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1.
Journal of Hepatology ; 77:S321-S322, 2022.
Article in English | EMBASE | ID: covidwho-1996633

ABSTRACT

Background and aims: Patient-reported outcome measures (PROMs) are increasingly used as exploratory end points in clinical trials. The aim of this studywas to evaluate the temporal relationship between health-related quality of life (HrQoL) and liver fibrosis using generic (SF-36) and disease-specific (PSC-PRO) tools. Method: Patients with large-duct PSC were invited to complete HrQoL questionnaires in an outpatient setting at baseline (V1) and follow-up (V2) visits at least 12 months apart. Transient elastography liver stiffness (LS;Echosens, France) measurementswere recorded on the same day. SF-36 and PSC-PRO health domains were scored out of a maximum of 100% and 5, respectively. Mean scores were calculated for each domain with lower SF-36 and higher PSC-PRO scores representing poorer quality of life. Advanced fibrosis (F3-6) was defined based on published cutoff of LS >9.6kPa in PSC. Results: Fifty-five patients (64% male) with median age 45 years (range: 20–77) and median PSC duration 11 years (range: 2–26) attended both study visits. The median time between visits was 417 days (range: 362–582). The mean scores were numerically lower at V2 than V1 in all the SF-36 domains but only three domains showed statistically significant difference: bodily pain (74% vs 83%, p < 0.01), energy/fatigue (47% vs 57%, p < 0.0001), and mental summary score (66% vs 71%, p < 0.001). There were no differences in any of the PSCPRO domains between the visits. When stratified by baseline LS >9.6 kPa threshold (Figure 1), SF-36 physical functioning mean score dropped in the F3-6 group but increased slightly in the F0-2 group (−9.0 ± 17% vs 0.4 ± 21%, p = 0.01). In the PSC-PRO, the emotional impact mean score increased in the F3-6 group but decreased in the F0-2 group (0.6 ± 0.7 vs −0.1 ± 0.5, p < 0.01). Therewere no significant differences in mean scores in the other domains between the visits.(Figure Presented)Conclusion: Therewasworsening of bodily pain, levels of energy and mental health even within a year in patients with large-duct PSC. Patients with advanced fibrosis reported lower physical functioning and higher emotional impact of their disease compared to those without advanced fibrosis. Changes in PROMs are related to liver fibrosis and need to be considered in future antifibrotic drug trials. These findings, however, need to be interpreted in the context of imposed restrictions during the Covid-19 pandemic which may have had a significant psycho-social impact on patients.

2.
Auris Nasus Larynx ; 2022 Aug 04.
Article in English | MEDLINE | ID: covidwho-1977018

ABSTRACT

OBJECTIVE: To identify differences in inpatient otolaryngology consultations and interventions for patients based on COVID-19. METHODS: Records were reviewed for all patients for whom otolaryngology was consulted at a high-volume tertiary care hospital from April 30, 2020 to October 1, 2020. Demographic information, length of stay, COVID-19 status, indication for consultation, and otolaryngology interventions were recorded. Statistical analysis was performed using R software. RESULTS: Bleeding composed a significantly higher proportion of otolaryngology consults in COVID-19 positive patients (28% vs. 8.4%, p<0.0001). Management of bleeding was the most common procedure performed in positive patients (n=37, 35%), and they had a higher median number of interventions performed when compared to bleeding patients who tested negative (1, IQR 1-2 vs. 1, IQR 0-1, p=0.04). COVID-19 positive patients with bleeding were more likely to expire than those with other indications for otolaryngology consultation (50% vs. 7%, p<0.001). CONCLUSION: Bleeding and associated interventions comprised the predominant discrepancy between COVID-19 positive and negative patients in our cohort. We encourage routine use of simple and cost-effective methods to decrease risk of bleeding.

4.
Circulation ; 144:2, 2021.
Article in English | Web of Science | ID: covidwho-1710640
5.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1632819

ABSTRACT

Introduction: COVID-19 may negatively impact prognosis for patients with chronic HFrEF, and vice versa. However, large-scale data characterizing the interplay of COVID-19 and HFrEF on clinical outcomes are scarce. Methods: We examined the TriNetX health database from January 2020-September 2020 to conduct 2 analyses. Analysis A excluded patients with HFpEF and included patients with a positive inpatient or outpatient test for COVID-19, with a 3-way comparison of patients 1) without prior HF, 2) HFrEF without recent worsening HF event (WHFE) (i.e., no HF hospitalization or outpatient IV diuretic within prior 1 year), and 3) worsening HFrEF (i.e., HF hospitalization or outpatient IV diuretic within prior 1 year). Outcomes included mortality at 30 days and composite all-cause mortality or hospitalization following COVID-19 test. Analysis B included patients with HFrEF who underwent PCR testing for COVID-19, and compared patients with a positive versus negative test. Outcomes were mortality at 30 days and worsening HF (i.e., HF hospitalization or outpatient IV diuretic use). Results: In analysis A, 98,014 (99%) patients had no prior HF, 524 (0.5%) had HFrEF without WHFE, and 514 (0.5%) had worsening HFrEF. After adjustment for confounders, compared with patients without HF, worsening HFrEF was independently associated with excess mortality (p<0.01), whereas HFrEF without WHFE was not statistically significant (p=0.06) (Table). In analysis B, 1,038 (7%) had a positive test for COVID-19 and 13,800 (93%) had only negative tests. After adjustment, testing positive for COVID-19 was independently associated with mortality and worsening HF (all p<0.01). Conclusions: In this US population of ambulatory and hospitalized patients, after accounting for confounders, worsening HFrEF was independently associated with excess mortality after COVID-19 infection. Among patients with HFrEF, COVID-19 infection was associated with higher risk of death and worsening HF events.

6.
Journal of Spinal Cord Medicine ; 44(SUPPL 1):S280, 2021.
Article in English | EMBASE | ID: covidwho-1569422

ABSTRACT

Background: This project is the second phase of a clinical quality improvement (QI) project, which aims to develop a pilot program to provide transitional services to persons with spinal cord injury (SCI). Transitional services refer to those provided during the acute period post-discharge from inpatient rehabilitation, as persons with SCI reintegrate to community living. The first phase of the QI project is documented elsewhere. Objectives: To contribute to the holistic understanding of the barriers and facilitators that influence the transition process, and ways of supporting persons with spinal cord injury (SCI) through the transition. Methods: This project includes analysis of surveys that were distributed under the previous phase of the QI project as well as development, administration, and analysis of second round surveys. This project also includes an environmental scan and researching evaluation methods for similar projects in the published literature. Provision of services during the COVID-19 pandemic was researched. Results: There are a variety of transitional models of care from outpatient clinics to in-home and communitybased services. Survey respondents described challenges during their transition experience with emergent challenges noted by those who discharged during the COVID-19 pandemic. Community services in Calgary were described to identify gaps in support for persons with SCI during the transition. Conclusions: The transition from hospital to home must be bolstered, and context-relevant rehabilitation is needed. Future programs must be developed to weather uncertain circumstances, such as a global pandemic or inclement weather, to ensure continuous support for persons with SCI.

7.
Radiotherapy and Oncology ; 161:S241-S242, 2021.
Article in English | EMBASE | ID: covidwho-1492800

ABSTRACT

Purpose or Objective CD19 CAR-T therapy is the most effective salvage treatment for relapsed/refractory DLBCL. However the manufacture of CAR-T cells takes several weeks and patients (pts) are at risk of progression during this time and usually require some form of bridging therapy to contain their disease. Radiotherapy (RT) is an attractive bridging option, as the chance of response to further conventional cytotoxic therapy is low. RT is generally delivered in the window between apheresis and infusion and requires careful scheduling. The aim of this study is to evaluate the feasibility, toxicity and early outcome of bridging RT in a cohort of pts undergoing CAR-T therapy for DLBCL. Materials and Methods This was a prospective analysis of pts receiving bridging RT since the start of CAR-T programme at our institution. We collected data on pt demographics, disease and RT details, as well as outcomes including early response, relapse, survival and toxicity. Results (Table presented.) Between April 2019 & January 2021 a total of 27 pts have received bridging RT. Of these 23 have been infused (1 not infused due to COVID19, 1 due to cardiac function & 2 pending). The CAR-T therapy was delivered in 1 Haematology Institution, but bridging RT in 9 different referring centres. Pt and disease characteristics and RT details are shown in table 1. The median time from CT planning scan to start of RT was 10 days (4-42). The median time between apheresis and start of RT was 5 days (-37-21;3 patients received RT prior to apheresis at -37,-35 &-29 days) and median time between end of RT and CAR-T infusion was 19 days (10-116). No pts were delayed due to RT toxicity. Toxicity data was available for 22 pts. 10 (45.5%) reported no toxicity. Only 1 pt had grade 3 toxicity (vomiting & diarrhoea) and RT was stopped. The most common toxicities were skin reaction (n=5) & fatigue (n=4). 25/27 (92.6%) pts underwent a PET-CT between bridging RT & infusion. In 22 (88%) pts there was response in treatment field (CMR=2, PMR=20). In 13 (59.1%) of those pts there was evidence of progressive disease (PD) outside the field, but none were prevented from receiving CAR-T infusion due to PD. With median FU of 8.8 (0.6-20.6) months from date of CAR-T infusion, 12/ 23 (52.2%) infused pts have relapsed, (2 infield, 5 out of field, 5 in both) with a local control rate of 69.6%;CMR (12;52.2%) and PMR (4;17.4%). 7 pts have died since infusion, 6 due to PD and 1 due to sepsis. Median PFS was 5.1 months (95% CI 0.0-11.9 months) and median OS 17.8 months (95% CI 12.7-22.9 months). 1 pt had infusion delayed due to COVID19 infection and died of PD. Conclusion RT was a safe and effective bridging option in this cohort of DLBCL pts pre CAR-T therapy. With close collaboration between Haematologists and Radiation Oncologists, it is possible to deliver a course of radical dose RT in the narrow window between apheresis and infusion, even across a wide geographical network. Further work is required to determine which pts benefit most from bridging RT and the optimal dose and schedule.

8.
International Journal of Radiation Oncology Biology Physics ; 111(3):e308-e309, 2021.
Article in English | EMBASE | ID: covidwho-1433382

ABSTRACT

Purpose/Objective(s): The COVID19 pandemic required radiation oncologists (ROs) to consider shorter treatment courses to minimize patient and staff exposure and conserve healthcare resources. Hematologic ROs adopted hypofractionated radiation therapy (hRT) regimens according to guidelines published by the International Lymphoma Radiation Oncology Group (ILROG). We report for the first time the preliminary efficacy and toxicity of these novel hypofractionated regimens in the treatment of hematologic malignancies. Materials/Methods: We conducted a multicenter, multinational retrospective study under the direction of the ILROG. All patients receiving hRT according to ILROG guidelines from 1/1/2020 to 8/31/2020 were included. Patient and treatment details were abstracted from separate institutional databases. Toxicity was graded using CTCAE v5.0. Results: Ninety-three patients from 4 institutions treated with 114 RT courses were included. Patient and treatment details are displayed in Table 1. Median follow up for the cohort was 179 days, and 77 patients (82%) were alive at last follow up. Maximal toxicity experienced by patients included Grade 1 (n = 16), Grade 2 (n = 1) and Grade 3 (n = 1) toxicities. Of 80 sites with response assessment within the RT field, 69% of patients achieved a complete response (n = 55), 20% partial response (n = 16), 9% stable disease (n = 7), and 2% progressive disease (n = 2). No COVID19 infections during or after RT have been documented in this patient cohort. Conclusion: HRT according to ILROG guidelines resulted in low rates of acute toxicity and reasonable short-term treatment efficacy. Longer follow up and comparison with control groups is needed to draw more definitive conclusions and will be presented at the Annual Meeting.

9.
Journal of the American Board of Family Medicine ; 34(2):455-457, 2021.
Article in English | EMBASE | ID: covidwho-1314532
10.
Canadian Journal of Agricultural Economics ; : 1, 2021.
Article in English | Academic Search Complete | ID: covidwho-1150110

ABSTRACT

This paper assesses the earlier projections made by the authors in March 2020 about the impact of COVID‐19 on Canada's food security. First, as measured in the early part of the second quarter of 2020, COVID‐19 is associated with an increased prevalence of household food insecurity as measured by Statistics Canada. Also, as we predicted, we did not observe a rapid general increase in food prices that would have suggested a breakdown in parts of the food system. In this regard, we now develop a general insight that we believe is worthy of ongoing consideration. Put simply, concerns expressed about food insecurity should not be seen as tantamount to a failure of our food supply system. Household income, for example, is an important part of the story. The converse is also true: the success of our food supply system as measured by its capacity to adapt to challenges like COVID‐19 or provide a variety of food at relatively low prices—while necessary, and (in our opinion) critical considerations—will not alone eliminate food insecurity in Canada. The oversimplified conflation of food insecurity concerns with the robustness of our food supply system does a disservice to ongoing efforts to address food insecurity as well as our capacity to assess and improve the Canadian food supply system. (English) [ABSTRACT FROM AUTHOR] Cet article évalue les projections antérieures faites par les auteurs en mars 2020 au sujet de l'impact de la COVID‐19 sur la sécurité alimentaire du Canada. Premièrement, tel que mesuré au début du deuxième trimestre de 2020, la COVID‐19 est associée à une prévalence accrue de l'insécurité alimentaire des ménages telle que mesurée par Statistique Canada. De plus, comme nous l'avions prédit, nous n'avons pas observé une augmentation générale rapide des prix des denrées alimentaires qui aurait suggéré une rupture dans certains maillons du système alimentaire. À cet égard, nous développons maintenant une vision générale qui, à notre avis, mérite d’être maintenue. En termes simples, les préoccupations exprimées au sujet de l'insécurité alimentaire ne doivent pas être considérées comme équivalant à une défaillance de notre système d'approvisionnement alimentaire. Le revenu du ménage, par exemple, est une partie importante de l'histoire. L'inverse est également vrai: le succès de notre système d'approvisionnement alimentaire tel que mesuré par sa capacité à s'adapter à des défis comme le COVID‐19 ou à fournir une variété d'aliments à des prix relativement bas ‐ bien que nécessaire, et (à notre avis) des considérations critiques ‐n’éliminera pas en soit, l'insécurité alimentaire au Canada. L'association simplifiée à l'extrême des préoccupations liées à l'insécurité alimentaire et à la robustesse de notre système d'approvisionnement alimentaire ne rend pas service aux efforts en cours pour lutter contre l'insécurité alimentaire ainsi qu'à notre capacité d'évaluer et d'améliorer le système d'approvisionnement alimentaire canadien. (French) [ABSTRACT FROM AUTHOR] Copyright of Canadian Journal of Agricultural Economics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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