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1.
J Emerg Med ; 62(5): 685-689, 2022 May.
Article in English | MEDLINE | ID: covidwho-1778287

ABSTRACT

BACKGROUND: The COVID-19 pandemic significantly disrupted emergency medicine residents' education. Early in the pandemic, many facilities lacked adequate personal protective equipment (PPE), and intubation was considered particularly high risk for transmission to physicians, leading hospitals to limit the number of individuals present during the procedure. This posed difficulties for residents and academic faculty, as opportunities to perform endotracheal intubation during residency are limited, but patients with COVID-19 requiring intubation are unstable and have difficult airways. Case Scenario: When PPE is being rationed, who should be the one to perform an intubation on a patient with respiratory failure from severe COVID-19? DISCUSSION: We examined this case scenario using the ethical frameworks of bioethical principles and virtue ethics. Bioethical principles include justice, beneficence, nonmalfeasance, and autonomy, and virtue ethics emphasizes the provision of moral exemplars and opportunities to exercise practical wisdom. Arguments for an attending-only strategy include the role of the attending as a truly autonomous decision maker and the importance of providing residents with a moral exemplar. A resident-only strategy benefits a resident's future patients and provides opportunities for residents to exercise character. Strategies preserving the dyad of attending and resident maintain these advantages and mitigate some drawbacks, while intubation teams may provide the most parsimonious use of PPE, but may elide resident involvement. CONCLUSIONS: There exist compelling motivations for involving senior residents and attendings in high-risk intubations during the COVID-19 pandemic. A just strategy will preserve residents' role whenever possible, while maximizing supervision and providing alternative routes for intubation practice.


Subject(s)
COVID-19 , Emergency Medicine , Internship and Residency , Humans , Pandemics , Personal Protective Equipment
2.
Fendler, Annika, Shepherd, Scott, Au, Lewis, Wilkinson, Katalin, Wu, Mary, Byrne, Fiona, Cerrone, Maddalena, Schmitt, Andreas, Joharatnam-Hogan, Nalinie, Shum, Ben, Tippu, Zayd, Rzeniewicz, Karolina, Boos, Laura, Harvey, Ruth, Carlyle, Eleanor, Edmonds, Kim, Rosario, Lyra Del, Sarker, Sarah, Lingard, Karla, Mangwende, Mary, Holt, Lucy, Ahmod, Hamid, Koreweg, Justine, Foley, Tara, Bazin, Jessica, Gordon, William, Barber, Taja, Emslie-Henry, Andrea, Xie, Wenyi, Gerard, Camille, Deng, Daqi, Wall, Emma, Agua-Doce, Ana, Namjou, Sina, Caidan, Simon, Gavrielides, Mike, MacRae, James, Kelly, Gavin, Peat, Kema, Kelly, Denise, Murra, Aida, Kelly, Kayleigh, O'Flaherty, Molly, Dowdie, Lauren, Ash, Natalie, Grounthoud, Firza, Shea, Robyn, Gardner, Gail, Murray, Darren, Kinnaird, Fiona, Cui, Wanyuan, Pascual, Javier, Rodney, Simon, Mencel, Justin, Curtis, Olivia, Stephenson, Clemency, Robinson, Anna, Oza, Bhavna, Farag, Sheima, Leslie, Isla, Rogiers, Aljosja, Lyengar, Sunil, Ethell, Mark, Messiou, Christina, Cunningham, David, Chau, Ian, Starling, Naureen, Turner, Nicholas, Welsh, Liam, As, Nicholas van, Jones, Robin, Droney, Joanne, Banerjee, Susana, Tatham, Kate, O'Brien, Mary, Harrington, Kevin, Bhide, Shreerang, Okines, Alicia, Reid, Alison, Young, Kate, Furness, Andrew, Pickering, Lisa, Swanton, Charles, Gandhi, Sonia, Gamblin, Steve, Bauer, David, Kassiotis, George, Kumar, Sacheen, Yousaf, Nadia, Jhanji, Shaman, Nicholson, Emma, Howell, Michael, Walker, Susanna, Wilkinson, Robert, Larkin, James, Turajlic, Samra.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-310349

ABSTRACT

CAPTURE (NCT03226886) is a prospective cohort study of COVID-19 immunity in patients with cancer. Here we evaluated 585 patients following administration of two doses of BNT162b2 or AZD1222 vaccines, administered 12 weeks apart. Seroconversion rates after two doses were 85% and 59% in patients with solid and hematological malignancies, respectively. A lower proportion of patients had detectable neutralizing antibody titers (NAbT) against SARS-CoV-2 variants of concern (VOCs) vs wild-type (WT). Patients with hematological malignancies were more likely to have undetectable NAbT and had lower median NAbT vs solid cancers against both WT and VOCs. In comparison with individuals without cancer, patients with haematological, but not solid, malignancies had reduced NAb responses. Seroconversion showed poor concordance with NAbT against VOCs. Prior SARS-CoV-2 infection boosted NAb response including against VOCs, and anti-CD20 treatment was associated with undetectable NAbT. Vaccine-induced T-cell responses were detected in 80% of patients, and were comparable between vaccines or cancer types. Our results have implications for the management of cancer patients during the ongoing COVID-19 pandemic.

3.
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.

4.
Journal of Social & Personal Relationships ; : 1, 2021.
Article in English | Academic Search Complete | ID: covidwho-1403170

ABSTRACT

The COVID-19 pandemic has fundamentally altered life for individuals worldwide. Specifically, at the time of data collection (late April 2020), most forms of face-to-face interactions were limited and, in some cases, prohibited, as close contact with others increases the rate of transmitting the virus. As social beings, engaging in social distancing may have negative consequences on well-being. However, many individuals maintained their social connections by means of computer-mediated communication (CMC), such as hosting FaceTime happy hours or family reunions. Utilizing a nationally representative sample of 985 adults from the United States, this study investigated the association between social distancing adherence and positive affect and the extent to which this association might be mediated by CMC frequency. Results did not indicate a direct effect of social distancing adherence on positive affect. However, an indirect effect between these two variables occurred when mediated by CMC frequency. Specifically, greater social distancing adherence predicted greater frequency of CMC, which predicted greater positive affect. These findings held controlling for age, gender, race/ethnicity, relationship status, and income. Results suggest that despite social distancing, CMC may be a beneficial way to engage with others during and, perhaps, beyond COVID-19. [ABSTRACT FROM AUTHOR] Copyright of Journal of Social & Personal Relationships is the property of Sage Publications, Ltd. 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.)

5.
Soc Sci Med ; 284: 114243, 2021 09.
Article in English | MEDLINE | ID: covidwho-1327137

ABSTRACT

RATIONALE: Substantial health behavior change (e.g., social distancing, mask-wearing) is needed to slow COVID-19. Yet, adherence to these guidelines varies, and avoiding social contact may contribute to declines in emotional adjustment. OBJECTIVE AND METHODS: Drawing on prior research linking social motives to health behavior and well-being, we investigated the associations among social motives (prosocial motivation, gratitude) and resilience to social distancing (health behavior adherence, emotional adjustment) in a US nationally representative sample (N = 1007) collected in April 2020. RESULTS: Prosocial motivation, but not gratitude, correlated with health behavior adherence and social distancing practice. Conversely, gratitude, but not prosocial motivation, correlated with emotional adjustment (daily accomplishments, meaning in life, thriving, psychological distress, positive and negative affect). Analyses controlled for gratitude/prosocial motivation, self-focused motivation, COVID-19 worries, work arrangement, stay-at-home order, likelihood of COVID-19 diagnosis, and demographics. CONCLUSION: Public health campaigns focusing on the benefits of health behaviors for others, rather than just oneself, may promote adherence and emotional adjustment.


Subject(s)
COVID-19 , Pandemics , COVID-19 Testing , Emotional Adjustment , Health Behavior , Humans , Motivation , SARS-CoV-2
6.
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
7.
JMIR Public Health Surveill ; 6(3): e19969, 2020 07 17.
Article in English | MEDLINE | ID: covidwho-1172934

ABSTRACT

BACKGROUND: In the absence of vaccines and established treatments, nonpharmaceutical interventions (NPIs) are fundamental tools to control coronavirus disease (COVID-19) transmission. NPIs require public interest to be successful. In the United States, there is a lack of published research on the factors that influence public interest in COVID-19. Using Google Trends, we examined the US level of public interest in COVID-19 and how it correlated to testing and with other countries. OBJECTIVE: The aim of this study was to determine how public interest in COVID-19 in the United States changed over time and the key factors that drove this change, such as testing. US public interest in COVID-19 was compared to that in countries that have been more successful in their containment and mitigation strategies. METHODS: In this retrospective study, Google Trends was used to analyze the volume of internet searches within the United States relating to COVID-19, focusing on dates between December 31, 2019, and March 24, 2020. The volume of internet searches related to COVID-19 was compared to that in other countries. RESULTS: Throughout January and February 2020, there was limited search interest in COVID-19 within the United States. Interest declined for the first 21 days of February. A similar decline was seen in geographical regions that were later found to be experiencing undetected community transmission in February. Between March 9 and March 12, 2020, there was a rapid rise in search interest. This rise in search interest was positively correlated with the rise of positive tests for SARS-CoV-2 (6.3, 95% CI -2.9 to 9.7; P<.001). Within the United States, it took 52 days for search interest to rise substantially after the first positive case; in countries with more successful outbreak control, search interest rose in less than 15 days. CONCLUSIONS: Containment and mitigation strategies require public interest to be successful. The initial level of COVID-19 public interest in the United States was limited and even decreased during a time when containment and mitigation strategies were being established. A lack of public interest in COVID-19 existed in the United States when containment and mitigation policies were in place. Based on our analysis, it is clear that US policy makers need to develop novel methods of communicating COVID-19 public health initiatives.


Subject(s)
Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Public Opinion , Search Engine/trends , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/statistics & numerical data , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Cross-Cultural Comparison , Humans , Pneumonia, Viral/epidemiology , Retrospective Studies , United States/epidemiology
8.
Cancer Treat Res Commun ; 25: 100261, 2020.
Article in English | MEDLINE | ID: covidwho-956074

ABSTRACT

BACKGROUND: UK COVID-19 mortality rates are amongst the highest globally. Controversy exists on the vulnerability of thoracic cancer patients. We describe the characteristics and sequelae of patients with thoracic cancer treated at a UK cancer centre infected with COVID-19. METHODS: Patients undergoing care for thoracic cancer diagnosed with COVID-19 (RT-PCR/radiology/clinically) between March-June 2020 were included. Data were extracted from patient records. RESULTS: Thirty-two patients were included: 14 (43%) diagnosed by RT-PCR, 18 (57%) by radiology and/or convincing symptoms. 88% had advanced thoracic malignancies. Eleven of 14 (79%) patients diagnosed by RT-PCR and 12 of 18 (56%) patients diagnosed by radiology/clinically were hospitalised, of which four (29%) and 2 (11%) patients required high-dependency/intensive care respectively. Three (21%) patients diagnosed by RT-PCR and 2 (11%) patients diagnosed by radiology/clinically required non-invasive ventilation; none were intubated. Complications included pneumonia and sepsis (43% and 14% respectively in patients diagnosed by RT-PCR; 17% and 11% respectively in patients diagnosed by radiology/clinically). In patients receiving active cancer treatment, therapy was delayed/ceased in 10/12 (83%) and 7/11 (64%) patients diagnosed by RT-PCR and radiology/clinically respectively. Nine (28%) patients died; all were smokers. Median time from symptom onset to death was 7 days (range 3-37). CONCLUSIONS: The immediate morbidity from COVID-19 is high in thoracic cancer patients. Hospitalisation and treatment interruption rates were high. Improved risk-stratification models for UK cancer patients are urgently needed to guide safe cancer-care delivery without compromising efficacy.


Subject(s)
COVID-19/epidemiology , SARS-CoV-2/pathogenicity , Thoracic Neoplasms/epidemiology , Adult , COVID-19/complications , COVID-19/virology , Critical Care , Female , Hospitalization , Humans , Male , Middle Aged , Thoracic Neoplasms/complications , Thoracic Neoplasms/virology , United Kingdom/epidemiology
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