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1.
Lung Cancer ; 165: 34-42, 2022 Jan 20.
Article in English | MEDLINE | ID: covidwho-1654901

ABSTRACT

INTRODUCTION: The diagnostic pathway for lung cancer can be long. Availability of front-line targeted therapies for NSCLC demands access to good quality tissue for genomic sequencing and rapid reporting of results. Diagnosis of lung cancer and availability of tissue was delayed during the COVID-19 pandemic. METHODS: A pilot study assessing Guardant360™ cfDNA-NGS in patients with radiological-suspected advanced-stage lung cancer was performed at an academic cancer centre during COVID-19. Variants were tiered using AMP/ASCO/CAP guidelines and discussed at a tumour molecular board. The primary endpoint was the proportion of patients who commenced targeted treatment based on cfDNA-NGS results without tissue molecular results, predicted to be ≥ 10%. RESULTS: Between April 2020-May 2021, 51 patients were enrolled; 49 were evaluable. The median age was 71 years, 43% were never-smokers, 86% had stage IV disease. 80% of evaluable cfDNA-NGS were informative (tumour-derived cfDNA detected). cfDNA-NGS detected 30 (61%) AMP/ASCO/CAP tier 1 variants, including 20 additional tier 1 variants compared to tissue testing. Three patients with non-informative cfDNA-NGS had tier 1 variants identified on tissue testing. Eleven (22%; 95%CI 12%-27%) patients commenced targeted therapy based on cfDNA-NGS results without tissue molecular results, meeting the primary endpoint. Median time to results was shorter for cfDNA-NGS compared to standard-of-care tissue tests (9 versus 25 days, P < 0.0001). CONCLUSION: Blood-first cfDNA-NGS in NSCLC patients increased the breadth and rapidity of detection of actionable variants with high tissue concordance and led to timely treatment decisions. A blood-first approach should be considered to improve the speed and accuracy of therapeutic decision-making.

2.
Journal of Modern Literature ; 45(1):87-102, 2021.
Article in English | ProQuest Central | ID: covidwho-1613515

ABSTRACT

The topic of aging has been somewhat overlooked, in disability studies, perhaps owing to the adage that "everyone is disabled if they live long enough." If the life course is simply a state of debility, why create a distinct category for bodily and sensory impairment? Disability in old age, I argue, is not a mark of precarity but of capability. The work of writers and artists who continue to experiment formally while becoming increasingly disabled in later years (Beethoven, Henry James, Merce Cunningham) offers an opportunity to complicate "late style" as developed by Theodor Adorno and Edward Said and account for the role of complex embodiment in the production of new work. Finally, I consider Samuel Beckett, whose characters are often aging and disabled and for whom bodily and sensory decline are central to their ability to "go on. "

3.
Lung Cancer ; 156: 147-150, 2021 06.
Article in English | MEDLINE | ID: covidwho-1219424

ABSTRACT

Durvalumab is the first approved adjuvant immunotherapy agent for patients with stage III NSCLC treated with concurrent chemoradiotherapy and is associated with improved overall survival. In order to minimise the number of hospital visits for patients receiving durvalumab during the COVID-19 pandemic we implemented 4-weekly (20 mg/kg) durvalumab in place of 2-weekly infusions at The Royal Marsden Hospital. We assessed the potential impact of the safety of a 4-weekly schedule in patients receiving adjuvant durvalumab. We carried out a retrospective study of 40 patients treated with 2-weekly and 4-weekly infusions of durvalumab prior to and during the COVID-19 pandemic. Clinical documentation was analysed from 216 consultations across 40 patients receiving 2-weekly durvalumab and 66 consultations of 14 patients who switched from 2-weekly to 4-weekly durvalumab during the COVID-19 pandemic. In patients receiving 2-weekly durvalumab, the rate of grade 3 and 4 toxicities was 15 % compared to 7% in patients receiving 4-weekly durvalumab. Pre-existing autoimmune disease was considered a risk factor for the development of grade 3 or 4 toxicities. We did not observe any difference in the rate of grade 1 and 2 toxicities between the two groups. Our findings support the use of 4-weekly durvalumab during the COVID-19 pandemic and beyond, obviating the need for 2-weekly face-to-face consultations and blood tests, relevant given the current pandemic and the need to re-structure cancer services to minimise patient hospital visits and exposure to SARS-CoV-2.


Subject(s)
COVID-19 , Lung Neoplasms , Antibodies, Monoclonal , Humans , Lung Neoplasms/drug therapy , Pandemics , Retrospective Studies , SARS-CoV-2
4.
Br J Nurs ; 30(7): 428-432, 2021 Apr 08.
Article in English | MEDLINE | ID: covidwho-1178578

ABSTRACT

This article describes nurse education with the Open University in Scotland (OUiS). Although there are problems with nurse recruitment and retention across the UK, in Scotland the landscape is somewhat different, with greater support for students required in remote and rural areas. Despite these challenges, the OUiS continues to recruit to the commissioned numbers of places. OUiS nursing students are primarily health care support workers who are a key group within the health and social care workforce but historically have faced many challenges in developing clear career pathways into nursing. At the heart of the OU is the fundamental recognition of distance online pedagogy, complemented by work-based learning support by employers. Partnership working between the OU, employers and education commissioners is crucial to its success.


Subject(s)
Education, Nursing , Universities , Education, Nursing/trends , Forecasting , Humans , Scotland
5.
BMJ Supportive & Palliative Care ; 11(Suppl 1):A17, 2021.
Article in English | ProQuest Central | ID: covidwho-1138409

ABSTRACT

IntroductionTreatment escalation plans (TEP) enable the documentation of senior clinician-led and patient-centred advance care planning. The COVID-19 pandemic highlighted the importance of early decision-making regarding treatment escalation and early palliative care involvement. At the Royal Marsden Hospital, a TEP form was created collaboratively by Palliative Care and Acute Oncology teams in response to the pandemic. It detailed current issues including cancer diagnosis, possible clinical interventions and prognosis.MethodsA retrospective study was performed of TEP completion in non-elective admissions from 6th-27th April 2020. We reviewed patient factors including prognosis, DNACPR status, palliative care involvement and patient outcomes using electronic patient records and TEP forms. A survey was emailed to all clinical staff for feedback on the TEP forms and their impact.ResultsOf the 197 non-elective admissions, 105 (53.3%) had a TEP completed. Compared to those without a TEP, patients who had a TEP completed were more likely to be on a non-curative than curative treatment pathway (91/105 (86.6%) vs 50/92 (54.3%;p<0.001 χ2), have a documented DNACPR status (78.1% vs 18.5%;p<0.001 χ2), have palliative care input (55.2% vs 25%;p<0.001 χ2) or died (18.1% vs 6.5%;p=0.015 χ2) during admission. Suspected or confirmed COVID-19 infection did not impact upon TEP completion in this cohort. The online survey was completed by 59 staff members including 30 consultants. 74.5% respondents felt that the TEP form had a positive impact on patient care, with comments on possible refinements and improvements given.ConclusionsIn a specialist cancer centre rates of completion of TEP forms were higher in non-curative patients receiving increased levels of palliative care input. The TEP form had a perceived positive impact on patient care amongst clinicians, although overall uptake was disappointing. We plan to update the TEP form in response to feedback, and re-audit after 6 months.

6.
Curr Atheroscler Rep ; 22(9): 48, 2020 07 25.
Article in English | MEDLINE | ID: covidwho-1103544

ABSTRACT

PURPOSE OF REVIEW: The COVID-19 pandemic has infected over > 11 million as of today people worldwide and is associated with significant cardiovascular manifestations, particularly in subjects with preexisting comorbidities and cardiovascular risk factors. Recently, a predisposition for arterial and venous thromboses has been reported in COVID-19 infection. We hypothesize that besides conventional risk factors, subjects with elevated lipoprotein(a) (Lp(a)) may have a particularly high risk of developing cardiovascular complications. RECENT FINDINGS: The Lp(a) molecule has the propensity for inhibiting endogenous fibrinolysis through its apolipoprotein(a) component and for enhancing proinflammatory effects such as through its content of oxidized phospholipids. The LPA gene contains an interleukin-6 (IL-6) response element that may induce an acute phase-type increase in Lp(a) levels following a cytokine storm from COVID-19. Thus, subjects with either baseline elevated Lp(a) or those who have an increase following COVID-19 infection, or both, may be at very high risk of developing thromboses. Elevated Lp(a) may also lead to acute destabilization of preexisting but quiescent atherosclerotic plaques, which might induce acute myocardial infarction and stroke. Ongoing studies with IL-6 antagonists may be informative in understanding this relationship, and registries are being initiated to measure Lp(a) in subjects infected with COVID-19. If indeed an association is suggestive of being causal, consideration can be given to systematic testing of Lp(a) and prophylactic systemic anticoagulation in infected inpatients. Therapeutic lipid apheresis and pharmacotherapy for the reduction of Lp(a) levels may minimize thrombogenic potential and proinflammatory effects. We propose studies to test the hypothesis that Lp(a) may contribute to cardiovascular complications of COVID-19.


Subject(s)
Coronavirus Infections/blood , Coronavirus Infections/complications , Inflammation/etiology , Lipoprotein(a)/blood , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Thrombosis/etiology , Acute-Phase Proteins/analysis , Acute-Phase Proteins/genetics , Anticoagulants/therapeutic use , Apolipoprotein E4/genetics , Atherosclerosis/etiology , Betacoronavirus , Biomarkers/blood , Biomedical Research , Blood Component Removal , COVID-19 , Coronavirus Infections/epidemiology , Genotype , Humans , Inflammation/prevention & control , Interleukin-6/antagonists & inhibitors , Interleukin-6/blood , Lipoprotein(a)/genetics , Pandemics , Pneumonia, Viral/epidemiology , Race Factors , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Thrombosis/prevention & control
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