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1.
Journal of Thoracic Oncology ; 17(9):S250, 2022.
Article in English | EMBASE | ID: covidwho-2031518

ABSTRACT

Introduction: In Portugal, in 2020, 5415 new lung cancer patients were diagnosed and 4797 deaths were caused by lung cancer. Lung cancer ranks third in terms of cancer incidence and is the leading cause of cancer mortality. Early diagnosis, complete and fast patient assessment and staging, multidisciplinary approach, access to personalized medicine, new treatment options and research are essential to improve survival and quality of life. Access to clinical trials is critical for this improvement.The aim of this study is to assess the techniques available to the diagnostic work-up, treatments, the waiting time and the needs perceived by physicians. Methods: The Portuguese Lung Cancer Study Group launched a survey in order to study the diagnostic approach and treatment of lung cancer patients in Portugal. An online survey with 47 questions was sent to all Portuguese hospitals that treat lung cancer, referring to the pre-COVID-19 pandemic experience. Results: Responses from 31 Portuguese hospitals were collected, between May and September 2020. Availability to bronchoscopy, image-guided transthoracic needle biopsy (TNB), endobronchial ultrasound- transbronchial needle aspiration (EBUS-TNBA), PET/CT, molecular biology testing is presented in table I. In 58% (n=18) the molecular biology test was performed as a "reflex test". About 68% (n=21) of hospitals used next generation sequencing. Two hospitals (7%) reported not having access to liquid biopsies.Video-assisted thoracoscopic surgery was the main surgical technique (61%;n=19). The waiting time for the first radiation oncology consultation was less than 15 days in 71% (n=26). About 61% (n=19) of hospitals had clinical trials. A wide majority of doctors (77%) would like to have more clinical trials. In 71% (n=22) of the hospitals, it was possible to refer patients to Palliative Care receiving systemic anticancer therapy. [Formula presented] Conclusions: Despite the limitations of the methods, this study allowed us to deepen our knowledge about the work-up technologies and treatments available for lung cancer patients in Portugal. It has also identified future opportunities, such as increasing accessibility to some diagnostic tools and clinical trials. Keywords: Diagnosis and treatment approach, Lung Cancer in Portugal, Health Services Research - Portugal

2.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927698

ABSTRACT

RATIONALE Pulmonary rehabilitation (PR) is an important management modality in individuals with chronic lung disease. The internet is commonly used as a source of health information by individuals with lung disease. Given the ongoing COVID-19 pandemic and closure of in-person PR programs, many patients with lung disease rely on online resources for exercise training;however, the quality and reliability of online information on PR has not been evaluated. Thus, the objective of this study is to characterize internet resources on PR, and to assess the readability, content and quality of patient-directed PR resources. METHODS The first 200 websites for the search term 'pulmonary rehabilitation resources and exercise' were analyzed in Google, Yahoo and Bing. Website content was evaluated based on a predefined scoring system of the key components of PR, as described in the most recent international consensus guidelines. Website quality and reliability were determined using the validated DISCERN instrument and the Global Quality Scale (GQS). RESULTS A total of 70 unique websites were identified with the two most common categories being academic resources (63%) and foundation/advocacy organizations (33%). The average reading grade level of PR websites was equivalent to grade 11. There was significant heterogeneity in content (Table 1) across websites related to exercise training, education, and behaviour change (17.7 ± 5.1 out of 30). Most websites focused on traditional modalities of aerobic (96%) and resistance training (87%), in contrast to balance exercises (16%) and inspiratory muscle training (19%). A small majority of websites provided education focused on smoking cessation (59%), breathing strategies (59%), and nutrition (54%), with fewer websites addressing self-efficacy (37%) and motivation (13%). Website quality was good across PR websites (DISCERN median score 4.0 IQR (3.0-4.0) and GQS 4.0 IQR (2.0-4.0) out of 5 for both measures). CONCLUSIONS PR content varied significantly across websites and only partially captured items outlined in the PR international consensus guidelines. Website quality was good, suggesting that most PR websites were overall useful for patients;however, the higher-than-recommended reading level of patient education materials may compromise utilization and comprehension of PR resources. Efforts need to be made to better tailor online PR resources to the general lung population. (Figure Presented).

3.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925282

ABSTRACT

Objective: To analyze the characteristics of commercially available sleep-exclusive apps using the Mobile Health Index and Navigation (MIND) apps database published by the Division of Digital Psychiatry at BIDMC for app review. Background: Over 70 million Americans endure a chronic sleep disorder during their lifetime. Due to the COVID-19 pandemic, mobile app benefits have been postulated as a means of expanding patient access to scientifically-based interventions in aiding their sleep disorders. With the increasing adoption of mobile health apps, it is critical that information regarding these mobile apps are sufficiently analyzed. Design/Methods: Using pre-specified criteria, we identified 106 sleep related mobile apps in the iOS and Google Playstores, and rated them using a 105 question review that is part of the MIND database. Questions focused on: Accessibility, Privacy & Security, Clinical Foundation, Engagement Style, and Interoperability. The features of the 106 apps were compared to a control group of non-sleep apps to evaluate the features and limitations sleep apps bear relative to the remainder of the marketplace. Results: The most common features of sleep apps were mindfulness (68.9%), deep breathing (54.7%), and psychoeducation (30.2%). Regarding functionality, 39.6% of apps have accessibility features and 49.1% can be used offline. However, sleep apps lack sleep trackers (22.6%), exportability features (21.7%), and opportunities to collaborate with one's provider (7.6%). Only 10.4% of sleep apps have an efficacy study. Conclusions: Sleep apps in the marketplace are primarily used to help the user fall and stay asleep. In its current state, sleep apps can assist only the user as a self-help tool. The lack of sleep tracking, support, exportability, the inability to collaborate with one's provider and efficacy studies limit the potential of implementing sleep apps for clinical use.

4.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925152

ABSTRACT

Objective: We aimed to assess the characteristics of the pain application (app) marketplace and determine improvements to mobile health (m Health) that could assist patients with pain disorders in obtaining more accessible care. Background: During the COVID-19 pandemic, complementary and integrative therapies delivered via mHealth technologies have become more popular due to their accessibility. As more users are downloading apps to address health concerns, it is important to analyze the ever growing marketplace's features and limitations. Design/Methods: After searching the iOS and Google Play Stores for commercially available pain apps that met pre-specified search criteria, trained app raters entered 47 apps into the Mobile-Health Index and Navigation Database (MIND) published by the Division of Digital Psychiatry at BIDMC. Through a 105-question objective rating framework, each app was evaluated for its accessibility, privacy, cost, functionalities, features, and clinical foundations. The data was compared with a control group of non-pain apps-matched for platform and cost -to examine the traits of pain apps in contrast with the rest of the marketplace. Results: The top features were 44.7% (21/47) offered symptom tracking, 34.0% (16/47) offered medication tracking, and 42.6% (20/47) offered physical health exercises. Just 2.13% (1/47) of apps offered HIPAA privacy protections or had a crisis management feature. Additionally, only 10.64% (5/47) of pain apps were supported by efficacy studies. Conclusions: Commercially available pain apps are typically used to record pain episodes or document medications. However, the lack of privacy, crisis management, and efficacy studies may be preventing their clinical implementation.

5.
Journal of Mental Health Policy and Economics ; 25(SUPPL 1):S30, 2022.
Article in English | EMBASE | ID: covidwho-1913242

ABSTRACT

Background: COVID-19 has increased interest and uptake of mental health apps. As healthcare payers consider reimbursement for some apps and creation of app formularies, questions remain about the state of these apps and how to judge their value. As apps are not static and constantly changing and updating, we investigated the dynamics of the app marketplaces to better understand their privacy, efficacy, and safety features in the 'real world'. Methods: A sample of 250 apps were reviewed between September 1st 2021 and December 1st 2021. Apps were selected from mindapps. org based on their age of last review on mindapps.org, with apps approaching six months since being updated in this database reviewed first. Mindapps.org is the world's largest free-to-access database of mental health apps that currently curates 650 apps each rated across 105 dimensions. For this study, each of the 250 apps were again reviewed across 105 dimensions and results were compared to changes from the prior rating of the same app ∼6 months ago. Results: The average app updates every 364 days although some nearly weekly. Privacy features changed the most since the last update with 38% of apps reflecting a change. 37% of apps changed in regards to features offered with the most common change as adding physical exercise related content to the apps. Functionality and access changed in 27% of apps with the most common change being increase in accessibility features as well as offering offline access to the app. 20% of apps changed their cost structure with 12% adding a fee for use of the app. Reviewers noted that ads to support apps were in some cases intrusive. Discussion: The dynamic nature of the app stores is reflected in app privacy, features, and functionality. For payers to be able to offer app formularies, they need to create metrics to assess these changes in the app landscape or else tightly control app updates themselves. Other aspects necessary for valuation such as real-world engagement with the apps as well as mean effect size are not publicly available and thus not reported in our results. To truly understand the economic value of mental health apps, dynamic pricing models combined with transparency in data reporting from apps will be necessary.

7.
Journal of Thoracic Oncology ; 16(3):S285-S286, 2021.
Article in English | EMBASE | ID: covidwho-1159457

ABSTRACT

Introduction: The first patient with COVID-19 in Portugal was diagnosed on March 2. There was a lack of knowledge concerning the risks of COVID-19 infection in lung cancer patients, prognostic factors, the influence of cancer treatments and cure criteria. Treatments and consultations were readjusted in order to maintain the ones that increase patients’ survival, while reducing the risks of SARS-CoV-2 infection. International and national “guidelines” were followed, but each hospital had its own strategies to reduce COVID-19 risk. Purpose: The Portuguese Lung Cancer Study Group launched a survey in order to study the early impact of COVID-19 in lung cancer patients, changes in treatments and the way of implementation of COVID-free circuits. Methods: A survey was sent to lung cancer doctors of all the Portuguese hospitals. Results: At the data cut-off, information from twenty one hospitals was collected, corresponding to about 66% (n=3.446) of each year new diagnoses of lung cancer in Portugal. In March and April there was a reduction in newly lung cancer diagnosed patients while comparing with 2019: in March, 86% had a reduction;in April, 90% of the hospitals reported a reduction and it was greater than 40% in eight hospitals (38%). About 62% of the doctors considered less referral from primary care as a cause, and 33% delayed biopsies or other imaging exams. The most difficult exams to obtain were CT guided biopsies and EBUS for 48%. The majority of the hospitals (57%) were also referral for COVID-19 patients’ treatment. In 48% of the lung cancer treating departments’ there were doctors reallocated to COVID-19 treatment areas. In 48% the assistance teams were divided into teams that weren’t previously working together. The majority of doctors (90%) reported having individual protection equipment available. Hospitals performed teleconsultation (100%), and, in seven hospitals (33%), more than half of the consultations were done using communication technology. All the hospitals were able to perform SARS-CoV-2 testing. It was done before every cycle of chemotherapy in 90% of the hospitals. In the majority (67%) it was only performed before day D1, in D1 and D8 chemotherapy protocols. About 19% reported changes in prescription of adjuvant chemotherapy and in maintenance chemotherapy, 33% increased the prescription of oral chemotherapy, 33% changed the periodicity, 29% reported reduction in inclusion in clinical trials. In 33% there was an earlier end of chemotherapy in ECOG2 and vulnerable patients. In 38% the prescription of G-CSF (Granulocity-colony stimulating factor) increased, being used for prophylaxis if the risk of febrile neutropenia was more than 10-15%. The periodicity of consultations was changed for patients under TKI treatment in 86%, and 67% hospitals reported changes in immune checkpoint inhibitor treatment schedule. In 29% oral drugs could be delivered at patients’ home. All the patients admitted for surgery were tested for SARS-CoV-2, and 86% performed SARS-COV-2 testing before radiotherapy. Conclusion: Portuguese hospitals responded to the sudden need of creation of COVID-free circuits, change protocols and even teleconsultation. With a larger follow up we will study the late consequences of COVID-19 pandemic in lung cancer diagnosis and treatment. Keywords: COVID-19, survey, Portuguese Lung Cancer Study Group

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