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1.
Ieee Access ; 10:99709-99723, 2022.
Article in English | Web of Science | ID: covidwho-2070265

ABSTRACT

Crowd sourcing and human computation has slowly become a mainstay for many application areas that seek to leverage the crowd in the development of high quality datasets, annotations, and problem solving beyond the reach of current AI solutions. One of the major challenges to the domain is ensuring high-quality and diligent work. In response, the literature has seen a large number of quality control mechanisms each voicing (sometimes domain-specific) benefits and advantages when deployed in largescale human computation projects. This creates a complex design space for practitioners: it is not always clear which mechanism(s) to use for maximal quality control. In this article, we argue that this decision is perhaps overinflated and that provided there is "some kind" of quality control that this obviously known to crowd workers this is sufficient for "high-quality" solutions. To evidence this, and provide a basis for discussion, we undertake two experiments where we explore the relationship between task design, task complexity, quality control and solution quality. We do this with tasks from natural language processing, and image recognition of varying complexity. We illustrate that minimal quality control is enough to repel constantly underperforming contributors and that this is constant across tasks of varying complexity and formats. Our key takeaway: quality control is necessary, but seemingly not how it is implemented.

2.
Atherosclerosis (00219150) ; 355:N.PAG-N.PAG, 2022.
Article in English | Academic Search Complete | ID: covidwho-2014908
4.
Geburtshilfe Und Frauenheilkunde ; 82(6):S51-S51, 2022.
Article in German | Web of Science | ID: covidwho-1984499
6.
Sleep ; 45(SUPPL 1):A22, 2022.
Article in English | EMBASE | ID: covidwho-1927381

ABSTRACT

Introduction: COVID-19 resulted in many office workers switching to remote work. Emerging studies report working from home has negatively affected sleep health (SH) and psychological well-being. Our aim was to evaluate the relationship between SH and healthand work-related quality of life and explore whether these associations differed pre- and post-COVID-19 emergence. Methods: Baseline data from 125 adults enrolled pre- (n=59) and post-COVID-19 emergence (n=66) in a clinical trial with desk jobs were included in this analysis (86.4% White;49.6% female;43.9±10.7 y). Health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire, which addresses eight health concepts (physical, social, and role functioning;mental health;health perceptions;energy or fatigue;pain;general health) and yields 2 summary scales (mental component summary, physical component summary). Workplace productivity and worker health was measured using the Health and Work Questionnaire (HWQ). Six SH dimensions were assessed using questionnaires (satisfaction, alertness) and 7 nights of actigraphy (regularity, timing, efficiency, duration). Each dimension was categorized as good or poor;a composite score was created based on the sum of good SH dimensions. Multiple linear regression models were adjusted for gender and age and stratified by enrollment pre- or post-COVID-19 emergence. Data are presented as standardized coefficients (β) and p-values (p). Results: Compared to participants enrolled prior to COVID-19, those enrolled post-COVID-19 had worse SF-36 emotional, social, and general health and greater HWQ-assessed impatience (all p<0.05);however, SH did not differ between those enrolled pre- and post-COVID. Prior to COVID-19, greater SH was associated with higher SF-36 physical component scores (β=.389, p=.003);however, no association was observed post-COVID (β=.137, p=.271). In contrast, no association was observed pre-COVID between SH and SF-36 mental component scores (β=.181, p=.160), but greater SH was associated with greater mental component scores post- COVID (β =.308, p=.004). Furthermore, better SH was associated with lower stress post-COVID (β =-.423, p<.001). Conclusion: SH was associated with HRQoL and workplace and worker health, though these associations sometimes differed between pre- and post-COVID emergence. Research should explore whether promoting SH in employees impacts their personal and workplace-related quality of life.

7.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333596

ABSTRACT

MOTIVATION: In the event of an outbreak due to an emerging pathogen, time is of the essence to contain or to mitigate the spread of the disease. Drug repositioning is one of the strategies that has the potential to deliver therapeutics relatively quickly. The SARS-CoV-2 pandemic has shown that integrating critical data resources to drive drug-repositioning studies, involving host-host, hostpathogen and drug-target interactions, remains a time-consuming effort that translates to a delay in the development and delivery of a life-saving therapy. RESULTS: Here, we describe a workflow we designed for a semi-automated integration of rapidly emerging datasets that can be generally adopted in a broad network pharmacology research setting. The workflow was used to construct a COVID-19 focused multimodal network that integrates 487 host-pathogen, 74,805 host-host protein and 1,265 drug-target interactions. The resultant Neo4j graph database named "Neo4COVID19" is accessible via a web interface and via API calls based on the Bolt protocol. We believe that our Neo4COVID19 database will be a valuable asset to the research community and will catalyze the discovery of therapeutics to fight COVID-19. AVAILABILITY: https://neo4covid19.ncats.io.

8.
ACS Catalysis ; : 3909-3922, 2022.
Article in English | Scopus | ID: covidwho-1783933

ABSTRACT

Kurt Faber, a synthetic organic chemist by training, strongly influenced the field of biocatalysis throughout the course of his four-decade career (from the late 1980s to the early 2020s). The evolution of his career has gone hand in hand with the development of biocatalysis into a mature and versatile discipline originally deep-rooted in organic chemistry that quickly integrated techniques from molecular biology. His work has provided numerous grounds for recognizing natural catalysts as essential tools in organic synthesis, complementing the more chemical approaches. An important aspect of Kurt Faber's career encompasses teaching, mentoring, and encouraging the development of younger scientists worldwide. His book, Biotransformations in Organic Chemistry, now in its seventh edition, has become a recognized tool for training generations of chemists and biotechnologists and remains a reference worldwide. At Biotrans 2021, the 15th International Symposium on Biocatalysis and Biotransformations (originally scheduled to be held in Graz, Austria, and eventually held online due to the COVID-19 pandemic), Kurt Faber received the Biotrans senior award in recognition of his innovative contributions to the field. In this Account, we would like to acknowledge his contributions to the field of biocatalysis, highlighting both the growing importance of this discipline in many (industrial) sectors and the profound changes that have occurred in recent decades, while reflecting on some of Kurt Faber's most important discoveries and his legacy to this field. © 2022 The Authors. Published by American Chemical Society.

9.
Non-conventional in English | National Technical Information Service, Grey literature | ID: grc-753476

ABSTRACT

This investigation report describes a case of COVID-19 in a combined military and civilian office workspace and the contact investigation and mitigation efforts that followed. This office space included an embedded public health officer who was able to conduct the contact investigation and advise on the outbreak response. Over a 3-day period, the index case unintentionally exposed 150 coworkers to SARS-CoV-2 through participation in carpools, conferences, and small meetings. Of these exposures 37 were considered medium risk at the time and 113 were considered low risk. A total of 5 contacts reported COVID-like-symptoms at the time of the investigation and another 5 developed symptoms during the14-day quarantine period and all were directed to self-isolate. None of the contacts required hospitalization and all the symptomatic contacts tested negative for SARS-CoV-2. With the advice and aid of the embedded public health officer, the office authorized telework, conducted thorough cleaning of spaces, distributed informative messaging, conducted virtual question-and-answer forums, and evaluated outbreak policies. This report demonstrates that the close integration of public health and office management can lead to rapid identification of those at risk of infection and implementation of mitigation and control efforts to stop the spread of disease.

10.
MEDLINE; 2022.
Preprint in English | MEDLINE | ID: ppcovidwho-329653

ABSTRACT

Neutralizing antibodies targeting the SARS-CoV-2 spike protein have shown a great preventative/therapeutic potential. Here, we report a rapid and efficient strategy for the development and design of SARS-CoV-2 neutralizing humanized nanobody constructs with sub-nanomolar affinities and nanomolar potencies. CryoEM-based structural analysis of the nanobodies in complex with spike revealed two distinct binding modes. The most potent nanobody, RBD-1-2G(NCATS-BL8125), tolerates the N501Y RBD mutation and remains capable of neutralizing the B.1.1.7 (Alpha) variant. Molecular dynamics simulations provide a structural basis for understanding the neutralization process of nanobodies exclusively focused on the spike-ACE2 interface with and without the N501Y mutation on RBD. A primary human airway air-lung interface (ALI) ex vivo model showed that RBD-1-2G-Fc antibody treatment was effective at reducing viral burden following WA1 and B.1.1.7 SARS-CoV-2 infections. Therefore, this presented strategy will serve as a tool to mitigate the threat of emerging SARS-CoV-2 variants.

11.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-329567

ABSTRACT

The extent of SARS-CoV-2 infection throughout the United States population is currently unknown. High quality serology is a key tool to understanding the spread of infection, immunity against the virus, and correlates of protection. Limited validation and testing of serology assays used for serosurveys can lead to unreliable or misleading data, and clinical testing using such unvalidated assays can lead to medically costly diagnostic errors and improperly informed public health decisions. Estimating prevalence and clinical decision making is highly dependent on specificity. Here, we present an optimized ELISA-based serology protocol from antigen production to data analysis. This protocol defines thresholds for IgG and IgM for determination of seropositivity with estimated specificity well above 99%. Validation was performed using both traditionally collected serum and dried blood on mail-in blood sampling kits, using archival (pre-2019) negative controls and known PCR-diagnosed positive patient controls. Minimal cross-reactivity was observed for the spike proteins of MERS, SARS1, OC43 and HKU1 viruses and no cross reactivity was observed with anti-influenza A H1N1 HAI titer during validation. This strategy is highly specific and is designed to provide good estimates of seroprevalence of SARS-CoV-2 seropositivity in a population, providing specific and reliable data from serosurveys and clinical testing which can be used to better evaluate and understand SARS-CoV-2 immunity and correlates of protection.

12.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-329367

ABSTRACT

Asymptomatic SARS-CoV-2 infection and delayed implementation of diagnostics have led to poorly defined viral prevalence rates. To address this, we analyzed seropositivity in US adults who have not previously been diagnosed with COVID-19. Individuals with characteristics that reflect the US population (n = 11,382) and who had not previously been diagnosed with COVID-19 were selected by quota sampling from 241,424 volunteers (ClinicalTrials.gov NCT04334954 ). Enrolled participants provided medical, geographic, demographic, and socioeconomic information and 9,028 blood samples. The majority (88.7%) of samples were collected between May 10th and July 31st, 2020. Samples were analyzed via ELISA for anti-Spike and anti-RBD antibodies. Estimation of seroprevalence was performed by using a weighted analysis to reflect the US population. We detected an undiagnosed seropositivity rate of 4.6% (95% CI: 2.6 - 6.5%). There was distinct regional variability, with heightened seropositivity in locations of early outbreaks. Subgroup analysis demonstrated that the highest estimated undiagnosed seropositivity within groups was detected in younger participants (ages 18-45, 5.9%), females (5.5%), Black/African American (14.2%), Hispanic (6.1%), and Urban residents (5.3%), and lower undiagnosed seropositivity in those with chronic diseases. During the first wave of infection over the spring/summer of 2020 an estimate of 4.6% of adults had a prior undiagnosed SARS-CoV-2 infection. These data indicate that there were 4.8 (95% CI: 2.8-6.8) undiagnosed cases for every diagnosed case of COVID-19 during this same time period in the United States, and an estimated 16.8 million undiagnosed cases by mid-July 2020.

13.
Critical Care Medicine ; 50(1 SUPPL):503, 2022.
Article in English | EMBASE | ID: covidwho-1691836

ABSTRACT

INTRODUCTION: Tocilizumab (TCZ) is a recombinant monoclonal anti-interleukin-6 receptor antibody approved for use in children with juvenile idiopathic arthritis (JIA) and cytokine release syndrome (CRS) secondary to chimeric antigen receptor T-cell (CART) therapy. It is increasingly used off-label for other pediatric indications, though limited data exist describing safety and outcomes in these populations. This study describes TCZ use in JIA/CRS and other indications. Safety when administered during active infection and overall clinical outcomes were explored. METHODS: We performed a retrospective study of inpatients in a large children's hospital who received IV TCZ from 1/2016-5/2021 for any indication. Data included demographics, indication, dose amount, number of doses, safety events on days 0-7 after TCZ, use of extracorporeal support (ES), presence of concurrent infection, and survival to discharge. Exploratory analyses assessed characteristics associated with mortality. RESULTS: Data from 103 TCZ courses (n=87 pts) were analyzed. Median age was 14 yrs, and 66% had a primary oncologic diagnosis or had received myelosuppressive treatment (ONC/M). Indications for TCZ included CRS (56%), autoimmune disease (27%), GVHD (5%), and COVID-19 (4%). Median TCZ dose was 8 mg/kg. 18% of courses were administered during active infection, and ES was used in 15% of courses. New onset of ALT and AST >3x upper limit of normal occurred in 25% and 33% of courses, respectively. In patients without an ONC/M diagnosis (n=21), 10% of courses resulted in new onset neutropenia and 3% thrombocytopenia. Overall survival to discharge was 83%. Covariates associated with mortality by univariable analysis included an ONC/M diagnosis (OR 5.1 [95% CI 1.2-21], receipt of TCZ in an ICU (7 [1.8-41]), receipt of TCZ during active infection (3.8 [1-14), and use of ES (19 [4.6-91]). Only ES remained significant in multivariable analysis (OR 13 [3.1- 57]). CONCLUSIONS: TCZ is used for a range of pediatric inpatient indications, most commonly CRS. Risk factors for mortality are confounded by severity of illness, though administration during active infection was not independently associated with increased mortality. Prospective studies are needed to better understand the safety and efficacy of the off-label use of TCZ in children with inflammation.

14.
Critical Care Medicine ; 50(1 SUPPL):722, 2022.
Article in English | EMBASE | ID: covidwho-1691797

ABSTRACT

INTRODUCTION: Interest in using bedside C-reactive protein and ferritin levels to identify patients with hyperinflammatory sepsis who might benefit from anti-inflammatory therapies piqued with the COVID-19 pandemic experience. These widely available low-cost biomarkers might be similarly useful for assessing inflammatory profiles of all critically ill children with sepsis and septic shock and eventually guiding the use of precision anti-inflammatory therapies. We hypothesized groupbased trajectories of CRP and ferritin among critically ill children with sepsis would be associated with mortality and distinct inflammatory cytokine profiles. METHODS: Children with sepsis and organ failure from 9 pediatric intensive care units were enrolled in a prospective, observational cohort. Plasma CRP (mg/dL), ferritin (ng/mL), and 29 cytokine levels were measured at two samplings during sepsis (median Day 2 and Day 5). Group-based multi-trajectory models (GBMTM) identified groups of children with distinct patterns of CRP and ferritin. RESULTS: Two hundred and fifty-five children had at least 2 CRP and ferritin measurements. Five distinct clinical multitrajectory groups were identified with significantly different median maximum organ failures (MOF) and mortality. Group 1 had normal CRP and ferritin levels (n = 8;median MOF 2.0 [interquartile range 1.0, 2.0] and 0 % mortality);Group 2 had high CRP levels that became normal, with normal ferritin levels throughout (n = 80;median MOF 2.0 [1.0, 2.0] and 5% mortality);Group 3 had high ferritin levels alone (n=16;median MOF 2.5 [2.0, 3.0] and 6.3% mortality);Group 4 had very high CRP levels, and increased ferritin levels (n = 121;median MOF 2.0 [2.0, 4.0] and 10.7% mortality);and, Group 5 had very high CRP and very high ferritin levels (n = 30;median MOF 3.0 [2.0, 4.0] and 40% mortality). Cytokine responses differed across the 5 groups, with ferritin levels associated with macrophage inflammatory protein 1 a, and CRP levels reflective of many cytokines. CONCLUSIONS: Bedside CRP and ferritin levels can be used together to compute distinct groups of children with sepsis who have different systemic inflammation cytokine responses and mortality risks potentially targetable in clinical trials evaluating specific anti-inflammatory therapies.

15.
23rd International Conference on Human-Computer Interaction , HCII 2021 ; 13094 LNCS:280-297, 2021.
Article in English | Scopus | ID: covidwho-1565278

ABSTRACT

This study aims to empirically identify opinion leaders on Twitter from the lens of Innovation Diffusion theory. We analyzed pandemic-specific tweets from casual users as well as from the US President to map their conversation for the purpose of finding opinion leaders over a three month period at the onset of the pandemic. By applying network analysis following with cluster enrichment as well as sentiment analysis, we recognize potential thought leaders, but we could not find strong evidence for opinion leaders according to the Innovation Diffusion theory. We interpret that users tweet for two different purposes - tweets to elicit agreement and tweets to elicit debate. © 2021, Springer Nature Switzerland AG.

16.
Journal of Clinical Oncology ; 39(28 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1496284

ABSTRACT

Background: The COVID-19 pandemic resulted in the use of telemedicine for evaluation and management visits in radiation oncology departments to decrease in-person interactions. The primary objective of this study is to evaluate the utility of telemedicine for patient consultation and its effect on radiotherapy simulation and treatment processes. Methods: A standardized simulation requisition directive was used for all consults (telemedicine and inperson) undergoing simulation for external beam radiation therapy at a single tertiary care institution from January to December 2020. These directives were reviewed at daily multidisciplinary peer review meetings;modifications occurring as a result of this review were prospectively recorded in a departmental quality database. Descriptive statistics were used to identify characteristics associated with consultation type. Mann Whitney and Chisquare tests were used to compare continuous and categorical variables. Results: 1500 consecutive patients were reviewed in this prospective peer review process;444 (29.6%) had telemedicine visits preceding simulation and 1056 (70.4%) had in-person consults. The median time between physician simulation order and date of simulation was 5 days (IQR: 2-11 days) for telemedicine visits and 4 days (IQR: 1-8 days) for in-person consults (p<0.05). Significant differences were observed in telemedicine usage across months (p<0.05) with the highest percentage in July, September, and August (50%, 45.9% and 45%, respectively). As a result of prospective multidisciplinary peer review, 397 modifications in 290 simulations were recorded in total;101/444 (22.7%) telemedicine simulations had modifications compared to 189/1056 (17.9%) following inperson consultation (p<0.05). The most common modifications for telemedicine visits resulted from immobilization device changes (n=32, 23.5%), arm positioning (n=19, 14.0%), and changes in the radiotherapy care path (n=17, 12.5%). For telemedicine consults, the median radiotherapy fraction dose was 2.66 Gy (2-4 Gy) and median fraction number was 16 (5-28). There was no difference for fractionation preference between telemedicine and in person consults (p=0.084). Seven (1.6%) telemedicine visits and 7 (0.7%) in-person consults needed resimulation during the entire study period (p=0.136). Conclusions: Telemedicine is a powerful tool with the potential to revolutionize the radiation oncology daily practice. In the initial learning phase, it appears that there is a higher frequency of simulation modifications for patients evaluated by telemedicine. Therefore, as departmental processes incorporate telemedicine in the future, thorough attention is needed to encourage review of common modifications as well as identify patients at high risk of error at time of simulation who may also benefit from in-person evaluation prior to simulation.

17.
Archives of Disease in Childhood ; 106(SUPPL 1):A476-A477, 2021.
Article in English | EMBASE | ID: covidwho-1495119

ABSTRACT

Background The rise in mental health presentations to Paediatric Emergency Departments (PED) during the Covid pandemic has been well documented. Whilst it has never been more important to accurately assess the mental health risk posed to young people on their arrival in PED, staff undertaking these assessments often have little formal training or oversight. Whilst physical presentations can be quantified by clinical parameters and evidenced investigations, the accurate assessment of mental health cases is inherently subjective, yet just as crucial. Objectives To assess the level of agreement between professionals routinely assessing undifferentiated mental health presentations in PED using video vignettes. Methods We identified mental health-related presentations to a tertiary PED over a one-month period. We selected six cases by random number generation, carefully altered/anonymised the details and engaged actors to re-create the presentations. Using an existing assessment matrix, participating PED and CAMHS (child and adolescent mental health service) staff watched the video vignettes and allocated presentations to 'green', 'amber' or 'red' risk categories. A free marginal multi-rater Kappa was used to assess the level of agreement between responses (0 indicating no agreement and 1 perfect agreement). Staff were asked to rate their confidence in assessing the vignettes on a modified likert scale numbered 1-5 (5 = very confident). This was undertaken as a service evaluation project after discussion with relevant Trust R&D teams. Results The Kappa for all responses was Kfree=0.21 (95%CI 0.04-0.38). Table 1 outlines Kappa values and self-reported confidence within each staff category. Conclusions When assessing the severity of mental health presentations on a simple traffic-light system, the agreement between PED staff was very low. This was lowest amongst nursing staff, who may be less familiar with the assessment matrix. Concordance was high amongst CAMHS staff, admittedly with few participants. This likely reflects their greater exposure and training. Despite the wide variation in responses, each staff group reported their collective confidence in assessing the cases similarly. This may point to a lack of standardised training and staff awareness. In order to best support young people during mental health difficulties, an accurate, objective and standardised assessment is key. This keeps young people safe, informs the level of support/ supervision they require and is crucial to de-escalate crises. This process starts in PED but practice is widely variable in our single-centre study - a level of inconsistency we would not tolerate in the assessment of physical symptoms. We plan to undertake regular multi-disciplinary training led by CAMHS to encourage standardised and robust assessments. We hope to improve the productivity and accuracy of discussions between PED and CAMHS and improve the patient journey for young people. We plan to repeat the vignettes following this intervention.

19.
International Journal of Radiation Oncology, Biology, Physics ; 111(3):e455-e455, 2021.
Article in English | Academic Search Complete | ID: covidwho-1428056

ABSTRACT

Stereotactic Body Radiation Therapy (SBRT) is considered standard of care for inoperable early stage non-small cell lung cancer (NSCLC) and is commonly delivered in 1-5 fractions. Single fraction SBRT is supported by randomized data demonstrating equivalent safety compared to fractionated approaches. The purpose of this study is to measure trends in the utilization of SBRT fractionation in NSCLC patients in the National Cancer Database (NCDB) from 2004-2016. The NCDB was queried for patients with cT1-T3N0M0 NSCLC who were treated with a known SBRT dosing schema during the study period (including 30-34 Gy/1 fraction, 54-60 Gy/3 fractions, 48-50 Gy/4 fractions, and 50-60 Gy/5 fractions). Adjusted logistic regression was used to assess the association of treatment year with the annual percentage of patients who received SBRT using 1, 3, 4, and 5 fractions. Average annual percentage changes (AAPC) were computed and compared to determine if a significant change (defined a priori as P < 0.01) occurred in the use of different fractionation schemes over time. Multivariable analysis was used to evaluate factors associated with receipt of single fraction SBRT. The analytic cohort consisted of 39,536 patients. Use of 3 fraction SBRT decreased from 72.6% in 2004 to 20.3% in 2016 (AAPC -10.6% per year, 95% CI: [-12.1%, -9.1%], P < 0.001). During this interval, a corresponding increase in the use of 5 fraction SBRT also occurred, from 6.5% in 2004 to 53.7% in 2016 (AAPC +18.3% per year, 95% CI: [+13.3%, +23.4%], P < 0.001). No significant change was observed in single fraction and 4 fraction SBRT utilization;< 1% of patients per year received single fraction SBRT in all but three years of the study with a 1.1% percent utilization rate in 2016. On logistic regression, cT2 patients were less likely to receive single fraction SBRT (Odds Ratio 0.592, 95% CI: 0.414-0.846) while academic facility (Odds Ratio 5.821, 95% CI: 4.331-7.823) and Charlson Deyo Score > 2 (Odds Ratio 1.447, 95% CI: 1.038-2.017) were significantly associated with receipt of single fraction SBRT. Age, insurance, distance to treatment facility, and treatment year were not significantly associated with single fraction SBRT. Single fraction SBRT use remained scarce in the United States during 2004-2016, with no clear indication of increased utilization after 2014 when RTOG0915 was first reported. With prospective evidence that long-term toxicity, local control, and survival are similar to 3-4 fraction regimens, the application of single fraction SBRT in the clinic may warrant further interest in light of the recent COVID-19 pandemic and the implementation of the alternative payment model. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science 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.)

20.
International Journal of Radiation Oncology, Biology, Physics ; 111(3):S92-S93, 2021.
Article in English | Academic Search Complete | ID: covidwho-1428037

ABSTRACT

The primary objective of this study is to evaluate the utility and value of an institutional, multi-disciplinary peer review process prior to radiotherapy simulation. Over a period of 3 months and through an iterative process, a standardized simulation requisition directive (SSRD) was developed, piloted, modified, and subsequently implemented for all patients treated with external beam radiotherapy at a single tertiary care institution from January to December 2020. The SSRDs were reviewed at a daily multi-disciplinary peer review conference ("morning huddle");modifications in the simulation process consequential to the review were prospectively recorded in a quality database. Descriptive statistics were used to identify characteristics associated with modifications. Independent sample t test and Chi-square test were used to compare continuous and categorical variables. A total of 1500 consecutive SSRDs were prospectively reviewed and met inclusion criteria for this study. The median time between the physician SSRD order and date of simulation was 4 days (Range: 0-97 days), and the majority of patients were treated with curative intent (n = 872, 58%). A total of 369 modifications on 269 (17.9%) simulation directives were recorded and parsed into 17 categories. The most common modifications resulted from omission of pregnancy testing orders (n = 92, 24.9%), immobilization device changes (n = 88, 23.8%), changes in the radiotherapy care path (n = 56, 15.1%), and arm positioning (n = 43, 11.6%). Modifications were less likely to occur if the directives were entered within 1 week of simulation (15.6% vs. 21.7%, P = 0.0028). Significant differences were also observed across tumor sites (P = 0.0091) with the highest modification rates observed for stomach, esophagus, and pelvis sites (40%, 30%, and 26.9% modified, respectively). A significant change in department workflow and clinic visits occurred in March 2020 as a result of COVID-19, with transition to virtual platforms. An increased rate of simulation directive modifications was also observed for patients simulated after these changes were implemented (April – December 2020 19.3% vs. Jan – March 2020 13.5%, P = 0.013). No differences in modification rates were observed by modality, i.e., photon or proton therapy (P = 0.20). Overall, with this prospective peer review process, only 14 patients (0.9%) needed re-simulation during the entire study period. Prospective peer review prior to simulation in radiotherapy identifies actionable change in approximately 18% of procedures, and results in an extremely low, < 1% rate of re-simulation. SSRDs ordered > 1 week before from simulation and gastrointestinal and pelvic sites were at higher risk of requiring modifications during peer review. As departmental processes transition to virtual meeting platforms, more thorough attention is needed to identify patients at higher risk of simulation modifications. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science 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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