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Patients with severe COVID-19 usually develop acute respiratory distress syndrome (ARDS) characterised by acute hypoxemic respiratory failure (HRF) and bilateral pulmonary infiltrates [1, 2]. The common reason for HRF occurring in the course of ARDS is the ventilation-perfusion mismatch or the intrapulmonary shunt [3]. Generally, HRF is defined as an acute condition where the arterial oxygen tension is below 60 mmHg on room air or oxygen is required to maintain measurements of pulse oximetry above 90% with low or normal partial carbon dioxide pressure [4]. Therapeutic options are limited to target the ongoing pathological processes of ARDS, and hence mechanical ventilation continues to be the mainstay for patient management [5]. Non-invasive ventilation (NIV) and high flow nasal cannula oxygen therapy (HFNC) can play a role in providing respiratory support to COVID-19 patients before developing severe HRF or in circumstances where there is limited access to more invasive techniques [1]. © Springer Nature Switzerland AG 2020.
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Transmission of COVID-19 is primarily through droplets (only short distances) and fomite spread (e.g., clothing, equipment, furniture) that can become contaminated by the virus [1]. In contrast, aerosols are composed of much smaller fluid particles that can remain suspended in the air for prolonged periods [2]. Current evidence suggests that coronaviruses can survive in the aerosol within fluid particles under certain conditions [3, 4]. Some events can potentially lead to aerosolization of virally contaminated body fluid (aerosol-generating procedures "AGPs"), including coughing/sneezing/expectorating, NIV, HFNC, jet ventilation, delivery of nebulized medications via simple face mask, cardiopulmonary resuscitation (before tracheal intubation) and tracheal extubation [5, 6]. A higher risk of viral aerosolization was reported with tracheal suction (without a closed system), tracheal intubation, laryngoscopy, bronchoscopy/gastroscopy and tracheostomy/cricothyroidotomy [6]. Thus, these procedures carry a potential increased risk of nosocomial infection to healthcare workers (HCWs) and COVID-19 has now been classified as a high consequence infectious disease (HCID), emphasizing the significant risk to HCWs and the healthcare system [1]. © Springer Nature Switzerland AG 2020.
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The deadly COVID-19 outbreak has wreaked havoc around the globe. As of 2022, there have been around 42 million cases worldwide, with 1.14 million deaths. A fuller knowledge of the epidemic demonstrates that the irresponsibility of a single person can have far-reaching, irrevocable consequences. COVID-19 must be contained by social isolation. Consequently, a system to monitor and identify the human-endangering distance is required. The proposed technique uses Euclidean distance-derived bounding boxes and distance metrics to leverage the YOLOv5 object identification model to track known individuals. Experimentation demonstrated that the YOLO v5-based Euclidean distance method outperformed other deep learning algorithms such as YOLOv3 and YOLOv4. Our model achieved less inference time and a high process frame score with balanced mAP. © 2022, International Organization on 'Technical and Physical Problems of Engineering'. All rights reserved.
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Communicative competence represents an academic leader's ability to use language effectively. However, to date, communicative competence among academic leaders is not as effective as expected. This research aims to explore the affective factors hindering the academic leaders' communicative competence, identify the cultural factors affecting their communicative competence, and investigate the impact of using technology in developing communicative competence during the Covid-19 pandemic. This qualitative study employed semi-structured interviews with nine academic leaders from different universities in Iraq. It adopts four theories: communicative competence, leadership competence, communication and planned behaviour for the basis and guidance for data collection, data analysis, and interpretation. The qualitative data were transcribed and analysed using thematic analysis. It was found that the following Key factors, such as digital literacy became crucial during lockdown because of COVID-19. All meetings and conferences adopt online mode instead of physical appearance. In such a situation, majority respondents mentioned that communicative competence has proven helpful in problem-solving and developing critical skills. The respondents have proposed a framework for developing academic leaders' communicative competence for digital literacy post-Covid-19. Such as training to use digital tools for language usage, monitoring the electronic examination process more efficient and initiatives for communication competence. © 2022, Penerbit Universiti Kebangsaan Malaysia. All rights reserved.
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Background: Virtual platforms are used to share educational content and improve medical education learning. With the COVID-19 pandemic, the Radiation Oncology (RO) field is using these platforms to augment the quality and size of the audience reached. Objective(s): The hypothesis is that using Twitter to discuss the latest RO literature in a global journal club format can improve clinical practice and opportunities for collaboration. Method(s): This Twitter journal club is on the 3rd weekend each month. It has an asynchronous portion that allows for global participation (to overcome time zone differences) and a one-hour live Twitter chat to facilitate active discussion between authors, invited discussants and participants. A short summary and guiding questions are posted on the website prior and is broadcast to a mailing list. Participants use dual hashtags (#RadOnc #JC) in tweets to follow the discussion. This analysis focuses on the January 2021-February 2022 experience. NodeXL (Social Media Research Foundation, CA) and Symplur (W2O, CA) were used for analytics. Result(s): Mean total number of participants was 56 (range: 36-97). Mean increase in the Altmetric Attention Score (AAS), a measure of volume and source of attention chosen articles received, was 22 (Range: 4 to 83). The Prostate Cancer and Exercise journal club in January 2022 had the most participants (n=97). At baseline, 45% of respondents would sometimes encourage patients to exercise, 32% always, 15% rarely and 8% never (n=47). At the end of the journal club, 82% would recommend exercise to patients in the future and 12% would consider it (n=36). Exercise options encouraged were Group Programs (60.8%, 76/125), Monitoring Apps (24.8%, 31/125), Online Classes (12/125), and Pamphlets/Brochures (4.8%, 6/125). The most active journal clubs were on Bladder Cancer (BCON, 696 tweets and 57 participants), Postoperative Prostate Cancer (RADICALS, 599 tweets and 51 participants), and Radiobiology/Toxicity (HyTEC, 580 tweets). Conclusion(s): COVID-19 has shifted the medical education landscape in RO and the global oncology community. Twitter and social media platforms can be used to engage learners and discuss RO advances with the help of experts worldwide. This can foster interdisciplinary, global conversations for the benefit of medical education, integrated collaboration, and potentially translate to improved clinical outcomes (Table 1).
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SESSION TITLE: Pulmonary Involvement in Critical Care Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Cryptogenic organizing pneumonia (COP), also known as bronchiolitis obliterans organizing pneumonia (BOOP), is one of the idiopathic interstitial lung diseases that affects the alveolar epithelium and surrounding interstitium. Its diagnosis is usually delayed due to similar clinical presentation as other illnesses (e.g. pneumonia) [1]. CASE PRESENTATION: A 65-year-old male presented with rapidly progressive respiratory failure. Computed tomography (CT) of chest showed multifocal ground glass opacities. He had suboptimal response to antibiotics and had to be intubated on day 9 due to worsening respiratory failure. Bronchoscopy with bronchoalveolar lavage was performed, cytology of which revealed severe acute inflammation and mononuclear infiltration. Decision was made to perform open lung biopsy which showed polypoid plugs of organizing fibroblasts and myofibroblasts in the distal airways and alveoli with focal hyaline membrane and alveolar damage, consistent with acute onset fulminant COP. As expected, the patient responded fairly well to high-dose corticosteroids and was extubated on day 9 of intubation. DISCUSSION: Even though it is very rare, COP should be kept in differentials especially when initial interventions fail (as in our patient). There is no single laboratory study or intervention to diagnose this condition. Hence it is imperative to rule out other causes of similar presentation like pneumonia (using cultures, urine antigen testing, and viral polymerase chain reaction tests). The clinical picture is combined with supportive evidence like elevated erythrocyte sedimentation rate, leukocytosis, imaging findings, and bronchoscopic and histopathology evaluation [2]. Once diagnosed, it is important to rule out any associated CTD, for it can change management and prevent additional complications. The majority of patients with COP exhibit rapid response to glucocorticoid treatment. For fulminant disease, intravenous glucocorticoids (e.g. methylprednisolone 125-250 mg every six hours) should be initiated based on the clinical experience and case reports [3]. CONCLUSIONS: Diagnoses of interstitial lung diseases should be pursued in a systemic fashion from more common to less common. However, anchoring to common diagnoses should be avoided to negate delay in diagnoses and allow timely management. If initial workup is unrevealing, bronchoscopy and open lung biopsies should be performed while the patient is stable enough to undergo the interventions to avoid antibiotic resistance, morbidity and mortality associated with rapidly progressive noninfectious illnesses like fulminant COP. Reference #1: Drakopanagiotakis F, Polychronopoulos V, Judson MA. Organizing pneumonia. The American journal of the medical sciences. 2008 Jan 1;335(1):34-9. Reference #2: Cordier JF. Cryptogenic organising pneumonia. European Respiratory Journal. 2006 Aug 1;28(2):422-46. Reference #3: Nizami IY, Kissner DG, Visscher DW, Dubaybo BA. Idiopathic bronchiolitis obliterans with organizing pneumonia: an acute and life-threatening syndrome. Chest. 1995 Jul 1;108(1):271-7 DISCLOSURES: No relevant relationships by Fareeha Abid No relevant relationships by Vipin Garg No relevant relationships by Qirat Jawed No relevant relationships by Asnia Latif No relevant relationships by Ahmed Mowafy No relevant relationships by Muniba Naqi No relevant relationships by Muhammad Atif Masood Noori No relevant relationships by Hasham Saeed
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Background. The presence of extensive workload and pressure associated with COVID19 has resulted in a lot of mental and physical trauma in primary health care physicians (PHCC) across the world. Aim of the study. The present study is aimed at understanding the level of dissatisfaction in PHCC physicians in the Asser region of Saudi Arabia. The various risk factors associated with dissatisfaction also have been analyzed in this study. Method. An analytical cross-sectional study was performed on various PHCCs who were working in the Ministry of Health in the Asser region. Results. The overall analysis showed that around 73% of the physicians who responded showed dissatisfaction. The major factors that were found to affect satisfaction based on the variables analyzed include physicians who are males, Saudi Nationals, training residents, and those who received recognition. These four variables had a p value of less than 0.0001 making it statistically significant. Conclusion. The study observed that there is dissatisfaction amongst PHCC physicians towards the management of pandemics. The factors identified should help officials in order to address these issues [ FROM AUTHOR] Copyright of Cardiometry is the property of Cardiometry 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 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 . (Copyright applies to all s.)
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Digital twins (DTs) play a vital role in revolutionising the healthcare industry, leading to more personalised, intelligent, and proactive healthcare. With the evolution of personalised healthcare, there is a significant need to represent a virtual replica for individuals to provide the right type of care in the right way and at the right time. Therefore, in this paper, we surveyed the concept of a personal digital twin (PDT) as an enhanced version of the DT with actionable insight capabilities. In particular, PDT can bring value to patients by enabling more accurate decision making and proper treatment selection and optimisation. Then, we explored the progression of PDT as a revolutionary technology in healthcare research and industry. However, although several research works have been performed for smart healthcare using DT, PDT is still at an early stage. Consequently, we believe that this work can be a step towards smart personalised healthcare industry by guiding the design of industrial personalised healthcare systems. Accordingly, we introduced a reference framework that empowers smart personalised healthcare using PDTs by bringing together existing advanced technologies (i.e., DT, blockchain, and AI). Then, we described some selected use cases, including the mitigation of COVID-19 contagion, COVID-19 survivor follow-up care, personalised COVID-19 medicine, personalised osteoporosis prevention, personalised cancer survivor follow-up care, and personalised nutrition. Finally, we identified further challenges to pave the PDT paradigm toward the smart personalised healthcare industry.
Subject(s)
COVID-19 , Delivery of Health Care , Forecasting , Health Care Sector , HumansABSTRACT
COVID-19 is rapidly spreading over the world, resulting in a global health crisis. SARS-COV-2 is the pathogen of COVID-19, and prior research has suggested a link between the ABO blood group and coronavirus. The goal of this study is to look at the link between the ABO blood group and COVID-19 infection, severity, and death. Through detection of detect the association between blood group and (age and Gender) in COVID-19 infected. The 375 samples from many Hospital and Health center in Iraq- Wasit, Erbil, Kirkuk, and Sulaimani applied to determine the results of the present study included: Descriptive statistical data analysis:(Frequency, Percentage, Mean, and Mode and stander deviation) and inferential data analysis: Chi-square test and one-way ANOVA (F-Test). A result of this study shows that, there was a statistically significant association between Blood groups in age (p=0.01). Nevertheless, there was no statistically significant association between A, B, AB, and O) Blood Groups in related gender (p=0.19) which was more than the stander alpha of 0.05. © 2022 Author(s).
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Emerging technologies such as digital twins, blockchain, Internet of Things (IoT), and Artificial Intelligence (AI) play a vital role in driving the industrial revolution in all domains, including the healthcare sector. As a result of COVID-19 pandemic outbreak, there is a significant need for medical cyber-physical systems to adopt these emerging technologies to combat COVID-19 paramedic crisis. Also, acquiring secure real-time data exchange and analysis across multiple participants is essential to support the efforts against COVID-19. Therefore, we have introduced a blockchain-based collaborative digital twins framework for decentralized epidemic alerting to combat COVID-19 and any future pandemics. The framework has been proposed to bring together the existing advanced technologies (i.e., blockchain, digital twins, and AI) and then provide a solution to decentralize epidemic alerting to combat COVID-19 outbreaks. Also, we have described how the conceptual framework can be applied in the decentralized COVID-19 pandemic alerting use case. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Background: The 2019 coronavirus disease (COVID-19) poses great demands on medical care and resulted in delayed prescribing. Objective: To evaluate the number of newly dispensed antidepressant and anxiolytic drugs among the Dutch population, before and during COVID-19. Methods: Pharmacy dispensing data was obtained from Stichting Farmaceutische Kentallen on newly dispended antidepressants and anxiolytics, covering 96% of the Dutch population. The number and week of first-time dispensed drugs were determined for the period January – June 2019 and 2020, and age and sex of patients was recorded. Using independent t-tests, data was compared between men and women, age groups, and between 2019 and 2020. Age groups considered were children (0-9 years old), adolescents (10-19 years old), adults (20-64 years old), and elderly (65 year and older). Three time periods were considered: week 1-11 (in 2020 corresponding to the pre-COVID-19 lockdown period), week 12-19 (in 2020 corresponding to the COVID-19 lockdown), and week 20-26 (in 2020 corresponding to the post-COVID-19 lockdown). Results: An overall reduction was observed in 2020 for the number of newly dispensed antidepressants (139.186 in 2019 and 126.487 in 2020, respectively) and anxiolytics (200.661 in 2019 and 189.559 in 2020, respectively). In both 2019 and 2020, the drugs were significantly more often dispensed to women than men, and most were prescribed to adults followed by the elderly. For antidepressants, in both male and female adolescents, adults and elderly, for week 1-11 no significant differences were found between 2019 and 2020. Compared to 2019, a significant reduction in the number of dispensed antidepressants was seen in during 2020 COVID-19 lockdown in these groups (p<0.05). In adolescents, but not for the other age groups, a significant reduction in dispensing was also found post COVID-19 lockdown (p<0.001). For children, a general reduction in the number of dispensed antidepressant drugs was seen in 2020 before and during COVID-19 lockdown (p<0.001). In male children there was a significant reduction in dispensing during COVID-19 lockdown (p=0.04), which was not significant among female children. For anxiolytics, in both male and female children and adolescents, a general reduction of dispensing was seen throughout 2020 (p<0.05). In male adults, in 2020 a significant reduction in dispensing was found during COVID-19 lockdown (p=0.01), and for both male and female adults post-COVID-19 lockdown (p<0.05). For elderly, no significant differences in dispending were found between 2019 and 2020. Conclusions: Across all age groups a significant reduction was seen for the number of newly dispensed antidepressant drugs. For all age groups except the elderly a significant reduction in dispensed anxiolytic drugs was seen during COVID-19 lockdown. This data corresponds with reports of delayed care. However, in elderly no reduction was found for dispensed anxiolytics during COVID-19 lockdown. Future research should determine if the continued dispensing of anxiolytics among elderly during lockdown may reflect the fact that fear of COVID-19 may be greater among this age group, as they are over-represented in COVID-19 related hospital admissions and have the highest mortality rates. No conflict of interest
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Background: To address the rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) around the world, in the absence of a vaccine or adequate treatment for the 2019 coronavirus disease (COVID-19), many governments around the world enforced lockdown periods. While lockdowns are beneficial in reducing the spread of the virus, literature shows that lockdowns may also have a significant negative impact on mood, wellbeing, and health. In this context, we hypothesized that negative mood changes increase overall stress levels, which in turn has a negative effect on perceived immune fitness, expressed in a greater presence and severity of COVID-19 symptoms [1]. Objective: The aim of this study was to investigate the impact of mood and stress during COVID-19 lockdown on perceived immune fitness and reported COVID-19 symptoms. Methods: An online retrospective survey was held among Dutch adults, to evaluate the first lockdown in The Netherlands [1]. Questions were answered for the period before the lockdown (15 January–14 March 2020) as well as for the lockdown period (15 March–11 May 2020). Mood was assessed via 1-item scales including “stress”, “anxiety”, “depression”, “fatigue”, “hostile”, “lonely” and “happy” [2]. Perceived immune fitness was assessed on a scale ranging from 0 (very poor) to 10 (excellent) [3]. The COVID-19 Symptoms Scale comprised the items sneezing, running nose, sore throat, cough, and malaise/feeling sick, high temperature (up to 38 Celsius), fever (38 Celsius and higher), shortness of breath, and chest pain [1]. The severity of each of the nine items could be rated as none (0), mild (1), moderate (2), or severe (3). The sum score of items served as COVID-19 symptom severity score, with a possible range from 0 (no complaints) to 27 (severe complaints). In addition, the presence of COVID-19 symptoms was calculated by counting the number of symptoms with a score > 0. Assessments before and during COVID19 lockdown were compared using the Related Samples Wilcoxon Signed Rank Test. For each variable, difference scores (Δ, lockdown – before lockdown) were calculated. Pearson's correlations were calculated between difference scores. Results: Data of 1415 Dutch adults (64% women, age range: 18 to 94 years old) were analyzed. During lockdown, all mood ratings, stress, and perceived immune fitness were significantly poorer compared to the period before lockdown (p<0.0001). The COVID-19 symptom severity score as significantly higher during the lockdown period (p=0.018), but no difference was found for the number of reported COVID-19 symptoms (p=0.256). Significant correlations were found between mood changes and Δ stress (r ranged from 0.334 to 0.557, all p<0.0001). The correlation between Δ stress and Δ perceived immune fitness was also significant (r=-0.310, p<0.0001). Finally, Δ perceived immune fitness correlated significantly with difference scores for the presence (r=-0.223, p<0.0001) and severity (r=-0.245, p<0.0001) of COVID-19 related symptoms. Conclusions: The findings support the hypothesis that lockdown has a negative effect on mood and increases stress. This is reflected in poorer perceived immune fitness, which in turn is associated with a greater presence and severity of COVID-19 symptoms. No conflict of interest
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Background: Immune fitness has been defined as a state where an individual's immune system is resilient, having an inbuilt capacity to adapt to challenges by establishing, maintaining, and regulating an appropriate immune response in order to promote health and prevent and resolve disease [1]. Perceived reduced immune fitness can be a possible reason for absenteeism (staying home from work) or presenteeism (attending work despite health problems, possibly with reduced work performance). Objective: The purpose of the current study was to investigate the impact of reduced immune fitness on absenteeism and presenteeism at work, and the estimated associated costs for the Dutch economy. Methods: Dutch adults were recruited via Facebook to complete an online survey [2]. Participants could indicate whether in 2019 (i.e. pre-COVID-19) they were employed (owner or employee). Absenteeism and presenteeism related to perceived reduced immune fitness were assessed. To this end, questions were adapted from a recent study examining the cost of workplace hangovers and intoxication to the UK economy [3]. Questions concerned the number of days in 2019 that participants (a) did not work because they experienced reduced immune fitness and (b) did work although they experienced reduced immune fitness. With regard to presenteeism, they could further indicate, in comparison to a regular working day, how well they performed at work on days when they experienced reduced immune fitness. This was done by rating their performance on a scale ranging from 0% (compared to a regular day I achieved nothing/did not work) to 100% (my work was absolutely not influenced by experiencing reduced immune fitness). Statistics Netherlands provided information on the average Dutch income. Perceived immune fitness was assessed with the immune status questionnaire [1]. In line with Bhattacharya's method [3], the economic costs of absenteeism and presenteeism due to reduced immune fitness were calculated. Results: Data of N=466 participants with a mean (SD) age of 37 (15.2) years old (range: 18-65 years old), 67.4% female, was evaluated. Overall, 4.4 days of absenteeism, 27.1 days of presenteeism, and a 21% reduction of performance level were reported for presenteeism days. Females, higher educated, and older participants reported significantly higher rates of absenteeism and presenteeism, and lower performance levels on days working with reduced immune fitness. Significant correlations (p<0.05) were found between perceived immune fitness and the number of absenteeism (r = -0.350) and presenteeism days (r = -0.339). The estimated economic cost of absenteeism (€6.8± 0.064 billion euro) and presenteeism (€8.8 ± 0.083 billion euro) sum up to a total cost of €15.6± 0.147 billion euro. Conclusions: Perceived reduced immune fitness has a significant negative impact on work performance, expressed in both absenteeism and presenteeism. Based on the present sample, the associated annual costs for the Dutch economy for 2019 were estimated at 15.6 billion Euro. These high costs warrant further investigation. A large nationally representative sample should be conducted to verify these findings and yield a more accurate estimate of the associated economic costs of perceived reduced immune fitness. No conflict of interest
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Background: The 2019 coronavirus disease (COVID-19) poses great demands on hospitals and resulted in delayed care. It can be hypothesized that this delayed professional health care is reflected in a reduction of pharmacy dispensed analgesics. Objective: The purpose of this study was to investigate the possible impact of COVID-19 lockdown on the dispensing rates of analgesics drugs by Dutch pharmacies. Methods: Pharmacy dispensing data was obtained from Stichting Farmaceutische Kentallen on newly dispended analgesics (ATC2 N02), covering 1890 pharmacies and 96% of the Dutch population. Over-the-counter (OTC) painkillers were not considered. Age and sex of the patient were recorded, as well as the week of first-time dispensed drugs. Data were collected for the first half year of 2019 and the first half year of 2020. Patients were allocated to one of the following age groups: children (0-9 years old), adolescents (10-19 years old), adults (20-64 years old), and elderly (65 year and older). Further, data was combined into three time periods: week 1-11 (for 2020 corresponding to the pre-COVID-19 lockdown period), week 12-19 (for 2020 corresponding to the COVID-19 lockdown), and week 20-26 (for 2020 corresponding to the post-COVID-19 lockdown). Using independent t-tests, dispensing data was compared between males and females, age groups, and between 2019 and 2020. Results: An overall reduction was observed in the first half of 2020 for the number of newly dispensed analgesics (379.657 in 2019 and 360.094 in 2020, respectively). In both years, analgesics were significantly more often dispensed to females than to males, and most were prescribed to adults followed by the elderly. In addition, significantly more analgesics were dispensed in week 1-11 compared to the other time periods. In male children, compared to 2019 the reduction was only significant during the COVID-19 lockdown in 2020. For female children, no significant differences were found. For adolescents of both sexes, compared to 2019, a significantly reduced number of dispensed analgesics was found for all three time periods (p<0.001). In adults of both sexes, the reduction in dispensed analgesics in 2020 was only significant during the COVID-19 lockdown. In elderly, a reduction in dispensed analgesics in 2020 was found for pre- and during the COVID-19 lockdown (p<0.001), but not post-COVID-19 lockdown. In elderly males, a significant reduction in 2020 was found for pre-COVID lockdown, but not thereafter. For elderly females, the reduction in 2020 was significant for both week pre- (p<0.001) and during COVID-19 lockdown (p=0.02), but not thereafter. Conclusions: These findings show that the number of dispensed analgesics was significantly lower in 2020 compared to 2019. The reduction in dispensed analgesics was most consistently seen for the 2020 COVID-19 lockdown period, reflecting delayed professional health care across all age groups. Future research should investigate whether, due to delayed care, a substantial number of patients may have suffered from untreated pain complaints during the 2020 COVID-19 lockdown, or whether they have established pain relief via non-prescription painkillers. No conflict of interest
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Introduction: Patients (pts) with hematological malignancies (HMs) are at increased risk for severe COVID19 infection and death (Grivas, 2021). Currently, vaccination represents the most effective prevention approach. HM pts have been shown to have lower immune responses to COVID19 vaccine, particularly those with lymphoid malignancies (LMs) (Herishanu, 2021;Thakkar 2021;Tzarfari 2021). We conducted an observational cohort study at Moffitt Cancer Center (MCC) to evaluate the immune response following one and two doses of the mRNA1273 (Moderna) vaccine in cancer pts. Here we report the results for pts with LMs and assessed associated factors. Methods: MCC pts who presented for the first mRNA-1273 vaccine dose from 1/12/2021-1/25/2021 and who provided consent were enrolled. Blood samples were collected prior to the 1 st and 2 nd doses (Days 1 and 29) and ~28 days after the 2 nd dose (Day 57). The IgG response against the SARS-CoV-2 spike (S) protein was measured using a two-step ELISA adapted from the Krammer (Icahn School of Medicine at Mount Sinai) protocol. The total 103 LM pts who received both vaccine doses and had samples at all time points were included in analyses. The 214 pts with solid tumors (ST) were included as comparison. Associations of seroconversion (SV) rates with pt characteristics were evaluated using the Fisher exact test or Chi-square test as appropriate. Associations of antibody (Ab) titers with pt characteristics were examined using Kruskal Wallis test. Factors independently associated with SV rates were evaluated using multivariable logistic regression. All analyses were performed using SAS 9.4 and R studio. Results: Baseline characteristics, cancer treatments and SV rates by these factors are listed in Tables 1 and 2. 55 pts had B-cell non-Hodgkin lymphoma (B-NHL), 23 had chronic lymphocytic leukemia (CLL), 15 had T- or NK-cell lymphoma (T/NK lymphoma) and 10 had Hodgkin lymphoma (HL). SV rates were significantly lower for LM pts compared to ST pts (49.5% vs 86.9% after the 1st dose and 68.9% vs 98.1% after the 2 nd dose, respectively, p<0.0001 for both doses). Pts with CLL and B-NHL had the lowest SV rates (21.7% and 43.6% after dose 1 and 65.2% and 58.2% after dose 2, respectively). None of the 11 pts on anti-CD20 monoclonal Ab (mAb) seroconverted after 2 doses. Pts on BTK inhibitors (BTKi) or PI3K inhibitors (PI3Ki) or venetoclax also had low SV rates [4/12 (33.3%) after 2 doses]. Only 1 out of the 8 pts post CAR-T seroconverted, despite the fact that 6 pts had CAR-T >12 months ago and 6 pts were in remission and have not received any cancer treatment after CAR-T. Pts with CLL and B-NHL but not on CD20 mAb/BTKi/PI3Ki/venetoclax or post CAR-T had much higher SV rates (31.3-60.5% after dose 1 and 79.0-81.3% after dose 2, Table 3). Other factors associated with lack of SV after 2 doses included: lymphocyte <1 x 10 9/L, low IgG level and on anticancer treatment within 3 months. Multivariate analyses showed that diagnosis of CLL or B-NHL compared to ST, CAR-T and CD20 mAb/BTKi/PI3Ki/venetoclax were independently associated with decreased SV after 2 doses (Table 4). In the univariate model, Ab titers after 1 and 2 doses were significantly lower in pts with diagnosis of CLL/B-NHL, low lymphocyte count, low IgG and on cancer treatment (Figures 1-3). HL and T/NK lymphoma had titers comparable to solid tumors (Figure 1). Conclusions: Pts with CLL and B-NHL had low SV rates and Ab titers after receiving the mRNA-1273 vaccine when compared with ST, HL and T/NK-lymphoma. Current or past treatments with CD20 mAb/BTKi/PI3Ki/venetoclax and CAR-T were associated with lower immune response, with pooled SV rates of 16.7% after 2 doses. In general, LM pts had lower SV rates and Ab titers after the 1 st dose vs ST, but responses improved after the 2 nd dose. Further studies are needed to improve immune responses to COVID19 vaccines in LM pts, including the potential role of a 3 rd booster dose. [Formula presented] Disclosures: Gaballa: Adaptive Biotechnologies: Research Funding;Epizyme: Consultancy, Resear h Funding;TG therapeutics: Consultancy, Speakers Bureau;Beigene: Consultancy;ADC Therapeutics: Consultancy. Saeed: Bristol-Myers Squibb Company: Consultancy;sano-aventis U.S.: Consultancy, Membership on an entity's Board of Directors or advisory committees;Janssen Pharmaceutica Products, LP: Consultancy, Other: investigator;Celgene Corporation: Consultancy, Other: investigator;MEI Pharma Inc: Consultancy, Other: investigator;Kite Pharma: Consultancy, Other: investigator;Other-TG therapeutics: Consultancy, Other: investigator;Nektar Therapeutics: Consultancy, Other: research investigator;MorphoSys AG: Consultancy, Membership on an entity's Board of Directors or advisory committees;Other-Epizyme, Inc.: Consultancy;Other-Secura Bio, Inc.: Consultancy;Seattle Genetics, Inc.: Consultancy, Membership on an entity's Board of Directors or advisory committees. Shah: Pharmacyclics/Janssen: Honoraria, Other: Expenses;Pfizer: Consultancy, Other: Expenses;BeiGene: Consultancy, Honoraria;Servier Genetics: Other;Jazz Pharmaceuticals: Research Funding;Precision Biosciences: Consultancy;Amgen: Consultancy;Kite, a Gilead Company: Consultancy, Honoraria, Other: Expenses, Research Funding;Acrotech/Spectrum: Honoraria;Novartis: Consultancy, Other: Expenses;Bristol-Myers Squibb/Celgene: Consultancy, Other: Expenses;Adaptive Biotechnologies: Consultancy;Incyte: Research Funding. Locke: Janssen: Consultancy, Other: Scientific Advisory Role;BMS/Celgene: Consultancy, Other: Scientific Advisory Role;EcoR1: Consultancy;Allogene Therapeutics: Consultancy, Other: Scientific Advisory Role, Research Funding;Calibr: Consultancy, Other: Scientific Advisory Role;Amgen: Consultancy, Other: Scientific Advisory Role;Bluebird Bio: Consultancy, Other: Scientific Advisory Role;Umoja: Consultancy, Other;Cowen: Consultancy;Kite, a Gilead Company: Consultancy, Other: Scientific Advisory Role, Research Funding;Emerging Therapy Solutions: Consultancy;Gerson Lehrman Group: Consultancy;Moffitt Cancer Center: Patents & Royalties: field of cellular immunotherapy;Iovance Biotherapeutics: Consultancy, Other: Scientific Advisory Role;GammaDelta Therapeutics: Consultancy, Other: Scientific Advisory Role;Cellular Biomedicine Group: Consultancy, Other: Scientific Advisory Role;Wugen: Consultancy, Other;Takeda: Consultancy, Other;Novartis: Consultancy, Other, Research Funding;Legend Biotech: Consultancy, Other. Chavez: Abbvie: Consultancy;AstraZeneca: Research Funding;Kite/Gilead: Consultancy;Karyopharm Therapeutics: Consultancy;MorphoSys: Speakers Bureau;Epizyme: Speakers Bureau;Bristol Myers Squibb: Speakers Bureau;Merck: Research Funding;Adaptive: Research Funding;BeiGene: Speakers Bureau;Novartis: Consultancy;ADC Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding. Lancet: AbbVie: Consultancy;ElevateBio Management: Consultancy;Daiichi Sankyo: Consultancy;Celgene/BMS: Consultancy;Millenium Pharma/Takeda: Consultancy;BerGenBio: Consultancy;Agios: Consultancy;Astellas: Consultancy;Jazz: Consultancy. Sokol: Dren Bio: Membership on an entity's Board of Directors or advisory committees;Kyowa-Kirin: Membership on an entity's Board of Directors or advisory committees. Pinilla Ibarz: AbbVie, Janssen, AstraZeneca, Novartis, TG Therapeutics, Takeda: Consultancy, Other: Advisory;Sellas: Other: ), patents/royalties/other intellectual property;MEI, Sunesis: Research Funding;AbbVie, Janssen, AstraZeneca, Takeda: Speakers Bureau. Giuliano: Merck & CO: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding.
ABSTRACT
Purpose/Objective(s): Historically, work from home (WFH) policies were not common in radiation oncology (RO). With the onset of the COVID-19 pandemic and without oversight from professional organizations, many departments individually generated WFH policies. This study reports WFH policies and perceived impact on workflow and work-life balance within United States (US) academic RO departments for both residents and faculty. Materials/Methods: An IRB-approved questionnaire was developed and sent to one resident and one faculty member at each of the 92 US academic RO departments. Purposive sampling for residents and faculty was utilized. For residents, this consisted of the most senior resident and for faculty, a senior faculty member or the program director. If no reply was obtained after 3 weeks, an alternate member was selected. The survey remained open for 75 days. Categorical and continuous variables, along with free-responses were aggregated and reported. Results: 135 responses (residents n = 65, faculty n = 70) were received, representing 70.7% and 77.2% of the 92 programs respectively. A new WFH policy was reported by 83% faculty (58/70) and 92% residents (60/65), predominantly initiated within 2 months of the pandemic (60% faculty and 79% residents respectively). The initial WFH policy allowed moderate WFH for 40% faculty and 46% residents, while minimal WFH was offered for 30% faculty and 32% residents. Full WFH was reported by 14% of respondents in both categories. Policies have since contracted for 39% faculty and 62% of residents, being revoked for 11% of faculty and 22% of residents. 15/70 (21.4%) faculty and 12/65 (18.5%) residents report dissatisfaction with their current WFH policy. 18/70 (25.7%) faculty and 14/65 (21.5%) residents perceived negative sentiments from others regarding utilization of WFH. On a 4-point scale, residents and faculty reported personal/family life, research, and day-to-day productivity were positively impacted by WFH policy, while patient care was perceived as negatively impacted. No difference was reported for leadership or education. Conclusion: A variety of WFH policies have been adopted in RO. Understanding perceptions of the impact of different approaches can help to inform future policy and practice.
ABSTRACT
The aim of this study was to determine overall morbidity and mortality of COVID-19 infection in children on cancer treatment. It was an observational study, carried at Shaukat Khanum Cancer Hospital from 1st April 2020 to 31st July 2020. A total of 165 children on active cancer treatment were tested for COVID-19 with PCR;out of these, 17 were detected positive. Twelve children were symptomatic having fever with or without cough, sore throat, body aches, rash or diarrhea. Two children had concurrent gram negative bacteremia. Ten children (58.8%) required hospitalisation, 23.5% required oxygen and two had intensive care unit admission. One death was reported in this study. Chemotherapy was modified in five children, while elective surgery, chemotherapy and radiotherapy schedule were affected in eight children. Overall, the spread of Covid-19 was limited, the course of disease was mild, and anticancer treatment was provided and continued as per standard protocols. Key Words: Covid -19, Cancer, Anticancer chemotherapy, Immunosuppression, Children.
ABSTRACT
Introduction: Osler developed the 1st journal club in 1875 to reduce financial barriers to keeping up with global medical progress. Journal clubs have since become a widely accessible tool to improve patient safety & quality care. However, maintaining competence today is limited by exponentially increasing complexity & volume while resources stay siloed. In response the “#RadOnc” Twitter journal club was created in 2014 to accelerate knowledge translation across boundaries. Its lung cancer projects have included discussions on globally relevant articles, dual hashtags, & crowdsourced summaries to enhance to enhance clinical knowledge, online communication, & critical appraisal. Methods: We reviewed data from the journal club since 2014. The format included free article access, a weekend-long asynchronous chat, & a live hour including article authors. Targeted invitations were sent prior with introductions posted to a blog. Curated open-access summaries were created using Wakelet to facilitate discussions & allow future referencing. Dual hashtags (#RadOnc #jc) were tested in 2020. Single & dual hashtag data from January & February was analyzed and compared against chat transcripts to determine if dual hashtags appropriately focused content. Selected chats of immediate relevance were thematically analyzed for publication to guide local standards of practice. Results: Fifteen chats (37% ) had direct relevance to lung cancer (including palliative/supportive care, SCLC, & NSCLC) with all attended by article authors. The most recent lung cancer chat had 496 tweets & 2.9 million impressions. Altmetric scores ranged from 15 to 227 (top 5%). We identified 1853 tweets with “# RadOnc” and 1256 (68%) used “#RadOnc #jc”. Dual hashtags were used by 122/558 (22%). Participants spanned 13 countries (radiation oncologists (54/122, 44%), trainees (15/122, 12%), other physicians (9/122, 7%), patients (5/122, 4%), physicists (2/122, 2%), & radiation therapists (1/122, 1%)). Chats averaged 19 dual hashtag tweets/hr compared to 9 other “#radonc” tweets/hr (p=0.036). Most dual hashtag content was related to the journal club (542/542 for January & 713/714 for February). Two recent chats resulted in publications in academic journals. Conclusion: #RadOnc #jc has overcome limitations of traditional journal clubs & remained at the forefront of changing online practices to sustainably facilitate active global lung cancer discussions. This includes use of dual hashtags that are feasible to filter conversations & enable a chat within the hashtag of a growing community of practice. It has nurtured diverse perspectives including multidisciplinary experts, patients, & trainees from HICs & LMICs for rich digitized peer review & discussion. This informed the publication of the first crowdsourced global oncology guidelines for the COVID19 pandemic & emerging standard techniques for SCLC. Aggregation through Wakelet summaries may further reduce the reading burden. Together, #RadOnc #jc is becoming a platform for rapid knowledge translation & creation by encouraging & amplifying the voices of the global oncology community through crowdsourcing, rapid review, and open-access publication. We continue to assess its outcomes for quality improvement including reviewing our lung cancer specific data, chat metrics, author & article impact, & engagement including feedback from all stakeholders working towards improving cancer care. Keywords: Social Media, global oncology, Medical Education