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1.
Female Pelvic Med Reconstr Surg ; 28(3): e88-e92, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1735712

ABSTRACT

OBJECTIVE: This study aimed to assess and trend fears surrounding elective surgery and office procedures in benign gynecologic and urogynecologic patients during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This was a multicenter, prospective, observational study. Recruitment occurred from June 23, 2020, to March 23, 2021. Females 18 years or older presenting for elective benign gynecologic or urogynecologic surgery or office procedures were eligible. Patients were excluded if non-English speaking or undergoing an emergent procedure or surgery. Fear was assessed by the Surgical Fear Questionnaire (SFQ), which was also modified to include 2-4 additional questions pertaining to COVID-19 (modified version of the Surgical Fear Questionnaire [mSFQ]). Total SFQ scores and short- and long-term fear scores were compared between procedures and surgery and to historic data. RESULTS: A total of 209 patients undergoing 107 procedures or 102 surgical procedures completed the questionnaire. Participants were separated into subgroups determined by the timing of questionnaire completion related to phases of the pandemic. The most common procedure was urodynamics (n = 59 [55%]). The most common elective surgical procedure was hysterectomy (n = 59 [57.8%]). Furthermore, 72.5% of surgical procedures were for urogynecologic indications.Fear levels were low and not different in patients undergoing procedures versus surgery (12.38 ± 12.44 vs 12.03 ± 16.01, P = 0.958). There was no difference between procedures versus surgery for short- (6.21 ± 8.38 vs 6.81 ± 8.44, P = 0.726) or long-term fear (6.18 ± 8.89 vs 5.22 ± 8.20, P = 0.683). Compared with historic data, our hysterectomy patients had less surgical fear. The mSFQ demonstrated higher fear scores for both procedures and surgery (mSFQ, 20.57 ± 20.55 for procedures; 28.78 ± 28.51 for surgery). There were no significant fluctuations in SFQ score in relation to critical COVID-19 events. CONCLUSIONS: Fear of surgery and office procedures was low and consistent throughout the COVID-19 pandemic and lower than historic data.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , Elective Surgical Procedures , Fear , Female , Humans , Pandemics , Prospective Studies , SARS-CoV-2 , Surveys and Questionnaires
2.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-307373

ABSTRACT

Managing a pandemic requires continuous dissemination of infectious disease surveillance data. Legislation permits sharing de-identified patient data;however, current de-identification approaches are time-consuming and do not flex with changes in infection rates or population demographics over time. In this paper, we introduce a framework to dynamically adapt de-identification for near-real time sharing of patient-level surveillance data. The framework leverages a simulation mechanism, capable of being applied to any geographic level, to forecast and manage disclosure risks. We use data from Johns Hopkins University and the Centers for Disease Control and Prevention to demonstrate the framework's effectiveness in maintaining the privacy risk below a threshold based on public health standards for COVID-19 county-level case data from August 2020 to April 2021. Across all US counties, the framework's approach meets the threshold for 95.2% of daily data releases, while a policy based on current de-identification techniques meets the threshold for only 24.6%.

3.
PLoS One ; 16(3): e0248128, 2021.
Article in English | MEDLINE | ID: covidwho-1575679

ABSTRACT

BACKGROUND: The COVID-19 pandemic remains a significant global threat. However, despite urgent need, there remains uncertainty surrounding best practices for pharmaceutical interventions to treat COVID-19. In particular, conflicting evidence has emerged surrounding the use of hydroxychloroquine and azithromycin, alone or in combination, for COVID-19. The COVID-19 Evidence Accelerator convened by the Reagan-Udall Foundation for the FDA, in collaboration with Friends of Cancer Research, assembled experts from the health systems research, regulatory science, data science, and epidemiology to participate in a large parallel analysis of different data sets to further explore the effectiveness of these treatments. METHODS: Electronic health record (EHR) and claims data were extracted from seven separate databases. Parallel analyses were undertaken on data extracted from each source. Each analysis examined time to mortality in hospitalized patients treated with hydroxychloroquine, azithromycin, and the two in combination as compared to patients not treated with either drug. Cox proportional hazards models were used, and propensity score methods were undertaken to adjust for confounding. Frequencies of adverse events in each treatment group were also examined. RESULTS: Neither hydroxychloroquine nor azithromycin, alone or in combination, were significantly associated with time to mortality among hospitalized COVID-19 patients. No treatment groups appeared to have an elevated risk of adverse events. CONCLUSION: Administration of hydroxychloroquine, azithromycin, and their combination appeared to have no effect on time to mortality in hospitalized COVID-19 patients. Continued research is needed to clarify best practices surrounding treatment of COVID-19.


Subject(s)
Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19/drug therapy , Hydroxychloroquine/therapeutic use , Pandemics/prevention & control , Data Management/methods , Drug Therapy, Combination/methods , Female , Hospitalization , Humans , Male , SARS-CoV-2/drug effects
4.
Female Pelvic Medicine and Reconstructive Surgery ; 27(10 SUPPL 1):S119-S120, 2021.
Article in English | EMBASE | ID: covidwho-1511120

ABSTRACT

Objective: To assess and trend fears surrounding elective surgeries and office procedures with a standardized questionnaire in benign gynecologic and urogynecologic patients during the Coronavirus-19 (COVID) pandemic.We hypothesized that COVID-related fear was greater in surgical patients over procedural patients, that surgical fearwould be greater than historic data, and that fear levels would increase with the course of the pandemic. Methods: This is a multicenter, prospective, observational study. Recruitment occurred from June 23, 2020 until March 23, 2021. Females 18 years or older presenting for elective, benign gynecologic or urogynecologic surgery or office procedures were eligible. Patients were excluded if non-English speaking or undergoing an emergent procedure or surgery. Fear was assessed with the Surgical Fear Questionnaire (SFQ), a validated 8-item survey that evaluates short term (questions 1-4) and long term (questions 5-8) fears related to surgery. We modified the SFQ to include 2-4 additional questions about the COVID-19 pandemic (mSFQ) and to apply to procedures (10 questions) and surgeries (14 questions) (Table 1). Questions were scored on a scale of 0-10 with 0 being 'not at all afraid' and 10 being 'very afraid'. Total SFQ scores and short and long term fear scores were compared between procedures and surgeries and to historic data (Theunissen et al, 2016). Results: 209 subjects undergoing 107 procedures or 102 surgeries completed the questionnaire. Demographics are shown in Table 1. The prevalence of chronic pain, depression, and anxiety was similar to national statistics. The most common procedure was urodynamics (n = 59, 55%). Themost common elective surgery was hysterectomy (n = 59, 57.8%). 72.5% surgeries were for urogynecologic indications. Fear assessed by the SFQ (12.21 ± 16.21) was overall low and not different in subjects undergoing procedures versus surgery (12.38 ± 12.44 vs 12.03 ± 16.01, P = 0.958). Similarly, fear was not different between procedures vs surgery for short term (6.21 ± 8.38 vs 6.81 ± 8.44, P = 0.726) and long term fear (6.18 ± 8.89 vs 5.22 ± 8.20, P = 0.683). The mSFQ, which captured COVID-specific fears, demonstrated higher fear scores for both procedures and surgeries compared to SFQ (mSFQ 20.57 ± 20.55 for procedures, 28.78 ± 28.51 for surgeries versus 12.21 ± 16.21 for SFQ). These included fear of hospitalization, overworked doctors, concern for family, etc (Table 1). There were no significant fluctuations in SFQ score in relation to critical COVID-19 events (Figure 1). We compared our data to the largest study of surgical fear in 428 women undergoing benign hysterectomy outside of a pandemic by Theunissen et al 2016 and found a significantly lower fear in our population in both the short (6.5 ± 8.39 vs 16 ± 9.9, P < 0.001) and long term(5.71 ± 8.56 vs 9.3 ± 8.6, p < 0.001) scores. This lower level of surgical fear persisted solely comparing our hysterectomy subjects to the aforementioned data in both short term (7.37 ± 8.62 vs 16 ± 9.9, p < 0.001) and long term (5.12 ± 7.14 vs 9.3 ± 8.6, P < 0.001) scores. Conclusions: Fear of surgeries and office procedures was overall low and consistent throughout the COVID-19 pandemic. Compared to historic data, our patients had lower levels of surgical fear. Fear scores increased with the addition of COVID-specific questions, indicating some fear surrounding having a procedure or surgery during the pandemic. Interpretation of our results is limited by the fact that the patients surveyed had already decided to continue in-person care.

5.
JMIR Res Protoc ; 10(7): e23831, 2021 Jul 09.
Article in English | MEDLINE | ID: covidwho-1308224

ABSTRACT

BACKGROUND: More than 7% of the world's population is living with a chronic respiratory condition. In the United Kingdom, lung disease affects approximately 1 in 5 people, resulting in over 700,000 hospital admissions each year. People with respiratory conditions have several symptoms and can require multiple health care visits and investigations before a diagnosis is made. The tests available can be difficult to perform, especially if a person is symptomatic, leading to poor quality results. A new, easy-to-perform, point-of-care test that can be performed in any health care setting and that can differentiate between various respiratory conditions would have a significant, beneficial impact on the ability to diagnose respiratory diseases. OBJECTIVE: The objective of this study is to use a new handheld device (Inflammacheck) in different respiratory conditions to measure the exhaled breath condensate hydrogen peroxide (EBC H2O2) and compare these results with those of healthy controls and with each other. This study also aims to determine whether the device can measure other parameters, including breath humidity, breath temperature, breath flow dynamics, and end tidal carbon dioxide. METHODS: We will perform a single-visit, cross-sectional observational study of EBC H2O2 levels, as measured by Inflammacheck, in people with respiratory disease and volunteers with no known lung disease. Participants with a confirmed diagnosis of asthma, chronic obstructive pulmonary disease, lung cancer, bronchiectasis, pneumonia, breathing pattern disorder, and interstitial lung disease as well as volunteers with no history of lung disease will be asked to breathe into the Inflammacheck device to record their breath sample. RESULTS: The results from this study will be available in 2022, in anticipation of COVID-19-related delays. CONCLUSIONS: This study will investigate the EBC H2O2, as well as other exhaled breath parameters, for use as a future diagnostic tool.

6.
Cancer Rep (Hoboken) ; 4(5): e1388, 2021 10.
Article in English | MEDLINE | ID: covidwho-1235659

ABSTRACT

BACKGROUND: The understanding of the impact of COVID-19 in patients with cancer is evolving, with need for rapid analysis. AIMS: This study aims to compare the clinical and demographic characteristics of patients with cancer (with and without COVID-19) and characterize the clinical outcomes of patients with COVID-19 and cancer. METHODS AND RESULTS: Real-world data (RWD) from two health systems were used to identify 146 702 adults diagnosed with cancer between 2015 and 2020; 1267 COVID-19 cases were identified between February 1 and July 30, 2020. Demographic, clinical, and socioeconomic characteristics were extracted. Incidence of all-cause mortality, hospitalizations, and invasive respiratory support was assessed between February 1 and August 14, 2020. Among patients with cancer, patients with COVID-19 were more likely to be Non-Hispanic black (NHB), have active cancer, have comorbidities, and/or live in zip codes with median household income <$30 000. Patients with COVID-19 living in lower-income areas and NHB patients were at greatest risk for hospitalization from pneumonia, fluid and electrolyte disorders, cough, respiratory failure, and acute renal failure and were more likely to receive hydroxychloroquine. All-cause mortality, hospital admission, and invasive respiratory support were more frequent among patients with cancer and COVID-19. Male sex, increasing age, living in zip codes with median household income <$30 000, history of pulmonary circulation disorders, and recent treatment with immune checkpoint inhibitors or chemotherapy were associated with greater odds of all-cause mortality in multivariable logistic regression models. CONCLUSION: RWD can be rapidly leveraged to understand urgent healthcare challenges. Patients with cancer are more vulnerable to COVID-19 effects, especially in the setting of active cancer and comorbidities, with additional risk observed in NHB patients and those living in zip codes with median household income <$30 000.


Subject(s)
COVID-19/epidemiology , Neoplasms/epidemiology , Social Determinants of Health/statistics & numerical data , Socioeconomic Factors , Aged , COVID-19/diagnosis , COVID-19/therapy , COVID-19/virology , Comorbidity , Data Analysis , Female , Hospital Mortality , Humans , Male , Middle Aged , Neoplasms/complications , Neoplasms/immunology , Patient Admission/statistics & numerical data , Respiration, Artificial , Retrospective Studies , Risk Factors , SARS-CoV-2/immunology , Severity of Illness Index , United States/epidemiology
7.
ERJ Open Res ; 7(1)2021 Jan.
Article in English | MEDLINE | ID: covidwho-1076124

ABSTRACT

Asthma therapy, including monoclonal antibodies, was not associated with #COVID19 infection or hospitalisation in a UK severe asthma population. Shielding led to a reported worsening of mental health in nearly half of patients contacted (47%). https://bit.ly/3jImUsG.

9.
J Thromb Haemost ; 18(9): 2110-2117, 2020 09.
Article in English | MEDLINE | ID: covidwho-623519

ABSTRACT

COVID-19 is frequently accompanied by a hypercoagulable inflammatory state with microangiopathic pulmonary changes that can precede the diffuse alveolar damage characteristic of typical acute respiratory distress syndrome (ARDS) seen in other severe pathogenic infections. Parallels with systemic inflammatory disorders such as atypical hemolytic uremic syndrome (aHUS) have implicated the complement pathway in the pathogenesis of COVID-19, and particularly the anaphylatoxins C3a and C5a released from cleavage of C3 and C5, respectively. C5a is a potent cell signalling protein that activates a cytokine storm-a hyper-inflammatory phenomenon-within hours of infection and the innate immune response. However, excess C5a can result in a pro-inflammatory environment orchestrated through a plethora of mechanisms that propagate lung injury, lymphocyte exhaustion, and an immune paresis. Furthermore, disruption of the homeostatic interactions between complement and extrinsic and intrinsic coagulation pathways contributes to a net pro-coagulant state in the microvasculature of critical organs. Fatal COVID-19 has been associated with a systemic inflammatory response accompanied by a pro-coagulant state and organ damage, particularly microvascular thrombi in the lungs and kidneys. Pathologic studies report strong evidence of complement activation. C5 blockade reduces inflammatory cytokines and their manifestations in animal studies, and has shown benefits in patients with aHUS, prompting investigation of this approach in the treatment of COVID-19. This review describes the role of the complement pathway and particularly C5a and its aberrations in highly pathogenic virus infections, and therefore its potential as a therapeutic target in COVID-19.


Subject(s)
Blood Coagulation , COVID-19/immunology , Complement Activation , Complement C3a/metabolism , Complement C5a/metabolism , Inflammation/metabolism , Animals , Atypical Hemolytic Uremic Syndrome/complications , Atypical Hemolytic Uremic Syndrome/immunology , COVID-19/complications , COVID-19/pathology , Complement Inactivating Agents/pharmacology , Cytokines/metabolism , Hemoglobinuria, Paroxysmal/complications , Hemoglobinuria, Paroxysmal/immunology , Homeostasis , Humans , Immunity, Innate , Lung Diseases , Lung Injury , Signal Transduction
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