes for extracorporeal life support complications;and adverse outcome for maternal, fetus, and neonates were all collected. Results The cohort studied had a mean age of 30.3 years old, was racially diverse, and had few preexisting medical conditions before pregnancy. ECMO was indicated in 10/15 patients due to COVID-19 and 4/15 patients due to cardiac disease. ECMO was intended to be a bridge to recovery for 14/15 patients of which 11/14 patients recovered to discharge. The temporary ventricular decompression therapies used in VA ECMO patients were limited to the Protek Duo Right Ventricular Assist Device and TandemHeart device. No patients required transplantation or a durable mechanical device. Notable complications: 1 intrauterine fetal demise from placental malperfusion before ECMO was started;4 maternal deaths, of which 3 were related to ECMO;4 cardiac arrest events;1 limb ischemia event after ECMO cannulation;4 cannulation site hematomas;0 cannulation site hemorrhage;1 cardiac arrhythmia event;2 patients comprised all the intracranial hemorrhage events;and 2 patients comprised all the Gastrointestinal hemorrhage events. Conclusion To our knowledge;this is the first comprehensive documentation of adverse events in peripartum patients describing maternal, fetal, neonatal, and ECMO related outcomes. This data provides a standard format to evaluate risks of ECMO use in peripartum patients.Copyright © 2023 American College of Cardiology Foundation
ABSTRACT
BACKGROUND AND AIMS: The COVID-19 pandemic has impacted the care of patients with liver disease. We examined impact of COVID-19 on liver transplant (LT) activity in the USA. METHODS: LT listings in the United Network for Organ Sharing (UNOS) database (April 2018-May 2021) were analyzed to examine the impact of COVID-19 pandemic on the LT activity based on etiology: hepatitis C virus (HCV), alcohol-associated liver disease (ALD), alcoholic hepatitis (AH), and nonalcoholic steatohepatitis (NASH) complications: hepatocellular carcinoma (HCC) and acute-on-chronic liver failure (ACLF) grade 2 or 3) and Model for End-Stage Liver Disease (MELD) score. Joinpoint regression models assessed time trend changes on a log scale. RESULTS: Of 23,871 recipients (8,995 in the COVID era, April 2018-February 2020), mean age 52 years, 62% men, 61% Caucasian, 32% ALD, 15% HCC, 30% ACLF grades 2-3, and mean MELD score 20.5), monthly LT changes were a decrease of 3.4% for overall LTs and 22% for HCC after September 2020, and increase of 4.5% for ALD since 11/2020 and 17% since 03/2021 for ACLF grade 2-3. Monthly MELD scores increased by 0.7 and 0.36 after June 2020 for HCV and HCC respectively. CONCLUSIONS: The COVID-19 pandemic has impacted LT activity, with a decrease of LTs especially for HCC, and an increase of LTs for ALD and severe ACLF. Strategies are needed to reorganize cirrhosis patients to overcome the aftereffects of COVID-19 pandemic.
ABSTRACT
Background: Olfactory dysfunction (OD) is a common symptom of Corona Virus Disease 2019 (COVID-19). It is defined as the reduced or distorted ability to smell during sniffing (orthonasal olfaction) and represents one of the early symptoms in the clinical course of COVID-19 infection. A large online questionnaire-based survey has shown that some post-COVID-19 patients had no improvement 1 month after discharge from the hospital. Objective: To explore the efficacy of acupuncture for OD in COVID-19 infected patients and to determine whether acupuncture could have benefits over sham acupuncture for OD in post-COVID-19 patients. Methods: This is a single-blind, randomized controlled, cross-over trial. We plan to recruit 40 post-COVID-19 patients with smell loss or smell distortions lasting for more than 1 month. Qualified patients will be randomly allocated to the intervention group (real acupuncture) or the control group (sham acupuncture) at a 1:1 ratio. Each patient will receive 8 sessions of treatment over 4 weeks (Cycle 1) and a 2-week follow-up. After the follow-up, the control group will be subjected to real acupuncture for another 4 weeks (Cycle 2), and the real acupuncture group will undergo the 4-week sham acupuncture. The primary outcomes will be the score changes on the questionnaire of olfactory functioning and olfaction-related quality of life at week 6, 8, 12, and 14 from the baseline. The secondary outcomes will be the changes in the olfactory test score at week 6 and 12 from the baseline measured by using the Traditional Chinese version of the University of Pennsylvania Smell Identification Test (UPSIT-TC). Discussion: The results of this trial will help to determine the effectiveness of acupuncture for OD in post-COVID-19 patients. This may provide a new treatment option for patients.
ABSTRACT
Faced with Covid-19, and the need to adapt to environments that guarantee continuity of educational service in the context of social distancing, many universities did not initially plan the mechanisms for adapting to the virtual modality adequately. Therefore, this period of transition to e-learning was characterised by a decrease in academic performance . This article reports on a study that focused on determining whether the transition from a classroom to a virtual teaching–learning model had an effect or influence on the academic performance of university students in mechanical and electrical engineering at a public university in Peru during the period 2018 to 2021. The purpose of the study was to ensure the quality of the education system in the face of the implementation of a hybrid mode of teaching. Methodologically, a descriptive type of investigation and longitudinal non-experimental design were undertaken. The research methodology followed a hypothetical-deductive approach. The number of participants was 157 and a registration form was used to collect data on the indicators that made up the academic performance variable. The results reveal that the switch to a virtual teaching–learning modality significantly influenced the academic performance of the students. Student’s t-test found a significance equal to 0.000. Passing grades were achieved by 98.57% of students under the virtual teaching–learning modality, compared to 68.4% under classroom learning. ©Authors This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
ABSTRACT
Background and Aims: The COVID-19 pandemic has impacted the care of patients with liver disease. We examined impact of COVID-19 on liver transplant (LT) activity in the USA. Methods: LT listings in the United Network for Organ Sharing (UNOS) database (April 2018-May 2021) were analyzed to examine the impact of COVID-19 pandemic on the LT activity based on etiology: hepatitis C virus (HCV), alcohol-associated liver disease (ALD), alcoholic hepatitis (AH), and nonalcoholic steatohepatitis (NASH) complications: hepatocellular carcinoma (HCC) and acute-on-chronic liver failure (ACLF) grade 2 or 3) and Model for End-Stage Liver Disease (MELD) score. Joinpoint regression models assessed time trend changes on a log scale. Results: Of 23,871 recipients (8,995 in the COVID era, April 2018-February 2020), mean age 52 years, 62% men, 61% Caucasian, 32% ALD, 15% HCC, 30% ACLF grades 2-3, and mean MELD score 20.5), monthly LT changes were a decrease of 3.4% for overall LTs and 22% for HCC after September 2020, and increase of 4.5% for ALD since 11/2020 and 17% since 03/2021 for ACLF grade 2-3. Monthly MELD scores increased by 0.7 and 0.36 after June 2020 for HCV and HCC respectively. Conclusions: The COVID-19 pandemic has impacted LT activity, with a decrease of LTs especially for HCC, and an increase of LTs for ALD and severe ACLF. Strategies are needed to reorganize cirrhosis patients to overcome the aftereffects of COVID-19 pandemic.
ABSTRACT
OBJECTIVES: Older adults have a disproportionately higher COVID-19 risk; however, there is limited research investigating adherence to the major COVID-19 mitigation behaviors (handwashing, masking, social distancing) for older populations. We examined COVID-19 risk factors and predictors for adherence to COVID-19 mitigation behaviors among a national sample of US older adults. STUDY DESIGN: Data were retrieved for 3257 respondents from a nationally representative prospective sample of US Medicare beneficiaries aged ≥65 years. COVID-19 variables were collected in 2020, whereas all other data were collected in 2019. METHODS: We used multiple logistic regression to analyze COVID-19 risk factors and predictors for handwashing, masking, and social distancing to minimize COVID-19 spread. All models applied survey sampling weights. RESULTS: Factors significantly associated with increased odds of COVID-19 diagnosis among US older adults were Hispanic ethnicity (adjusted odds ratio [aOR] = 2.83, P = .01), income (aOR = 0.71, P = .04), residential care or nursing home (aOR = 2.62, P = .01), and generalized anxiety disorder (aOR = 2.38, P = .04). We identified multiple factors significantly associated with adherence to handwashing, masking, and social distancing. Most notably, older males had a significantly lower odds of practicing all three COVID-19 mitigation behaviors, and Black older adults had a significantly higher odds of masking (aOR = 7.94, P < .001) and social distancing (aOR = 2.33, P = .01). CONCLUSIONS: When prioritizing COVID-19 prevention efforts for older adults, risk factors that should be considered are race and ethnicity, income, residential setting, and anxiety. To effectively mitigate COVID-19 disease spread, public health professionals must also recognize sociodemographic and health factors may influence whether older adults adhere to handwashing, masking, and social distancing.
Subject(s)
COVID-19 , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing , Hand Disinfection , Humans , Male , Medicare , Physical Distancing , Prospective Studies , Risk Factors , SARS-CoV-2 , Surveys and Questionnaires , United States/epidemiologyABSTRACT
Objectives: Chronic liver disease (CLD) patients are hypothesized to have greater risks of liver decompensation following SARS-CoV-2 infection. Data evaluating COVID-19 in CLD patients remains sparse. We aim to evaluate whether SARS-CoV-2 infection in CLD patients is associated with increased risks of liver decompensation or acute on chronic liver failure (ACLF). Materials and Methods: Using the Common Data Schema from COVID-19 Research Database, a large U.S. database containing over 72 million linked patients with both electronic health records and claims data, we evaluated CLD patients with (CLD - COVID-19) vs. without COVID-19 (CLD without COVID-19). Patients had minimum 6-months follow-up until censoring event or end of study period (August 31, 2021) to evaluate incident liver decompensation (i.e. ascites, hepatic encephalopathy, variceal bleeding, hepatorenal syndrome, liver failure) and incident ACLF (EASL-CLIF definition). Outcomes were evaluated using adjusted multivariate Cox proportional hazards models. Results: Among 923,671 adults with CLD (44.7% women, 12.4% cirrhosis), 3.8% had CLD - COVID-19 and 96.3% had CLD without COVID-19. Over a median follow-up of 242-267 days, when compared to CLD without COVID-19, CLD - COVID-19 patients had significantly greater risk of liver decompensation (HR 1.22, 95% CI 1.13-1.32, p<0.001) and ACLF (HR 1.54, 95% CI 1.17-2.03, p<0.01). Among CLD patients with cirrhosis at baseline, COVID- 19 was similarly associated with higher risk of ACLF (HR 1.66, 95% CI 1.26-2.19, p<0.001). When evaluating individual organ failures in patients with ACLF, CLD - COVID-19 vs. CLD without COVID- 19 was associated with significantly greater risks of cardiovascular failure (HR 4.75, p<0.001), respiratory failure (HR 5.80, p<0.001), and renal failure (HR 3.93, p<0.001). Conclusion: Among a large U.S. cohort evaluating COVID-19 in CLD patients, SARS-CoV-2 infection was associated with significantly greater risks of liver decompensation and ACLF in patients with underlying CLD. The primary drivers of ACLF were the increased risks of cardiovascular failure, respiratory failure, and renal failure associated with COVID-19.
ABSTRACT
Background and Aim: The COVID-19 pandemic has modified liver disease-related care delivery with implementation of telemedicine, previously unavailable in safety net settings. We aimed to assess patient satisfaction with telemedicine for hepatology care (telehepatology) in vulnerable populations with fatty liver disease (FLD). Methods: From 06/01/2020-11/ 30/2021, 218 consecutive participants with non-alcoholic or alcohol-related FLD with or without advanced fibrosis/cirrhosis receiving care in hepatology clinics within the San Francisco safety net health care system were surveyed by phone or in person. Sociodemographic and clinical parameters were captured by self-report and through the electronic medical record. Satisfaction with telehepatology was measured using a Likert scale from 1-5 with 1 representing “very dissatisfied” and 5 representing “very satisfied”. Median time of survey assessment since onset of the pandemic (03/01/2020) was 60.3 (range 8.7-90.3) weeks. Alcohol use in the prior 12 months was categorized as none, moderate (#1 drink/day for women and #2 drinks/day for men), and heavy (>moderate). Severity of liver disease was assessed by liver biopsy (n=97), MR elastography (n=88), or presence of liver nodularity on abdominal imaging (n=33). Descriptive analyses were performed and multivariable models were used to assess factors associated with satisfaction with telehepatology, adjusting for age, sex, and time since pandemic onset. Results: Median participant age was 52 years, 62% were female;60% Hispanic, 20% Asian, 11% White, 3% Black, 6% other race/ethnicity;and 75% were non-English speakers. 37% used alcohol (23% had heavy alcohol use), 40% had diabetes, and 35% had advanced (stage 3-4) fibrosis/cirrhosis. 166 participants (76%) had received telemedicine care and 126 (58%) had telehepatology. Overall, 72% reported satisfaction (55% very satisfied) with telehepatology. A similar proportion of those with and without advanced fibrosis/cirrhosis were satisfied with telehepatology (70% vs 71%, p=1.0). Alcohol consumption (vs none) especially moderate use appeared to be associated with less satisfaction (Coef -1.1, p=0.004 for moderate use and Coef -0.5, p=0.2 for heavy use) but no other sociodemographic or clinical factors were associated with telehepatology satisfaction on multivariable analysis. Conclusions: In this diverse and vulnerable population, in which a significant proportion had advanced fibrosis/cirrhosis FLD, over 70% were satisfied with telehepatology. Importantly, alcohol use negatively impacted perceived satisfaction with telehepatology, suggesting that patients who use alcohol may benefit from adaptations to telemedicine care delivery. As vulnerable populations have known barriers to healthcare access, telehepatology represents an important modality for liver care, and has the potential for reducing health disparities.
ABSTRACT
Introduction: COVID-19 was declared a global pandemic in March 2020 and drastically changed daily life with ensuing stay-at-home orders. Studies have shown that adherence to healthy diet and exercise declined during this time. Internet search query data has been used to understand public interest in health-related behaviors such as smoking cessation. Therefore, the aim of this study was to examine whether internet searches for weight loss and bariatric interventions increased at the height of the pandemic. Methods: Google Ads Keyword Planner, a publicly available online tool, was used to obtain the search volumes for the keywords “weight loss,” “bariatric surgery,” “endoscopic weight loss procedure,” “gastric balloon,” and “endoscopic sleeve gastroplasty” per month from November 2017- October 2021. Search volumes were identified globally and by country (US, France, Spain, and Italy). Results: Globally, Google searches for “weight loss” peaked to 1,830,000 queries in April 2020, a 122% increase from April 2019 (Fig. 1a). By country, “weight loss” searches increased in April 2020 by 83% (1.8-fold) in the US, 311% (4-fold) in France, 679% (7.8- fold) in Spain, and 236% (3.4-fold) in Italy compared to the year prior (Fig. 1b,1c). Globally, average searches per month for “weight loss” from Mar 2020-Sep 2021 compared to prepandemic searches increased by 58% (Fig 1a). In the US, average monthly searches from Jul 2020-Sep 2021 increased by 43% for “bariatric surgery,” 16% for “gastric balloon,” 116% for “endoscopic sleeve gastroplasty,” and 309% for “endoscopic weight loss procedure” compared to Nov 2017-Jun 2020 averages (Fig. 2). Discussion: The COVID-19 pandemic heightened public interest in weight loss and endoscopic interventions. Several studies have shown that even one month into national lockdowns, people were reporting decreased physical activity, increased snack and alcohol consumption, and weight gain. This may have led to a rise in weight loss Google searches to combat these. Concurrently, research linking obesity with severe COVID-19 was publicized which may have contributed to an interest in weight loss. Elective procedures resumed in most hospitals in the US in summer 2020, possibly explaining the relative peaks in searches for bariatric procedures in July. Notably, interest in both weight loss and bariatric procedures not only increased during the height but have also remained elevated in 2021 as the planet slowly returns to a new normal. Furthermore, while total search volume is higher for ""bariatric surgery,"" there is clearly a rapidly rising interest in endoscopic procedures especially after July 2020. These data present an opportunity for gastroenterologists to provide continued patient education on optimal weight loss strategies varying from lifestyle modification, pharmacologic therapy, endobariatric therapy, and bariatric surgery. (Figure Presented) Figure 1. Google search volumes by month for the search query “weight loss” globally (1a), in the United States (1b), and in Europe (1c) from November 2017-September 2021 (Figure Presented) Figure 2. Google search volume by month for the search queries “bariatric surgery,” “endoscopic weight loss procedure,” “gastric balloon,” and “endscopic sleeve gastroplasty” in the United States from November 2017-September 2021
ABSTRACT
Purpose: The six radiation therapy (RT) centres in Atlantic Canada (AC) are equipped with modern technology capable of stereotactic, hypofractionated radiation techniques (SRS, SRT, SABR). However, these techniques remain significantly underutilized. A grant-funded, collaborative, regional quality improvement project was designed to support the implementation of precision RT techniques through inter-professional learning. The objective of this report is to describe the program design and early deliverables. Materials and Methods: A team from the AC Cancer Centres and Princess Margaret Cancer Centre was convened. A needs survey of AC RT centres conducted in 2019 and updated in 2020 guided program development. Adapting to COVID-19 pandemic restrictions, a virtual CME program delivered in four phases over four months was planned. The program includes expertled presentations and discussions, sharing of knowledge and protocols, and the development of centre-specific teams, goals, and implementation plans. A coordinated formative evaluation, using a realist evaluation approach, was designed to monitor implementation and address centre-specific and region-wide challenges to achieve accelerated implementation of precision RT techniques. Quantitative and qualitative methods will utilize the following data to be collected: use of the implementation strategies;timelines and local adoption of stereotactic RT techniques;specialists' knowledge and comfort level;specialists' satisfaction and experiences with the education received;and specialists' and decision-makers' perspectives on implementation processes, barriers, and facilitators. Results: Phase I and II consisted of two half-day virtual meetings. One hundred twenty-six participants including radiation therapists (40), radiation oncologists (27), medical physicists (19), planners (15), trainees (10), administrators (six), nurses (four), and others (five) from all six AC RT centres. Centres with developed protocols for stereotactic RT techniques provided expert content. Virtual break-out rooms grouped centre-specific inter-disciplinary teams who determined customized goals and commenced the development of implementation plans with leadership approval. Follow-up meetings will be conducted at two and four months. Grant funding was used to support meeting organization, RTT participation, online communication platforms, and a project coordinator. The evaluation is ongoing. Conclusions: With a collaborative expert-guided approach, evidence-based advancements in RT delivery can be accomplished in an accelerated manner on an AC regional basis despite variations in centre size and mandates. Evaluation of this process will inform on enablers to accelerate technology and improvements in the care of patients undergoing RT.
ABSTRACT
Purpose of Study Cystic Fibrosis (CF) is a progressive, genetic disease that affects over 30,000 individuals across the nation and results in decreased functionality of the lungs. Physical activity has a positive impact on the symptoms of CF and works to slow the decline in lung function. Additionally, activities with moderate intensity have been shown to improve sputum expectoration and oxygen saturation in children with CF. This study assessed whether using fitness trackers and providing a daily step goal would increase physical activity in hospitalized children and young adults with CF. Methods Used This prospective study included participants 6- 21 years of age who were admitted to the hospital for a pulmonary exacerbation of CF between October 2020-May 2021. Study enrollment occurred no more than 48 hours after hospital admission. Garmin vivosmart® 4 wrist-based activity trackers were issued and baseline data were tracked and analyzed for the first 2 study days. Pre-goal steps were defined as the average of steps taken on those 2 days. On study day 3, a step goal and menu of activities designed to increase physical activity were shared with the participant. Steps after goal setting were defined as the average of steps taken on study day 3 and beyond, excluding day of discharge. Data were collected from the electronic medical record and the activity tracker web-based profile and included the following: daily oxygen requirement, daily step count, sleep duration, overnight pulse oximetry levels, resting heart rate, calories expended, and intensity minutes. The primary outcome of change in daily steps and attainment of step goals was analyzed using descriptive statistical testing, means and standard deviations. Summary of Results Six patients, aged 6-18 years, completed the study. Mean baseline FEV1for study participants was 66% predicted (range 38 to 92%). Hospital length of stay ranged from 4-14 days. Participants took an average of 1772 ± 1011 steps before goal setting. This increased to an average of 3741 ± 1780 steps after goal setting. Overall, step goals were met 52% (Range 0-100%) of the time. Conclusions This intervention shows promise, as daily steps doubled from baseline during the intervention period. There was great variability among the participants, suggesting the device may help some people much more than others. Enrollment was initially planned for 20 patients;however, the SARS-CoV-2 pandemic and consequent changes to CF therapy drastically reduced hospitalizations during the study period. Though our results show a positive impact of increased physical activity following goal implementation, further research is needed to determine the effect such an intervention would have on a larger scale. Future directions of research include having a larger sample size, conducting a multi-center study to increase population diversity, and implementing a longer follow- up period to better assess long term benefits of intervention.