ABSTRACT
Background: Cancer patients undergoing systemic anti-cancer therapies (SACT) invariably experience toxicities precipitating presentations to Emergency Departments (ED). With the ongoing COVID-19 pandemic, it is imperative to continue to keep vulnerable immunocompromised patients out of hospital and encourage patients to contact SURC when symptoms develop. Peninsula Health (PH), SURC service was initiated post completion of a 12-month funded grant through the Victorian Government and has grown rapidly since its commencement. This nurse-led SURC model of care has been reported to achieve an investment return of $1.73 for every dollar invested. Method(s): ED presentations of Peninsula Health Oncology/Haematology patients pre- and post-SURC commencement were examined if potentially avoidable presentations have reduced. Ongoing SURC Episodes of care (Educations, phone, and physical attendances) between January 2022 to September 2022 captured in the SURC Access Database. Patient experience surveys were conducted post SURC phone contact and physical attendance if unwell. Patients and clinicians' surveys are ongoing. Result(s): Intermediate statistical data (COSA2021) collated June 2021 to December 2022 post-grant, we observed 43.30% reduction in ED presentations within SURC operation hours by patients considered SURC eligible when compared to pre-SURC figures. The SURC from January 2022 to September 2022 has recorded, 2567 episodes of care, provided to 601 individuals;educations (12.43%), incoming phone triage (45.77%), outgoing phone triage (31.40%), and attendances (10.40%). Most frequent SURC contacts were for care-coordination (28.43%), gastrointestinal symptoms (17.97%), diagnostics (8.81%), pain management (7.56%),)and medication advice (6.23%). Notably, more than one-third indicated they would have done nothing (36.93%) with 7.13% indicating they would have presented to ED without SURC. Closely aligning with the local cancer prevalence rates, the commonest tumour streams are breast (22.63%), lung (17.14%), and colorectal (15.64%). Conclusion(s): The SURC model of care continues to be an invaluable resource at PH to support cancer patients undergoing SACT which allows prompt access to specialist care while avoiding emergency presentations in the ambulatory setting. The model continues to expand post an additional government grant "SURC-additional support during COVID-19 and recovery" to increase additional support to vulnerable populations. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest. Copyright © 2022
ABSTRACT
Background: Cancer patients undergoing systemicanti-cancer therapies (SACT) invariably experience toxicities precipitating presentations to Emergency Departments (ED). With the ongoing COVID-19 pandemic, it is imperative to keep vulnerable immunocompromised patients out of hospital and encourage patients to contact SURC when symptoms develop. This nurse-led SURC model of care has been reported to achieve an investment return of $1.73 for every dollar invested. At Peninsula Health (PH), we recently established SURC supported by the Victorian Government and are evaluating its uptake and effectiveness. Methodology: Episodes of care (Educations, phone, and physical attendances) occurring between 31/08/2020 to 30/06/2021 were captured in the SURC Access Database and analysed. ED presentations pre-and post-SURC commencement were examined if potentially avoidable presentations have reduced. Baseline patient experience and post-SURC implementation surveys were conducted amongst patients and clinicians with local ethics approval. Results : 1923 SURC episodes of care were provided to 540 individuals (educations 28.2%, phone triage 63.3%, and attendances 8.5%). The commonest tumour stream was breast (23.0%), lung (20.1%) and colorectal (17.2%), closely aligning with the local cancer prevalence rates. Most frequent SURC contacts were for gastrointestinal symptoms (16.9%), pain management (9.5%), care-coordination (9.1%) and medication advice (6.5%). Notably, more than one-third indicated they would have done nothing (38.5%) or delayed seeking medical advice (10.9%) without SURC. During the first five months post-SURC commencement we observed a 47.0% decrease in avoidable presentations within SURC operation hours, and a 29.3% decrease in after-hours ED presentations. The results from the patient and clinician surveys will be updated at the meeting. Conclusions : The SURC model of care is an invaluable resource to support cancer patients undergoing SACT which allows prompt access to specialist care while avoiding emergency presentations in the ambulatory setting. Resources permitting, it should be standard of care across all health services providing cancer care.
ABSTRACT
Objectives: Prone ventilation is believed to improve oxygenation parameters in patients with severe coronavirus disease 2019 (COVID-19). However, the efficacy and safety profiles of prone ventilation among intubated COVID-19 patients remain unclear. The primary objective of this systematic review was to examine the effect of prone ventilation on the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) in intubated COVID-19 patients. Methods: Databases of MEDLINE, EMBASE and CENTRAL were systematically searched for any clinical trials or observational studies comparing prone versus supine position of ventilation in intubated COVID-19 patients from their inception until March 2021. Case reports and case series were excluded. Results: A total of 11 studies (n=606 patients) were included for quantitative meta-analysis. Prone ventilation improved PaO2/FiO2 ratio (studies=8, n=579, mean difference 46.75, 95%CI 33.35-60.15, p<0.00001;evidence=very low) and peripheral oxygen saturation (studies=3, n=432, mean difference 1.67, 95%CI 1.08-2.26, p<0.00001;evidence=low), both of which were statistically significant in intubated COVID-19 patients. However, no significant differences were observed in the arterial partial pressure of carbon dioxide (studies=5, n=396, mean difference 2.45, 95%CI -2.39-7.30, p = 0.32;evidence= very low), mortality rate (studies=1, n=215, odds ratio 0.66, 95%CI 0.32-1.33, p=0.24;evidence= very low) and number of patients discharged alive (studies=1, n=43, odds ratio 1.49, 95%CI 0.72-3.08, p=0.28;evidence=very low). However, none of the studies investigated the adverse events of both supine and prone ventilation in COVID-19 patients. Conclusions: This meta-analysis demonstrated that prone ventilation improved PaO2/FiO2 ratio and SpO2 in intubated COVID-19 patients. More randomized controlled trials are warranted to examine the adverse events of prone ventilation, and to improve the certainty of evidence and its homogeneity. (Figure Presented) .
ABSTRACT
Objectives: Many family planning providers faced disruptions to service delivery from the COVID-19 pandemic and needed to quickly implement telemedicine for contraceptive care. This study describes how Illinois providers responded to the uptake of telemedicine. Methods: We interviewed clinicians (n=20) from non-Planned Parenthood clinics (July – September 2020) and clinicians and staff (n=17) from Planned Parenthood of Illinois sites (December 2020 – March 2021) across the state. Interviews were conducted by phone or video, audio-recorded, transcribed, and coded in Dedoose. Analysis revealed themes focusing on telemedicine's effects on patient care and access to comprehensive contraceptive services, and on steps needed to improve telemedicine and sustain its benefits post-pandemic. Results: Interviewees expressed mostly positive attitudes towards telemedicine, highlighting its utility for counseling and prescription contraceptive methods, with additional benefits for rural patients and patients facing transportation, childcare, or other barriers to in-person visits. Challenges included rapid telemedicine rollout, patient barriers to accessing technology platforms, and reduced access to long-acting reversible contraception (LARC). Providers implemented changes to mitigate barriers, such as prioritizing same-day LARC insertion and removals, and eliminating required post-LARC follow-up visits. Providers noted virtual visits enhanced privacy for some and compromised privacy for others. All participants observed that continuation of telemedicine contraceptive services would depend on equitable reimbursement for telehealth services. Conclusions: Telemedicine contraception services can enhance access for patients who face barriers to care beyond those created by the pandemic. However, reimbursement parity for providers, patient-centered flexibility regarding telemedicine options, and measures to ensure access to all methods are important for long-term success.
ABSTRACT
Aims An outbreak of coronavirus disease 19 (COVID-19) has altered the dynamic of endoscopic practices. Many guidelines, questionnaires have been published addressing service resumption during the pandemic. Curious about the situation indifferent endoscopic units across the globe, the study was designed to evaluate different aspects of practice resumptionworldwide and their adherence to guidelines. Methods An online questionnaire was created and distributed by national/regional representatives and societies. Redcapplatform was used as the interface;afterwards, Microsoft Excel 2016 and Prism 5 were utilized for data analysis. Results From a total of 307 responses from 47 countries/regions was collected, 290 valid answers were analyzed. Almosthalf (47 %) were in post-peak period by August, 2020. Many units were not designated to be COVID-oriented facility. About15.5 % of centers remained unrecovered, mainly in North and South America;those were recovered, training was still withheld significantly. Nevertheless, opened centers kept safety measurements strictly. Patient load was decreased by 37 %,but waiting list was increased 0-25 %. Among many surveillance methods, body temperature, PCR and chest CT were themost common. 74.8 % increased post-procedural disinfection time and 68.2 % increase in per-case inspection were noted.PPE usage was implemented highly and shortage of these posed as one of the resumption barriers. Post-procedural patientsurveillance was not reinforced. Conclusions The study represented real-time global endoscopic service's adaptation to COVID-19 pandemic. Previouslypublished barriers upon practice resumption remained. Despite Delphi consensus' emphasis on post-procedural surveillance, application was not widely reinforced, raising concerns in disease control.