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1.
Journal of Clinical Oncology ; JOUR:94, 40(28 Supplement).
Article in English | EMBASE | ID: covidwho-2098608

ABSTRACT

Background: During the COVID-19 pandemic, remote cancer care, and video communication in particular, has become increasingly common in the context of routine visits and clinical trials. Though this medium has the potential to augment patient-provider communication, telehealth also raises concerns about the digital divide promoting disparities in access to cancer care. In this study, we surveyed oncology patients who declined to participate in a pilot study looking at a one-time pharmacist-led video visit for patients initiating oral anti-cancer medications to evaluate their primary reason for declining the intervention. Method(s): Between June 2021 and June 2022, we conducted a prospective survey among adult oncology patients at Columbia University Medical Center (CUMC) who declined a pilot study looking at a video visit intervention for patients initiating oral anti-cancer medications to assess the primary barriers to participation. The survey categorized specific reasons for decline into telehealth- related barriers (no access to electronic device, inability to navigate video visits specifically, patient preference for in person care) and trial-related barriers (patient too tired/unwell, no time to participate, not interested in this study specifically, not interested in clinical trial participation in general), and patients were asked to select the primary reason for declining among the list of options. Result(s): Twenty-three patients completed the survey (82% completion rate). Among 23 respondents, 9 patients (39%) described a technology-related barrier to participation, including 7 (30%) who owned a mobile device with video capacity, but did not know how to use video technology well enough for the visit, 1 (4%) who did not own a device with video capacity, and 1 (4%) who preferred in person visits. Fourteen respondents cited a reason unrelated to telehealth for declining participation, including 7 (30%) who did not feel the study would benefit them, 3 (13%) who did not have time, 2 (9%) who were too tired to participate in a study, and 2 (9%) who were not interested in participating in any kind of clinical trial. Conclusion(s): Video-based telehealth visits have become increasingly common in routine cancer care and clinical trials. Among oncology patients who declined participation in a pilot study looking at a pharmacist-led video consultation, over a third cited telehealth-related barriers to participation, the majority of whom had a mobile device, but did not know how to use video technology well enough to participate. Focusing efforts on training patients to use technology, particularly video communication, may help address the digital divide in cancer care.

3.
Journal of Clinical Outcomes Management ; 29(5):39-48, 2022.
Article in English | EMBASE | ID: covidwho-2067257

ABSTRACT

Objective: The COVID-19 pandemic has been a challenge for hospital medical staffs worldwide due to high volumes of patients acutely ill with novel syndromes and prevailing uncertainty regarding optimum supportive and therapeutic interventions. Additionally, the response to this crisis was driven by a plethora of nontraditional information sources, such as email chains, websites, non-peer-reviewed preprints, and press releases. Care patterns became idiosyncratic and often incorporated unproven interventions driven by these nontraditional information sources. This report evaluates the efforts of a health system to create and empower a multidisciplinary committee to develop, implement, and monitor evidence-based, standardized protocols for patients with COVID-19. Method(s): This report describes the composition of the committee, its scope, and its important interactions with the health system pharmacy and therapeutics committee, research teams, and other work groups planning other aspects of COVID-19 management. It illustrates how the committee was used to demonstrate for trainees the process and value of critically examining evidence, even in a chaotic environment. Result(s): Data show successful interventions in reducing excessive ordering of certain laboratory tests, reduction of nonrecommended therapies, and rapid uptake of evidence-based or guidelines-supported interventions. Conclusion(s): A multidisciplinary committee dedicated solely to planning, implementing, and monitoring standard approaches that eventually became evidence-based decision-making led to an improved focus on treatment options and outcomes for COVID-19 patients. Data presented illustrate the attainable success of a committee that is both adaptable and suitable for similar emergencies in the future. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

4.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P23, 2022.
Article in English | EMBASE | ID: covidwho-2064484

ABSTRACT

Introduction: Since the onset of the COVID-19 pandemic, telemedicine has become an increasingly utilized resource in all fields of medicine, allowing greater access to and efficiency of medical care. This study seeks to quantify the average reduction in cost to patients and carbon footprint attributable to telemedicine for endocrine cancer care. Method(s): This retrospective cohort study includes telemedicine visits for in-state patients from April 1, 2020, to June 20, 2021, at the endocrine oncology clinic of a single National Cancer Institute-designated comprehensive cancer center. The primary outcome is cost savings of endocrine cancer care with use of telemedicine. This includes 2 components: (1) direct costs of travel (round-trip distance of car travel) and (2) loss of productivity due to the clinic visit (loss of income from travel and in-office visit time). The secondary outcome is reduction of carbon footprint (kg CO2 emissions) with use of telemedicine. Result(s): There were 3171 telemedicine visits for 2921 patients conducted within the designated time frame. Telemedicine was associated with total savings of 494,895 round-trip travel miles for patients (9734 hours total drive time). An additional 3613 hours were saved in accounting for time to park, enter the building, and wait. Telemedicine resulted in an average savings of $145/visit for patients under 65 years old and $111/visit for patients greater than 65 years old. Additionally, telemedicine reduced the carbon footprint by an average of 46.18 kg CO2 emissions per visit. Conclusion(s): As the costs of medical care continue to rise, further implementation of telemedicine may result in significant savings for patients. This study found that telemedicine is associated with reduction in financial burden caused by both travel and time costs. Additionally, implementation of telemedicine may significantly reduce the carbon footprint of endocrine cancer care. These data need to be interpreted in the context of clinical efficacy of the telemedicine visit, which will require additional study of clinical impact, patient satisfaction, and oncological outcomes.

5.
American Journal of Transplantation ; 22(Supplement 3):984-985, 2022.
Article in English | EMBASE | ID: covidwho-2063500

ABSTRACT

Purpose: The COVID pandemic presents a unique set of challenges during pregnancy including thromboembolic complications, direct placental infection, transplacental transmission, and systemic hyperinflammatory state. The liver is the second most commonly affected organ in COVID infection after the lungs. Mechanisms of liver injury in COVID-19 patients include: direct viral cytopathic effect, drug-induced hepatotoxicity, worsening of underlying liver disease, cytokine storm, hypoxic ischemic injury, and cholangiopathy. Post-COVID cholangiopathy leads to marked cholestasis with ongoing jaundice that persists long after other organs have recovered from infection. Method(s): We describe three infants at Texas Children's Hospital with intrauterine or perinatal COVID exposure with persistent cholestasis and extrahepatic biliary obstruction (mimicking biliary atresia), suggesting cholangiopathy. Result(s): All three patients described in this case series developed liver failure in the setting of low GGT cholestasis with histologic evidence of extrahepatic biliary obstruction, and all three required liver transplantation within the first year of life. Conclusion(s): Though post-COVID cholangiopathy is described in adults in the literature, our series is unique in that it is the first to describe this phenomenon in infancy. Additionally none of our infants had moderate or severe COVID infection but still progressed to advanced liver disease. Though further studies are needed to determine if additional factors are at play, our case series certainly raises the question of if the timing of exposure/infection might play a role in overall prognosis.

6.
Chest ; 162(4 Supplement):A1586-A1587, 2022.
Article in English | EMBASE | ID: covidwho-2060846

ABSTRACT

SESSION TITLE: Technological Innovations in Imaging SESSION TYPE: Original Investigations PRESENTED ON: 10/17/22 1:30 PM - 2:30 PM PURPOSE: Central airway stenosis (CAS) is an important cause of pulmonary morbidity and mortality. Current grading and classification systems include subjective qualitative components, with limited data on reproducibility. We propose a novel radiographic segmentation approach to more objectively quantify CAS. Inter-rater reliability of this novel outcome, which is used in an ongoing randomized controlled trial (NCT04996173), has not been previously assessed. METHOD(S): Computed tomography (CT) scans demonstrating tracheal stenoses were identified in the Vanderbilt University Medical Center Benign Tracheal Stenosis registry. CTs were analyzed in OsiriX (Geneva, Switzerland) after upload via a secured cloud transfer service. Four independent readers with variable experience in CT interpretation were chosen (one chest radiologist, one pulmonary fellow, two internal medicine residents). Readers identified the point of nadir airway lumen, measured 1.5 cm above and below that point, then manually segmented visible tracheal lumen area on the soft tissue window of each axial CT slice within that 3 cm length. Missing ROI's were then generated in-between manual segmented areas. The Repulsor function was used to manually adjust the boundaries of the ROI to achieve fit. Intraclass correlation (ICC) was used to calculate the inter-rater reliability of the tracheal lumen volume of between readers. Other data collection variables included the type of CT scan, axial slice interval, the suspected underlying cause of CAS, and average stenotic volume. RESULT(S): Fifty CT scans from 38 individual patients identified in the registry from 2011-2021 were randomly chosen for inclusion. Most (22 of 38, 57.9%) had iatrogenic BCAS (either post-intubation or post-tracheostomy) and 10 (26.3%) had idiopathic subglottic stenosis. Half of the scans (n=25, 50%) were contrasted neck CT and half were non contrasted chest CTs. Scan slice thickness ranged 1 to 5 mm, median 2 mm (1.25-2.875). The median stenotic volume across all readers was 3.375 cm3 (2.52-4.51). The average ICC across all four readers was 0.969 (95% CI 0.944 - 0.982). CONCLUSION(S): Our proposed volume rendering and segmentation approach to BCAS proves to have substantial precision and agreement amongst readers of different skill levels. CLINICAL IMPLICATIONS: A NOVEL METHOD TO ASSESS SEVERITY OF BENIGN CENTRAL AIRWAY STENOSIS DISCLOSURES: No relevant relationships by Leah Brown No relevant relationships by Alexander Gelbard no disclosure on file for Robert Lentz;PI ofan investigator-initiated study relationship with Medtronic Please note: >$100000 by Fabien Maldonado, value=Grant/Research Support PI on investigator-initiated relationship with Erbe Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Consulting relationship with Medtronic Please note: $5001 - $20000 by Fabien Maldonado, value=Honoraria co-I industry-sponsored trial relationship with Lung Therapeutics Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Board of director member relationship with AABIP Please note: $1-$1000 by Fabien Maldonado, value=Travel No relevant relationships by Khushbu Patel No relevant relationships by Ankush Ratwani Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee No relevant relationships by Evan Schwartz Copyright © 2022 American College of Chest Physicians

7.
Chest ; 162(4):A1009, 2022.
Article in English | EMBASE | ID: covidwho-2060750

ABSTRACT

SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: PAP is a rare entity that can occur secondary to infection, malignancy, or trauma. Mucormycosis in the setting of Covid-19 pneumonia has been increasingly recognized but PAP has only recently been reported in this setting. CASE PRESENTATION: A 44 year-old man with type 2 diabetes, non-ischemic cardiomyopathy, hypothyroidism, and ulcerative colitis presented with dyspnea and cough in July 2021. He was diagnosed with Covid-19 pneumonia and initially treated with molnupiravir. Eight days later he presented to the emergency room with worsening dyspnea, hypoxemia and diabetic ketoacidosis. He required 3L of oxygen and was intubated for airway protection. CT chest revealed mild bilateral patchy opacities and dexamethasone was started. Unfortunately, persistent fevers and worsening respiratory status ensued and repeat chest CT on hospital day (HD) 8 showed a new large left upper lobe (LUL) cavitary lesion. Cultures ultimately grew Rhizopus microsporus and he was started on amphotericin then isavuconazole after acute kidney injury developed. Dexamethasone was discontinued and interval imaging after ten days showed dramatic growth of the cavitary lesion (9 x 6 x 3 cm) with new extension through the chest wall, infiltrating the intercostal spaces and pectoralis muscle. Due to ventilator dependency a tracheostomy was performed on HD 24. Despite anti-fungal therapy the cavitary lesion persisted, with evidence of osseous destruction of the third and fourth ribs, as well as new fluid collections within the cavity and hilar extension. On HD 46 he was transferred to our institution for Thoracic Surgery and Interventional Radiology (IR) evaluations. Percutaneous drain placement followed by pneumonectomy vs. staged cavernostomy was considered;however, on HD 50, the patient suddenly developed massive hemoptysis. CTA of the chest showed a 1.6 x 1.5 cm PAP with active hemorrhage from the LUL anterior segmental artery with dispersion into the cavity. Urgent coil and glue embolization was successfully performed by IR. Ultimately, thoracic surgical intervention was deemed too high risk and thus he was medically managed with a regimen of isavuconazole, amphotericin, and terbinafine. Hemoptysis did not recur and he was eventually discharged from the hospital and liberated from both mechanical ventilation and tracheostomy. Chest CT 6 months from the initial diagnosis has shown stable to mildly decreased size of the cavitary lesion. DISCUSSION: This is the first case to our knowledge of PAP as a complication of Covid-19 and Mucor superinfection in the United States. Five cases of this combination have been recently reported in other countries. Risk factors for Mucor infection after Covid appear to be uncontrolled diabetes, DKA, and steroid administration. CONCLUSIONS: A high index of suspicion should be maintained in patients with these risk factors, as PAP can present as massive hemoptysis and is often fatal. Reference #1: Hoenigl M, Seidel D, Carvalho A, et al. The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries [ 2022 Jan 25]. Lancet Microbe. 2022;10.1016/S2666-5247(21)00237-8. doi:10.1016/S2666-5247(21)00237-8 Reference #2: Pruthi H, Muthu V, Bhujade H, et al. Pulmonary Artery Pseudoaneurysm in COVID-19-Associated Pulmonary Mucormycosis: Case Series and Systematic Review of the Literature. Mycopathologia. 2022;187(1):31-37. doi:10.1007/s11046-021-00610-9 Reference #3: Coffey MJ, Fantone J 3rd, Stirling MC, Lynch JP 3rd. Pseudoaneurysm of pulmonary artery in mucormycosis. Radiographic characteristics and management. Am Rev Respir Dis. 1992;145(6):1487-1490. doi:10.1164/ajrccm/145.6.1487 DISCLOSURES: No relevant relationships by Kevin Patel No relevant relationships by Clifford Sung

8.
2022 IEEE World Conference on Applied Intelligence and Computing, AIC 2022 ; : 103-108, 2022.
Article in English | Scopus | ID: covidwho-2051928

ABSTRACT

In the time of Covid-19, when social distancing is one of the important solution for avoiding virus infection, human cleaner become the one of the major spreaders of the virus. Also day-by-day human cleaner cost and the number of senior citizens are increasing, autonomous surface cleaner is in demand. It is also useful for the industry places, offices, and other public and private places. Commercial surface cleaners are available in the market with having limited functionality of covering the entire surface area. In addition, these surface cleaners demands a good amount of human efforts. In this paper author proposed design of an efficient autonomous surface cleaner using deep learning and embedded technology. It is having complete area coverage planning and dynamic obstacles avoidance strategies. The prototype of the proposed design is developed and tested in a room area of the domestic environment. It covers the significant surface areas and clean the surface efficiently with minimal human efforts. © 2022 IEEE.

9.
Journal of the Intensive Care Society ; 23(1):42-43, 2022.
Article in English | EMBASE | ID: covidwho-2043022

ABSTRACT

Introduction: Recruitment in intensive care has long been discussed, with the pandemic bringing this into sharp focus. Most anaesthetists in training were fully redeployed into ICU rotas or provided technical expertise. As surge rotas settle and a 'new normal' is regained, the challenge of ICU consultant recruitment needs to be addressed. Historically, ICUs have been predominantly staffed by consultants trained in both anaesthetics and intensive care medicine (ICM), but the challenges of this career path have been augmented by COVID-19. Forecasts suggest a concerning supply shortage of both anaesthetic and ICM consultants.1 The latest recruitment round for ICM has been the most competitive year for applications (ratio 2.9:1 in 2021 compared to 1.49:1 in 2020).2 However, the anaesthetic/ICM dual-training contribution to this workforce has worryingly decreased from approximately twothirds to less than a half. But what factors are causing this and has COVID-19 redeployment worsened this? Objectives: As we emerge from the second wave of the pandemic, we assessed the attitudes of anaesthetists about future careers in intensive care. Methods: We performed a brief electronic survey of 100 dual-or single-specialty anaesthetists in training from four LETBs across England who were redeployed to ICU. Results: Our survey showed that 29% had a negative experience that dissuaded them from pursuing ICM careers or, in some circumstances, relinquish their ICM training number altogether. Promisingly, 64% had a positive experience, and of these 39% reaffirmed their desire to pursue a career in ICU and 13% developed a new interest in pursuing a career in ICU since their redeployment. Positive factors included, 'teamwork', 'complexity of patients' and 'adding variety to my anaesthetic practice'. Prominent negative factors were 'additional exams', 'two separate portfolios' and 'high risk of burnout'. Respondents suggested changes to attract more anaesthetists to dual-accredit with ICM. This included the removal of hurdles such as additional exams, separate portfolios, and duplicated assessments. The additional training time was also highlighted, particularly given that trainees already contribute significantly to ICM rotas. There was a need for more flexibility in training with dual trainees wanting to undertake advanced training modules like their anaesthetic counterparts. They also reported wanting more anaesthetic sessions in their future job plans possibly reflecting the desire for varied practice as a consultant. Conclusion: Although COVID-19 has had a positive effect by increasing ICM applications, this may be at the expense of dual-trained anaesthetic/ICM trainees. FFICM should consider the factors which dissuade these applicants and its future impact on skills available in ICU. Both the RCoA and the FFICM have recently announced changes to curricula and e-portfolio which may close some of these gaps. The pandemic has grabbed the attention of a few anaesthetists and presented an opportunity to work in a team that solves difficult physiological puzzles, rapidly escalates capacity, and increasingly focuses on staff wellbeing. We should capitalise on this and hope that COVID-19 will result in the conversion of some of our anaesthetic colleagues into dual-specialty ICM consultants.

10.
Nanotheranostics for Treatment and Diagnosis of Infectious Diseases ; : 319-352, 2022.
Article in English | Scopus | ID: covidwho-2035586

ABSTRACT

Carbon-based inorganic nanomaterials (CINMs) which include carbon nanotubes (CNTs), graphene quantum dots (GQDs), graphene (G), graphene oxide (GO), reduced graphene oxide (rGO), and mesoporous carbon nanoparticles (MCNPs) have gained significant interest in biomedical application. The unique geometries (i.e., dimensions: 0D, 1D, 2D, 3D), chemical functionality/surface chemistry, and tunable physical properties of the CINMs make more interesting materials for theranostic applications. These properties of CINMs endowed their use in the delivery of therapeutics (drug/gene/biomolecules) for therapy and diagnostics (imaging/tracking) as an agent for cells and tissue imaging. In this chapter, we will highlight the recent advancement of CINMs and their tunable structure for various drug delivery and optical properties for imaging cells and tissues using different imaging modalities. Furthermore, we will summarize the CINMs role and promising applications for theranostic applications in infectious diseases such as tuberculosis (TB), influenza (H1N1), Ebola virus disease (EVD), Middle East respiratory syndrome virus (MERS), severe acute respiratory syndrome coronavirus (SARS-CoV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and other infectious diseases and also discuss the future perspectives to find the desirable platforms. © 2022 Elsevier Inc. All rights reserved.

11.
West Afr J Med ; 39(9): 982-984, 2022 Sep 16.
Article in English | MEDLINE | ID: covidwho-2034207

ABSTRACT

This is a case of a 53-year-old African American woman with newly diagnosed concomitant acute cholecystitis, diverticulitis, and SARS-COV-2 infection. She underwent treatment for COVID-19 with antibiotics and supportive treatment, and on day 32 after initial symptoms presented, she had an elective laparoscopic cholecystectomy. Our patient was one of the first cases to present with acute cholecystitis and diverticulitis complicated by COVID-19, and serves as a template for surgical management of non-emergent abdominal pathologies in the midst of the COVID-19 pandemic.


Voici le cas d'une Afro-Américaine de 53 ans chez qui on a diagnostiqué récemment une cholécystite aiguë concomitante, une diverticulite et une infection par le SRAS-COV-2. Elle a été traitée pour l'infection COVID-19 avec des antibiotiques et un traitement de soutien, et le 32e jour après l'apparition des premiers symptômes, elle a subi une cholécystectomie laparoscopique élective. Notre patiente a été l'un des premiers cas à présenter une cholécystite et une diverticulite aiguës compliquées par le COVID-19, et sert de modèle pour la gestion chirurgicale des pathologies abdominales non urgentes au milieu de la pandémie de COVID-19. Mots-clés: COVID-19, Diverticulite, Cholécystite, SARCOV-2.


Subject(s)
COVID-19 , Cholecystitis, Acute , Diverticulitis, Colonic , Diverticulitis , Abscess/complications , Abscess/therapy , Anti-Bacterial Agents/therapeutic use , COVID-19/complications , Cholecystitis, Acute/complications , Cholecystitis, Acute/diagnosis , Cholecystitis, Acute/surgery , Diverticulitis/complications , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/surgery , Female , Humans , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
12.
Journal of Clinical and Diagnostic Research ; 16(9):XD01-XD04, 2022.
Article in English | EMBASE | ID: covidwho-2033406

ABSTRACT

Pandemic was new experience for entire humanity. Medical fraternity was no exception. The cases of mucormycosis were on the rise during the second wave of the pandemic. Presented here are two cases which were combination of two diseases, one of which was squamous cell carcinoma of head and neck region and other one was sinonasal mucormycosis. Both patients were diabetics and had history of Coronavirus Disease-2019 (COVID-19) infection in past. Our literature search doesn't reveal any previously reported cases of this rare combination. There were certain challenges in management. Both diseases were lethal and treatment of one cannot be prioritised over other. Challenges in managing those cases were, reconstruction planning, perioperative management and postsurgery adjuvant therapy. In absence of previous experience to treat this combination or any literature available new treatment protocol were formulated. Cases were discussed in multidisciplinary team meetings and treatment plans were formulated. Mucormycosis and oral squamous cell carcinoma both were operated and reconstructed in same sitting. In one patient revision endoscopic debridement had to be done. Amphotericin B was started once diagnosis was confirmed. Patients were followed-up on weekly basis during first month and imaging was done every 15 days. Both patients had satisfactory recovery without any sign of progression of mucormycosis. Adjuvant radiation was given in both cases at appropriate time. At follow-up both patients were free from disease for six months. From these unique experiences it can be recommended that combination of sinonasal mucormycosis and squamous cell carcinoma of head and neck is very rare. Both diseases can be treated simultaneously. Excision and reconstruction can be done in single sitting. There is no need to delay or avoid adjuvant radiation. Multidisciplinary team approach is the key for treatment.

13.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009579

ABSTRACT

Background: The COVID-19-associated global pandemic has brought many public and population health issues to light. A glaring issue is the disparities among and differences in susceptibility of diverse ethnicities. Viral infection is not the only area of healthcare facing this issue: disparities in prevalence, biology, prognosis, and outcomes of cancer exist, often based on socioeconomics and social determinants of health (SDoH). CHD have been debated and discussed at several levels, from local counties to the congress to the Centers for Medicare and Medicaid Services. Amid the debates and recommendations, it has been difficult to carve out a clear path forward. The complex factors involved include access to care because of financial challenges, biological and genetic factors, impact of SDoH, and access to screening, NGS testing, and clinical trials. CHD may contribute to almost 34% of deaths among adult cancer patients and additional spending of $230 billion. Addressing CHD could result in an indirect savings of as much as $1 trillion over 3 years (AACR, CDR, 2020). A comprehensive approach is needed to generate a groundswell of resources. This should include support for public policies aimed at improving understanding of the issue by all parts of the ecosystem (pharma, researchers, government agencies, physicians), adequate funding for federal and local initiatives, considerations of health in community planning and development, and collection of real-world data and evidence. At Carolina Blood and Cancer Care (CBCCA), the team decided to study this issue and initiate solutions one step at a time. Methods: CBCCA prioritized solutions in 5 categories. The top priority was to address issues impacting patients: access to care, NGS testing, cancer screening, SDoH, and clinical trial access. To address access to care issue (financial constraints), 2.5 FTEs (full-time equivalents) were allocated to carry out needs assessments and identify resources, including Medicaid eligibility, dual eligibility, other foundations, and sources for free drugs. A not-for-profit entity, No One Left Alone, was started to address CHD. Results: During 2021 CBCCA physicians saw 1787 unique cancer patients (both established and new). Of these, 319 needed IV anticancer treatment and an additional 104 needed oral oncolytics. Fifty-three could not pay for their cancer treatment. Another 101 patients needed assistance for out-of-pocket costs. Financial counselors procured free drugs worth $1,633,588 and an additional $135,931 in cash assistance for high out-of-pocket costs. The pharmacy team raised $253,218 for 64 patients (374 transactions) for out-of-pocket costs. As a result, not a single patient was left without treatment. Conclusions: Financial toxicity was addressed by allocating 0.5 FTE per oncologist to ensure access to care. In the next phase, CBCCA will address access to NGS testing.

14.
Indian Journal of Critical Care Medicine ; 26:S93, 2022.
Article in English | EMBASE | ID: covidwho-2006380

ABSTRACT

Introduction: COVID-19 pandemic started from Wuhan, China, and has spread across the world and whole humanity passed through this havoc of this pandemic. Healthcare system became overburdened due to scarcity of manpower and resources. Large number of cases treated in our hospital, here we are publishing our retrospective data of basic demographics and outcome of COVID-19 patients admitted in a tertiary care center in Surat. Materials and methods: This is a retrospective single-center study of demographics and outcomes of COVID-19 patients admitted to Sunshine Global Hospital between June 2020 and July 2021. Data were collected from the hospital information system and analysed. These all patients are diagnosed on basis of rapid antigen and, or RTPCR reports along with HRCT of the chest. Results: A total of 1525 COVID-19 patients were admitted between June 2020 and July 2021. Out of those patients, complete data of 1514 is available, among them, 1036 [68%] were males with a mean age of 54 years and 478 [32%] were females with a mean age of 55 years. The average length of stay in the hospital was 7 days. 1412 [93.2%] survived and 98 [6.4%] died. Among 297 [19%] patients admitted to ICU admission, 120 [7.9%] patients required intubation. Mean age was 55 years. Average length of stay [LOS] in ICU was 7 days and LOS in the hospital was 11 days. In the intubated patient, the average duration of ventilator support was 7 days. Tracheostomy was done in 43 [2.8%] patients. Out of 120 intubated patients, 44 survived and were discharged after an average in-hospital stay of 15 days, while 76 patients could not survive. Survival rate in ICU patients was 69.4% and among those requiring invasive mechanical ventilation 36.7%. Conclusion: Protocolised system of care helped limiting the mortality in the COVID-19 pandemic. Large majority of those who are intubated and survived required tracheostomy, prolonged mechanical ventilation, ICU, and hospital LOS.

15.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005667

ABSTRACT

Background: Ide-cel, a BCMA directed CAR T-cell therapy, was FDA approved 3/26/2021 for the treatment of RRMM after 4 prior lines of therapy. We evaluated the real-world outcomes of patients treated with standard of care ide-cel under the commercial FDA label. Methods: Ten US academic centers contributed data to this effort independent of the manufacturer. As of 1/10/2022, 138 patients were leukapheresed with overall manufacturing failure in 6 (4%). 108 patients were infused ≥ 30 days prior to data-cut off and constitute the study population for this retrospective analysis. Results: Table describes the study population compared to the pivotal KarMMa-1 trial (Munshi et al, NEJM 2021). Patients in our study were less likely to have ECOG PS of 0/1 (77%) and more likely to be penta-refractory (41%). 67% of patients would not have met eligibility criteria for KarMMa. Common reasons for ineligibility (> 1 reason in 22% patients) were co-morbidities (28%), cytopenias (22%), prior therapy with alloSCT/ CAR-T/other BCMA therapy (19%), CNS myeloma/non-measurable disease/plasma cell leukemia (13%), and fitness (12%). 81% of patients received bridging therapy. Toxicity was comparable to that seen in KarMMa-1. Cytokine release syndrome (CRS) was seen in 82% (> grade 3: 4%) and immune effector cell-associated neurotoxicity syndrome (ICANS) in 15% (> grade 3: 5%) of patients, respectively. Tocilizumab and steroids were used in 72% and 25% of patients, respectively. Infections were seen in 34% of patients. Day 30 response was evaluable in 104 patients. Response rates were: ≥ partial response, 83%;≥ very good partial response, 64%;and ≥ complete response (CR), 34%. 11% of patients have died by data cut-off, 7 due to disease progression and 5 due to other causes (1 grade 5 CRS, 1 hemophagocytic lymphohistiocytosis, 1 progressive neurological weakness, 2 COVID-19). Conclusions: This multicenter retrospective study delineates the real-world outcomes of ide-cel CAR T-cell therapy for RRMM. Despite more patients being penta-refractory and less fit compared to the pivotal KarMMa trial, safety and 30-day responses in the real-world setting (overall response rate: 83%, CR: 34%) are comparable to the clinical trial population. Follow-up is ongoing and updated data will be presented.

17.
Cureus ; 14(7):e26480, 2022.
Article in English | MEDLINE | ID: covidwho-1975350

ABSTRACT

The coronavirus disease-2019 (COVID-19) pandemic is exacerbating the worldwide healthcare crisis. The pandemic has had an impact on nearly every system of our body. The Food and Drug Administration (FDA) gave immediate authorization of several vaccines to avoid critical COVID-19 outcomes following the rapid spread of the COVID-19. There have only been a few cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination-induced immune thrombocytopenia (ITP) so far. There should be enough information to identify whether some vaccination adverse effects, such as ITP, are caused by the vaccine. This study aims to determine how common ITP occurs after receiving the SARS-CoV-2 vaccine, as well as gender, age, symptoms, biomarkers, predicted outcomes, and sequelae. We looked at a number of research and compiled the best evidence of SARS-CoV-2 vaccine-induced thrombocytopenia currently available. To find the recommended reporting items, the search technique included keywords like "Immune thrombocytopenia," "COVID-19," "SARS-CoV-2," and "Vaccination." The search results were grouped using Boolean operators ("OR," "AND").

18.
Gastroenterology ; 162(7):S-594-S-595, 2022.
Article in English | EMBASE | ID: covidwho-1967337

ABSTRACT

Background : Robust COVID-19 vaccine-induced antibody (Ab) responses are important for protective anti-viral immunity. Data are urgently needed to determine whether vaccineinduced immunity is impacted by commonly used immunosuppressive drug regimens in IBD. Methods: We prospectively recruited 447 adults (90 healthy controls and 357 IBD) at nine UK centres. The IBD study population was established (>12 weeks therapy) on either thiopurine monotherapy (n=78), infliximab (IFX) monotherapy (n=61), thiopurine & IFX combination therapy (n=70), ustekinumab (uste) monotherapy (n=56), vedolizumab (vedo) monotherapy (n=62) or tofacitinib (tofa) monotherapy (n=30). Participants had two doses of either ChAdOx1 nCoV-19, BNT162b2 or mRNA1273 vaccines. The primary outcome was anti-SARS-CoV-2 spike (S1 RBD) Ab concentrations, measured using the Elecsys anti- SARS-CoV-2 spike (S) Ab assay, 53-92 days after second vaccine dose, in participants without prior infection, adjusted by age & vaccine type. Secondary outcomes included proportions failing to generate protective Ab responses (defined cut-off anti-S concentration 15 U/ml, which correlated with 20% viral neutralization). Results: Geometric mean S Ab concentrations (figure 1) were lower in patients treated with IFX (153U/ml;p<0.0001), IFX and thiopurine combination (109U/mL;p<0.0001), tofa (430U/ml;p<0.0001) and uste (561U/ml;p=0.013) compared to controls (1596U/ml). No differences in S Ab concentrations were found between controls and thiopurine monotherapy-treated patients (1020U/ml;p=0.62), nor between controls and vedo-treated patients (944U/ml;p=0.69). In multivariable modelling (figure 2), lower S Ab concentrations were independently associated with IFX (FC 0.10 [95% CI 0.07-0.14], p<0.0001), tofa (0.36 [95% CI 0.19-0.69], p=0.002) and uste (0.56 [95% CI 0.31-1.00], p=0.049), but not with thiopurine (0.77 [95% CI 0.54-1.11], p=0.17) or vedo (1.01 [95% CI 0.61-1.68], p=0.96). mRNA vaccines (3.67 [95% CI 2.72-4.96], p<0.0001) and older age (0.82 [95% CI 0.73-0.91], p=0.0003) were independently associated with higher & lower S Ab concentrations respectively. Protective Ab responses were generated by all thiopurine monotherapy, vedo, tofa and healthy control participants, but not by 11% of patients on IFX monotherapy, 13% on thiopurine & IFX combination therapy and 4% on uste. Conclusions : COVID-19 vaccine-induced Ab responses are significantly reduced in patients treated with IFX, or tofa, and to a lesser extent with uste. No significant reduction was seen in vedo or thiopurine monotherapy-treated patients. Our data suggest that 3rd primary or booster vaccine doses for IBD patients might be tailored to an individual's immunosuppressive treatment. (Figure Presented) (Figure Presented)

19.
Annals of Clinical Psychiatry ; 34(1):1, 2022.
Article in English | EMBASE | ID: covidwho-1913156

ABSTRACT

BACKGROUND: Mental health problems were heterogeÂneously increased among the population groups during the COVID 19 pandemic.1 The pandemic promoted existAîng suicide risk factors such as illicit drugs and alcohol use, access to lethal means, and social disconnectedness.2 According to the CDC, 40% of US adults reported sympÂtoms of depression, anxiety, or increased substance use during COVID-19, and 10.7% of the participants reported suicidal ideation.3 OBJECTIVE: This study aimed to compare suicide rates among adult population (18-64 years old) in Marion County, Indiana in 2019 and 2020. METHODS: Data for 2019 and 2020 was ed from coroners' records in Marion County, Indiana. In 2019 and 2020, a cumulative total of 130 and 157 suicide cases were reported, respectively. We identified 104 adult suicide cases in 2019 and 116 adult suicide cases in 2020 with age range of 18 to 64 years. We analyzed the data for age, race, genÂder, job, marital status and the method of suicide. RESULTS: From 2019 to 2020, adult suicides increased by 11.5%, from 104 to 116 cases. In 2019, cases were highest during the month of January (14.4%). Most cases were white (79.8%). The average age was 39.6 years old and male to female ratio was 3.9:1.1. Almost half of the cases (49%) were unemÂployed and 36.5% were employed. Regarding marital status, 47.1% of those died by suicide were never marÂried, 27.8% were married and 19.2% were divorced. Regarding the method of suicide, gunshot wound was the most common method (58.6%), followed by hangAîng (32.6%), drug toxicity, asphyxiation, and sharp force trauma with 1.9% each. In 2020, cases were highest in January (12%) and December (11.2%). In 2019, most cases were white (76.72%). The average age was 35.7 years old and male to female was 8.6:3. About one third of cases (33.6%) were unemployed and 43.1% were employed. Regarding mariÂtal status, the majority (58.6%) were never married, while 23.2% and 13.7% were married and divorced respectively. The most common method of suicide was gunshot wound (63.7%), followed by hanging (24.1%), drug toxicity (4.3%), and asphyxiation (4.3%). CONCLUSION: Suicide rates among adults increased by 11.5% in Marion County, Indiana. While white males had the highest suicide rates during both years, female suicides increased from 20% in 2019 to 26% in 2020. Average age of those who died by suicide was younger in 2020. A rise in suicide was seen in unmarried and employed individuals. Suicide by gunshot wounds and drug toxicity also increased. Our findings echoed the CDC findings.3 Public health measures which target certain population groups such can mitigate suicide rates during a global pandemic.

20.
Annals of Clinical Psychiatry ; 34(1):2, 2022.
Article in English | EMBASE | ID: covidwho-1913155

ABSTRACT

BACKGROUND: Suicide behavior among seniors is conÂsidered a significant public health problem across many countries. Its rates in the United States have increased steadily, especially in the life course of older white men, estimated at 48.7/100,000.1 Studies have described many stressors that play a role in attempting or dying by suicide in this age group, e.g., chronic physical ill-ness, mental illness, and social isolation. However, the influence of pandemics on suicide rates is not fully addressed, particularly those with lockdowns and limited social interactions. OBJECTIVE: We aim to study the impact of the COVID-19 pandemic on the rate of suicide among the geriatric populaÂtion in Marion County, Indiana. METHODS: Data for 2019 and 2020 was ed from coroners' records in Marion County, Indiana. In 2019 and 2020, a cumulative total of 130 and 157 suicide cases were reported, respectively. We identified 22 elderly suicide cases in 2019 and 34 elderly suicide cases in 2020 with age range of 65 to 94 years. We analyzed the data for age, race, gender, job, marital status, and the method of suicide. RESULTS: A total of 17% of elderly suicide cases are identiÂfied in 2019 and 22% of elderly suicide cases are identified in 2020. Elderly suicide cases increased by 55% from 2019 to 2020. In 2019, all elderly suicide cases were white, averAâge age was 76 years old, and male to female was 9:2 ~5:1. Approximately 59% of elderly suicide cases were retired, 27% were employed and only 2% were unemÂployed. Regarding marital status, 36% who died by suiÂcide were married, 32% were divorced and 18% were widowed. Most common method of suicide was gunÂshot wound (73%) followed by drug overdose (9%) and hanging (9%). Cases were highest in August (18%) and September (18%). In 2020, almost all elderly suicide cases were white (except one was black), average age was 75.7 years old, and male to female ratio was 10:1. Approximately 56% of elderly suicide cases were retired, 20% were employed, and 20% were unemployed. Regarding marital status, 35% were widowed, 30% were married, and 26% were divorced. Most common method of suicide was gunshot wound (88%), followed by drug overdose (6%), and hanging (6%). Cases were highest in August (21%), December (15%), June (12%) and July (12%). CONCLUSION: Based on our findings, elderly suicide increased by 55% in 2020 in Marion County, Indiana, compared to 2019. However, the other parameters (e.g., race, employment, marital status) remained relatively unchanged. Although previous studies explained the steady increase in the suicide rate among the elderly,1 we believe COVID-19 pandemic lockdown and the limited social interaction have contributed to the rise seen in 2020. In addition, the geriatric population is growing and expected to outweigh the youth in a few years2;hence addressing suicide among the elderly is an urgent public health problem, requires extra efforts, especially during similar circumstances.

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