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Hepatol Commun ; 6(4): 920-930, 2022 04.
Article in English | MEDLINE | ID: covidwho-1756574


Palliative care (PC) benefits patients with serious illness including end-stage liver disease (ESLD). As part of a cluster randomized trial, hepatologists were trained to deliver primary palliative care to patients with ESLD using an online course, Palliative Care Always: Hepatology (PCA:Hep). Here we present a multimethod formative evaluation (feasibility, knowledge acquisition, self-efficacy, and practice patterns) of PCA:Hep. Feasibility was measured by completion of coursework and achieving a course grade of >80%. Knowledge acquisition was measured through assessments before and throughout the course. Pre/post-course surveys were conducted to determine self-efficacy and practice patterns. The hepatologists (n = 39) enrolled in a 12-week online course and spent 1-3 hours on the course weekly. The course was determined to be feasible as 97% successfully completed the course and 100% passed. The course was acceptable to participants; 91.7 % reported a positive course experience and satisfaction with knowledge gained (91.6%). The pre/post knowledge assessment showed an improvement of 6.0% (pre 85.9% to post 91.9%, 95% CI [2.8, 9.2], P = 0.001). Self-efficacy increased significantly (P < 0.001) in psychological symptom management, hospice, and psychosocial support. A year after training, over 80% of the hepatologists reported integrating a variety of PC skills into routine patient care. Conclusion: PCA:Hep is feasible, acceptable, and improves learner knowledge and confidence in palliative care skills. This is a viable method to teach primary PC skills to specialists caring for patients with ESLD.

End Stage Liver Disease , Gastroenterologists , Gastroenterology , Hospice and Palliative Care Nursing , End Stage Liver Disease/psychology , Humans , Palliative Care/methods
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-318683


Fighting the COVID-19 pandemic, most countries have implemented non-pharmaceutical interventions like wearing masks, physical distancing, lockdown, and travel restrictions. Because of their economic and logistical effects, tracking mobility changes during quarantines is crucial in assessing their efficacy and predicting the virus spread. Chile, one of the worst-hit countries in the world, unlike many other countries, implemented quarantines at a more localized level, shutting down small administrative zones, rather than the whole country or large regions. Given the non-obvious effects of these localized quarantines, tracking mobility becomes even more critical in Chile. To assess the impact on human mobility of the localized quarantines in Chile, we analyze a mobile phone dataset made available by Telefónica Chile, which comprises 31 billion eXtended Detail Records and 5.4 million users covering the period February 26th to September 20th, 2020. From these records, we derive three epidemiologically relevant metrics describing the mobility within and between comunas. The datasets made available can be used to fight the COVID-19 epidemics, particularly for localized quarantines' less understood effect.

Semin Oncol ; 48(2): 145-151, 2021 04.
Article in English | MEDLINE | ID: covidwho-1174725


BACKGROUND: Leading scientific societies have recommended delaying and/or suspending active cancer treatment during the COVID-19 pandemic. Nevertheless, data on this novel infection in patients with a diagnosis of cancer receiving active treatment are scarce and it is unknown if these recommendations could have repercussions on future progress of the disease. The main objective of this study is to learn the COVID-19 incidence rate in outpatients with cancer receiving active treatment. METHODS: This work is a retrospective cohort study that included all patients with a diagnosis of cancer who received active cancer treatment in two Andalusian hospitals between February 26 and May 13, 2020. Variables regarding the patient, tumor, and development of COVID-19 were collected. A descriptive analysis was performed and the cumulative incidence of COVID-19 in these patients was evaluated. RESULTS: A total of 673 patients were included. The median age was 62 years. There was a low rate of comorbidity and 12.1% had an ECOG >2. Breast cancer was the most common cancer (41%), followed by colorectal and lung cancer. Stage IV cancer was reported in 52.7% of patients. The most common treatment was chemotherapy (53.9%). Treatment was delayed or suspended in 6% of patients. Only three patients developed COVID-19. The cumulative incidence was 0.44% and one person died due to infection. CONCLUSIONS: In the present retrospective cohort study we found a low incidence of COVID-19 infection in patients with cancer receiving active treatment in an outpatient setting. The sociodemographic factors of Andalusia may explain why these results differ from those presented by other colleagues in Spain, but raise questions about whether universal recommendations may put the benefits of antineoplastic therapy at risk.

COVID-19/epidemiology , Neoplasms/virology , Outpatients/statistics & numerical data , SARS-CoV-2/isolation & purification , Aged , COVID-19/transmission , COVID-19/virology , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Neoplasms/complications , Neoplasms/pathology , Neoplasms/therapy , Prognosis , Retrospective Studies , Spain/epidemiology