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1.
Advances in Human Biology ; 12(2):168-173, 2022.
Article in English | Web of Science | ID: covidwho-2155510

ABSTRACT

Introduction: Patient satisfaction in health care describes the degree to which patients' needs 'meet their expectations and provide an acceptable standard of care'. Therefore, their opinion should be incorporated to understand factors affecting patients' satisfaction with the health-care setting. The recent COVID-19 pandemic has posed a significant challenge for the field of dentistry owing to its working characteristics. It is difficult for dentists to provide optimum satisfaction to patients receiving dental care with such changes proposed. A study aiming to evaluate the patient's satisfaction receiving treatment in the Department of Dentistry during the pandemic was planned. Materials and Methods: A cross-sectional observational study from September to November 2020 was conducted. A self-administered printed questionnaire drafted in English/Gujarati was provided to 225 patients on completion of their dental treatment. Thirteen close-ended questions were included in determining the patient's satisfaction. Descriptive statistical analysis was used to describe the parameters of the questionnaire. The Chi-square test was used to find a significant association between parameters, and P < 0.05 was considered statistically significant. Results: About 74.3% of the participants were satisfied with dentist-patient communication. Positive response (80%) by patients where they were able to get an appointment as per their suitability and were informed in advance by the department if there were any changes. One hundred and sixty-eight (84%) patients responded that the waiting area was hygienic. One hundred and thirty-seven (68.5%) patients assured that their arrival was intimated to the respective dentist by supporting staff and that they were taken into an operatory for treatment within 10 min of arrival. Participants said that they were informed about the delay from their allotted appointment schedule with reasons;hence, better compliance (79%) was obtained from them. Conclusions: This cross-sectional study indicated that with proper communication, a positive response by participants over satisfaction was obtained even due to changing treatment patterns due to pandemic.

2.
Jundishapur Journal of Microbiology ; 15(1):1005-1020, 2022.
Article in English | GIM | ID: covidwho-2124957

ABSTRACT

Introduction: Self medication may be defined as the practice of use of medication for the treatment of any disease on their own without consulting concerned health care professional. If the practice is not correctly done due to lack of knowledge in students pursuing medical studies without evaluation by the trained medical professionals it can lead to ineffective treatment which can result in unnecessary expenses and drug dependence over a period of time. AIM: This study was conducted to find out self medication behaviour and its associated factors amongst dental students of Government Dental College and Hospital, Srinagar. Materials and methodology: A cross sectional study was conducted on 100 dental students and interns from Government Dental College And Hospital, Srinagar, Jammu and Kashmir between the month of September 2021 to November 2021 after ethical clearance was taken from said institution under order no GDC/Pedo/1677. A convenience sampling technique was used and survey consisting of 11 questions was be distributed amongst the dental students which included the questions of demographic variables and information related self medication with painkillers during the COVID times of 2020-2021 for any painful ailment and to evaluate awareness about side effects and loop holes of self medication. Data was collected and was statistically analysed using Statistical Package for Social Sciences (SPSS) version 21.

3.
Current Pediatric Research ; 26(6):1433-1436, 2022.
Article in English | EMBASE | ID: covidwho-2084143

ABSTRACT

Introduction: Guillain-Barrel Syndrome is an important cause of severe, acute weakness in children. Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) is the most common subtype. History of past infection was noticed in the majority of cases. In Wuhan China in late 2019, severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) originated and rapidly spread around the world. Case: We had 12 years old male child who was admitted with history sudden onset of lower limb weakness. He had history of contact with COVID-19 patient. Clinical and Laboratory finding suggesting of Guillain-Barre Syndrome. Discussion(s): This case is the first reported case of a child with GBS with past history acute SARS-CoV-2 infection one month back in our set up. GBS in a child has been reported associated with other forms of corona virus. The patient came with obvious symptomatology of GBS with symmetric ascending weakness with loss of reflexes. Conclusion(s): The relation between COVID-19 and GBS was demonstrated previously in case reports of adults with a different variety of GBS, like demyelinating, axonal, and Miller-Fisher in connection with COVID-19. Typical post infectious presentations have been seen in our report after one month. Copyright © 2022 Scientific Publishers of India. All rights reserved.

5.
Journal of General Internal Medicine ; 37:S248, 2022.
Article in English | EMBASE | ID: covidwho-1995811

ABSTRACT

BACKGROUND: Latinos are among the most heavily impacted populations by the COVID-19 pandemic in the United States due to intersectional barriers to care. Crowdsourcing open contests can be an effective means of community engagement but have not been well studied in Latino populations nor in addressing the COVID-19 pandemic. The objectives of this study were to implement a crowdsourcing open contest to solicit a name for a social marketing campaign addressing COVID-19 for Latinos in Maryland, and evaluate the contest through mixed-methods analysis. METHODS: We conducted descriptive statistics of entries and votes, and demographics of participants. Submitted text was analyzed through inductive thematic analysis to understand community attitudes towards the COVID-19 pandemic. RESULTS: We received 74 entries within a brief 2-week period, limited by the urgency COVID-19 pandemic. The top 10 entries were chosen by a panel of community judges and the winner was decided by popular votes. We received 383 votes within 1 week. The most common themes were collective efficacy, self-efficacy, and perceived benefits of COVID-19 testing. We subsequently incorporated these themes into campaign advertisements, and these ended up being the highest performing ads. CONCLUSIONS: Crowdsourcing is an effective means of community engagement and an agile tool for guiding interventions to address COVID-19, including in populations impacted by healthcare disparities such as Latino communities.

6.
Journal of General Internal Medicine ; 37:S228, 2022.
Article in Spanish | EMBASE | ID: covidwho-1995810

ABSTRACT

BACKGROUND: Latino communities are disproportionately affected by COVID-19. In response, our Johns Hopkins based team of investigators and community health workers expanded access to free COVID-19 testing, and later vaccinations, through trusted community venues in Baltimore, MD. To promote these services, we developed a community-driven culturally congruent social marketing campaign and website. This work was supported by the NIH RADxUP (Rapid Acceleration of Diagnostics - Underserved Populations) initiative. METHODS: The campaign name was chosen using a crowdsourcing open contest, evaluated by community judges and a popular vote. Campaign messaging was informed by prior focus groups and our community advisory board. The reach of the campaign was evaluated through online metrics (Google analytics and Facebook) as well as surveys of individuals obtaining COVID-19 testing or vaccination. Surveys were conducted over a 2-week period (6/25/21-7/9/21) at our main community-based venue, Sacred Heart Church. RESULTS: The campaign was named “Mejor Vive Sin Duda" ("Better to Live Without Doubt") based on the results of the crowdsourcing open contest, after which we developed the social marketing advertisements and website which launched in February 2021. Among 252 individuals surveyed in the 2-week period, 33% of respondents had seen or heard of the Mejor Vive Sin Duda campaign, with Facebook being the most popular means of campaign exposure. From March 1, 2021 to December 31, 2021, we received 9,100 unique visitors to the website and reached 254,910 people through paid social media advertisements. CONCLUSIONS: Social marketing campaigns present an opportunity to promote COVID-19 testing and vaccine uptake among Latino populations who face barriers to traditional healthcare settings. Community partnerships were integral to campaign success. Campaigns must be paired with accessible and culturally competent healthcare services to lead to equitable improvements in health outcomes.

7.
19th International Conference on Humanizing Work and Work Environment, HWWE 2021 ; 391:1261-1268, 2022.
Article in English | Scopus | ID: covidwho-1919573

ABSTRACT

Musculoskeletal disorders are prevalent in young adults in the present times. A major section of this age group are the students pursuing higher education. In the current pandemic situation due to COVID-19, the students have been forced into attending classes through online mode and so the infrastructure available at home may not be optimal ergonomically, leading to musculoskeletal discomfort amongst the students. In Interior Design course, the students are required to do practical work in a sitting position using the furniture available at home. They are also required to attend classes through computers, tablets and smartphones, which can also lead to musculoskeletal discomfort. As these students are exposed to the risk of developing musculoskeletal disorders, the present study was conducted with objectives (a) to gain insight into working methods and home workspace of the students, (b) to identify incidence of musculoskeletal discomfort experienced by interior design students during online learning and (c) to find out the perceived causes of musculoskeletal discomfort by the students. The sample of the study was 77 under-graduate students pursuing Interior Design course and data was collected using questionnaire. The findings of the study revealed that these students are in need of proper workspace and work environment at home, they need guidance in optimizing there working methods and developing proper work schedules and lastly, they need awareness regarding maintaining correct postures during sit-down work as well as corrective measures for optimizing their current work-station at home. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

8.
Journal of Urology ; 207(SUPPL 5):e667-e668, 2022.
Article in English | EMBASE | ID: covidwho-1886524

ABSTRACT

INTRODUCTION AND OBJECTIVE: The SARS-CoV-2 (COVID) pandemic threatened access to healthcare, raising concerns that patients were going underdiagnosed and undertreated. The aim of our study was to understand the impact of the COVID pandemic on diagnosis and surgical management of common urological conditions. METHODS: Using a large multi-center electronic health record network (TRINETx) consisting of 46 healthcare organizations, we conducted an epidemiological study investigating the number of patients newly diagnosed with common urological conditions and those undergoing urologic surgeries at yearly intervals from March 1st, 2016 to March 1st, 2021. Relevant international classification of diseases (ICD) codes used to identify urologic conditions are elaborated on in Table 1. Current procedural terminology (CPT) codes used to identify surgeries are detailed in Figure 1. We then determined the percentage of newly diagnosed patients who underwent surgery for each specific year. RESULTS: We saw a decrease in number of all urologic surgeries being performed during the initial year of the pandemic (Figure 1). From March 2020-2021, there was a >20% decrease in surgical case load for benign prostatic hyperplasia procedures (-29.5%), prostate biopsies (-30.1%), incontinence procedures (-33.6%), and vasectomies (-22.8%), compared to the preceding year. Radical cystectomies and orchiectomies saw the lowest decrease, -5.9% and -8.6%, respectively. A similar trend was seen in the number of individuals newly diagnosed with urologic conditions and percentage of patients undergoing surgical intervention. The lowest drops were seen with ureteral stent placements (-5.0%) and prostate biopsies (-3.1%). CONCLUSIONS: The number of people receiving urologic diagnoses and surgical case load for urologic procedures significantly reduced during the first year of the COVID pandemic. Providers should be aware of this healthcare disparity, and greater efforts made to identify these missed patients moving forward.

9.
Annals of Movement Disorders ; 5(1):23-37, 2022.
Article in English | Scopus | ID: covidwho-1863087

ABSTRACT

Movement disorders are relatively sparse amongst COVID-19 patients. However, in the setting of large number of COVID-19 cases, relatively rare acute to subacute onset, para-infectious or post-infectious movement disorders such as myoclonus and myoclonus-Ataxia with or without opsoclonus have increasingly become more evident. Our objective of writing this paper is to summarize the available evidence documenting new onset hyperkinetic movement disorders associated with COVID-19. Myoclonus is the most frequently reported movement disorder associated with COVID-19 alone or in combination with ataxia and tremors. Apart from isolated myoclonus, myoclonus with ataxia, opsoclonus myoclonus ataxia syndrome have been reported post COVID. Isolated cerebellar ataxia is the other most commonly described movement disorder post COVID. Tremors, Chorea and dystonia are rarely described hyperkinetic movement disorders in association with COVID. Treatments being offered for hyperkinetic movement disorders consists of symptomatic treatment with benzodiazepine, anti-seizure drugs, immunomodulatory treatment with steroids, intravenous immunoglobulin and rehabilitative therapies. In this review we summarize the neurological features, investigations, treatments, and outcomes of all the published cases of hyperkinetic movement disorders associated with COVID-19. © 2022 All rights reserved.

10.
Annals of Movement Disorders ; 5(1):12-22, 2022.
Article in English | Scopus | ID: covidwho-1863086

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with a myriad of potential neurological manifestations, with de novo movement disorders still being reported. There is growing concern about a possible new wave of neurological complications in the aftermath of the COVID-19 pandemic. The objective of our review is to summarize all available evidence documenting new-onset movement disorders associated with COVID-19, with focus on hypokinetic movement disorders and their pathogenesis. We identified 66 new-onset movement disorder cases from using the PubMed and Google Scholar databases. Myoclonus was the most frequently reported movement disorder associated with COVID-19 alone or in combination with ataxia and tremor, while parkinsonism was the most notable movement disorder associated with the pandemic. To date, only eight cases of de novo parkinsonism associated with COVID-19 have been reported in the literature. Their exact pathophysiology is not well-understood but can include viral neuroinvasion-neurodegeneration, central nervous system-specific immune activation, vascular damage, systemic inflammation, autoimmune mechanisms, hypoxia, or metabolic disturbances. Although it is difficult to point out the specific relationship between SARS-CoV-2 and movement disorders, in this brief review, we unfold various potential plausible mechanisms responsible for the pathogenesis of movement disorders, with focus on hypokinetic movement disorders. Clinicians should closely monitor patients who have recovered from COVID-19 for the possibility of new-onset COVID-19-Associated movement disorders. Longitudinal follow-up studies are necessary to ascertain the long-Term neurological and neuropsychological consequences of the disease and the associated evolution of movement disorders. © 2022 All rights reserved.

11.
Journal of the American College of Cardiology ; 79(9):1823-1823, 2022.
Article in English | Web of Science | ID: covidwho-1849432
12.
Journal of the American College of Cardiology ; 79(9):2073-2073, 2022.
Article in English | Web of Science | ID: covidwho-1849260
13.
Journal of the American College of Cardiology ; 79(9):2379-2379, 2022.
Article in English | Web of Science | ID: covidwho-1848444
14.
J. Clin. Diagn. Res. ; 16(3):SR4-SR6, 2022.
Article in English | Web of Science | ID: covidwho-1791831

ABSTRACT

Tic disorders are one of the most prevalent neurodevelopmental disorders and if unattended, can have other psychological impact. It can present as poor academic performance, poor concentration, low confidence, anxiety, depression and many others. This case series is about seven children diagnosed with tic disorder, as per Diagnostic and Statistical Manual (DSM) 5 criteria. These children underwent standard behavioural training module comprising of behavioural rewards, Habit Reversal Training (HRT), relaxation training, identification and management of emotions and social skills training;which was planned following case conceptualisation. Yale Global Tic Severity Scale (YGTSS) was used before starting therapy and while completing the therapy. Considering the severity of symptoms and distress caused by them, three children were started on medicine (clonidine) along with therapy. Same therapy module was provided online for those children (three) who were not able to come for direct training due to geographic distance and Coronavirus disease-2019 (COVID-2019) pandemic restrictions. All the seven children showed favourable improvement in terms of severity and improvement in the co-morbid conditions. All of them responded to the individualised treatment protocol and showed difference in pre (mean=38) and post (mean=12) total tic severity score suggesting response to treatment. Among them, two children scored zero. This case series demonstrates the application of behavioural therapy including varied strategies as per the individual case conceptualisation.

15.
18th International Computer Conference on Wavelet Active Media Technology and Information Processing, ICCWAMTIP 2021 ; : 101-105, 2021.
Article in English | Scopus | ID: covidwho-1746081

ABSTRACT

The fast expansion of the COVID-19 epidemic has revealed the shortcomings of current healthcare institutions in dealing with public emergency situations. One of the big reasons of Covid-19 spread is the lack of standard track and trace mechanisms in healthcare infrastructures. Furthermore, throughout the epidemic, the transmission of disinformation has accelerated, and existing platforms lacking capability of verifying the veracity of information, resulting to social unrest and illogical conduct. Therefore, building a track and trace system is critical to ensuring that data collected by the government and the public entities is accurate and dependable. It is obvious that implementing state-of-the-art predictive models like Artificial Neural Network and Blockchain-based traceable mechanisms can help to prevent the spreads of the new variants. In this paper, we proposed a Blockchain based traceable model to track and trace the infected cases so to help an effective planning to prevent the spread. © 2021 IEEE.

16.
Elife ; 10:28, 2021.
Article in English | Web of Science | ID: covidwho-1677760

ABSTRACT

For the first time, we have used phase-contrast X-ray tomography to characterize the three-dimensional (3d) structure of cardiac tissue from patients who succumbed to Covid-19. By extending conventional histopathological examination by a third dimension, the delicate pathological changes of the vascular system of severe Covid-19 progressions can be analyzed, fully quantified and compared to other types of viral myocarditis and controls. To this end, cardiac samples with a cross-section of 3.5mm were scanned at a laboratory setup as well as at a parallel beam setup at a synchrotron radiation facility the synchrotron in a parallel beam configuration. The vascular network was segmented by a deep learning architecture suitable for 3d datasets (V-net), trained by sparse manual annotations. Pathological alterations of vessels, concerning the variation of diameters and the amount of small holes, were observed, indicative of elevated occurrence of intussusceptive angiogenesis, also confirmed by high-resolution cone beam X-ray tomography and scanning electron microscopy. Furthermore, we implemented a fully automated analysis of the tissue structure in the form of shape measures based on the structure tensor. The corresponding distributions show that the histopathology of Covid-19 differs from both influenza and typical coxsackie virus myocarditis.

17.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1637552

ABSTRACT

Introduction: Right ventricular (RV) dysfunction after cardiac surgery presents a significant challenge. Epoprostenol (EPO) is a pulmonary vasodilator that can be administered via inhalation and is often used in patients with post-operative RV dysfunction. However, the effects of EPO on RV performance have not been well studied. Furthermore, EPO is generally contraindicated in WHO Group 2 pulmonary hypertension. The purpose of this study is to describe the hemodynamic consequences of weaning inhaled epoprostenol (iEPO) in post-operative RV dysfunction and potentially identify any predictive markers for successful weaning. Methods: This is a single-center case series of patients receiving iEPO after cardiac surgery identified by convenience sampling. Inclusion criteria included post-cardiac surgery patients, >18 years, and receiving iEPO for RV dysfunction. Exclusion criteria included pregnancy, open chest, SARS-COV-2 pneumonia, left ventricular assist device use, extracorporeal membrane oxygenation use, heart transplantation, or receiving iEPO for refractory hypoxia. A paired two sample t-test compared the hemodynamic parameters collected pre and post iEPO weaning. Results: EPO weaning was associated with a decrease in mean pulmonary artery pulsatility index (PAPi) (pre-wean 1.81 vs post-wean 1.57, p=0.04) and increase in pulmonary artery systolic pressure (PASP) (46.5mmHg vs 55.1mmHg, p=0.01). Cardiac index and right atrial pressure were not significantly different (p=0.35 and p=0.26 respectively). Case 5 had EPO weaning failure and had the lowest baseline PAPi in the cohort. Conclusion: iEPO weaning is associated with dynamic changes in PASP and PAPI in post-operative cardiac surgery patients. This finding supports the conceptual role of iEPO in improving post-operative RV-PA coupling and RV performance. Baseline PAPi may be a predictive marker to guide the weaning process. However, larger cohorts are needed to confirm these findings.

18.
Gastroenterology ; 160(6):S-220, 2021.
Article in English | EMBASE | ID: covidwho-1595927

ABSTRACT

Introduction: The coronavirus disease 2019 (COVID-19) pandemic is a global health crisiswhich has caused a significant healthcare burden. Fever, cough and dyspnea are the classicsymptoms of COVID-19 but emerging literature has reported diarrhea, vomiting, loss ofappetite and other gastrointestinal symptoms (GI) as well. In this meta-analysis, we evaluatedthe association of diarrhea, vomiting and anorexia with outcomes in COVID-19 hospitalizedpatients.Methods: Data from observational studies describing GI symptoms and outcomes of COVID-19 hospitalized patients from December 1, 2019 till June 30, 2020 was extracted followingMOOSE guidelines with a consensus of four independent reviewers. Adverse outcomes weredefined as admission to the intensive care unit (ICU), oxygen saturation <90%, invasivemechanical ventilation (IMV), severe disease and in-hospital mortality. Data was analyzedusing Review Manager 5.4. The odds ratio (OR) and 95% confidence interval (95%CI) wereobtained and forest plots were created using random-effects models.Results: Out of 24 studies with 13,741 confirmed COVID-19 patients, 17 studies (4087patients), 5 studies (897 patients) and 5 studies (1751 patients) provided data on COVID-19 hospital outcomes and GI symptoms of diarrhea, anorexia and vomiting respectively. In patients with poor outcomes, the prevalence of diarrhea was 13.3%(187/1398), anorexia37%(172/464) and vomiting 7.6%(67/883). In meta-analysis, patients with anorexia(OR:4.27;95%CI:2.73–6.67;p<0.00001) and vomiting (OR:1.85;95%CI:1.13–3.05;p=0.02)had higher odds of poor outcomes compared to better outcomes with 0% heterogeneity (p=0.68 and p=0.91) respectively. Patients with diarrhea had no significant association withpoor outcomes (OR:1.04 (95%CI:0.75–1.44;p=0.81) with 23% heterogeneity (p=0.19).Conclusion: Our meta-analysis suggests that COVID-19 patients with anorexia and vomitinghad higher risk of poor outcomes and disease severity. Future studies should focus onwhether identification of GI invasion along with fecal PCR testing will help in early triageof high risk patients and improve outcomes.(Figure Presented)Figure 1: Forest Plot of Anorexia with Outcome in COVID-19 hospitalizations(Figure Presented)Figure 2: Forest Plot of Vomiting with Outcome in COVID-19 hospitalizations(Figure Presented)Figure 3: Forest Plot of Diarrhea with Outcome in COVID-19 hospitalizations

19.
Blood ; 138:1930, 2021.
Article in English | EMBASE | ID: covidwho-1582178

ABSTRACT

Background/objectives: The COVID-19 pandemic led to a dramatic reduction of in-person medical care in the general population;however, impacts have not been well-characterized for patients with hematologic malignancies. This study assessed the impact of COVID-19 on healthcare delivery for patients with hematologic malignancies with documented active treatment. Methods: Patients from the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database with confirmed diagnosis of AML, DLBCL, FL, MCL, CLL or MM, and age ≥ 18 years at initial diagnosis were included. To be included in the study, documented receipt of at least one systemic, non-maintenance line of therapy between March 1, 2016 - February 28, 2021 was required. Patients were categorized into treatment types within lines of therapy: Oral therapy (OralTx);outpatient infusions (OutPtTx);and inpatient infusions, including hematopoietic transplants and CAR-T cell therapy (InPtTx). Monthly visit rates were calculated as the number of visits (telemedicine or in-person [in-clinic treatment administration, vitals, and/or labs]) per active patient per 30-day standardized month. Only visits occurring within a line of therapy were included (i.e. during active therapy, excluding surveillance). Telemedicine was only available for ion during the pandemic period. We used time-series forecasting methods on pre-pandemic monthly visit rate data (March 2016 - February 2020) to estimate projected counterfactual visit rates between March 2020 - February 2021 (expected in-person visit rates if the pandemic had not occurred) for all diseases combined, each disease, and each treatment type. Differences between projected and actual monthly visit rates during the pandemic period were considered statistically significant and related to the pandemic if the actual visit rate was outside of the 95% prediction interval (PI) surrounding the projected estimate. Results: A total of 22,559 patients were included in this analysis (6,241 OralTx, 14,501 OutPtTx, 7,675 InPtTx): 4,069 AML, 3,641 DLBCL, 2,004 FL, 1,899 MCL, 4,574 CLL and 6,701 MM. There was a gradual downward trend in in-person visit rates across all diseases over the study period (March 2016 - February 2021, Figure) and general visit frequencies were lower for OralTx and higher for OutPtTx and InPtTx overall. For all diseases combined, early pandemic months (March - May 2020) saw an 18% (95% PI 8.9% - 25%) reduction in in-person visit rates averaged across OralTx and OutPtTx, with the projected rate being 1.5 (95% PI 1.3 - 1.6) visits per patient per month, compared to an actual rate of 1.2. Reductions in the in-person visit rates were significant for all 3 treatment types for MM, for OralTx for CLL, and for OutPtTx for MCL and CLL. Telemedicine visit rates were greatest for patients who received OralTx, followed by OutPtTx, then InPtTx, with greater use in the early pandemic months and subsequent decrease in later months. All in-person visit rates increased close to predicted rates in the later half of the pandemic period. Conclusions: In treatment of hematologic malignancies, overall documented in-person visit rates for patients on OralTx and OutPtTx significantly decreased during early pandemic months, but returned close to the projected rates later in the pandemic. There were no significant reductions in the overall in-person visit rate for patients on InPtTx. Variability in these trends by disease type was observed, with significant reductions in in-person visits impacting MM, CLL, and MCL. Figure. Visit rates over time according to treatment category [Formula presented] Disclosures: Lau: Roche: Current equity holder in publicly-traded company;Flatiron Health Inc: Current Employment. Wang: Roche: Current equity holder in publicly-traded company;Flatiron Health: Current Employment. Davidoff: AbbVie: Other: Family member consultancy;Amgen: Consultancy. Huntington: Bayer: Honoraria;Thyme Inc: Consultancy;Novartis: Consultancy;Flatiron Health Inc.: Consultancy;Genentech: Consultancy;eaGen: Consultancy;Servier: Consultancy;AstraZeneca: Consultancy, Honoraria;TG Therapeutics: Research Funding;DTRM Biopharm: Research Funding;AbbVie: Consultancy;Pharmacyclics: Consultancy, Honoraria;Celgene: Consultancy, Research Funding. Calip: Pfizer: Research Funding;Roche: Current equity holder in publicly-traded company;Flatiron Health Inc: Current Employment. Shah: AstraZeneca: Research Funding;Seattle Genetics: Research Funding;Epizyme: Research Funding. Stephens: CSL Behring: Consultancy;TG Therapeutics: Membership on an entity's Board of Directors or advisory committees;AstraZeneca: Consultancy;Celgene: Consultancy;JUNO: Research Funding;Mingsight: Research Funding;Abbvie: Consultancy;Arqule: Research Funding;Adaptive: Membership on an entity's Board of Directors or advisory committees;Novartis: Research Funding;Epizyme: Membership on an entity's Board of Directors or advisory committees;Beigene: Membership on an entity's Board of Directors or advisory committees;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;Karyopharm: Membership on an entity's Board of Directors or advisory committees, Research Funding. Miksad: Flatiron Health Inc: Current Employment, Current holder of individual stocks in a privately-held company;Roche: Current equity holder in publicly-traded company. Parikh: GNS Healthcare: Current holder of individual stocks in a privately-held company;Onc.AI: Current holder of individual stocks in a privately-held company;Humana: Honoraria, Research Funding;Nanology: Honoraria;Thyme Care: Honoraria;Flatiron Health Inc: Honoraria. Takvorian: Pfizer: Research Funding;Genentech: Consultancy. Neparidze: GlaxoSmithKline: Research Funding;Janssen: Research Funding;Eidos Therapeutics: Membership on an entity's Board of Directors or advisory committees. Seymour: Flatiron Health Inc: Current Employment;Janssen: Membership on an entity's Board of Directors or advisory committees;Roche: Current equity holder in publicly-traded company;Karyopharm: Honoraria, Membership on an entity's Board of Directors or advisory committees;Pharmacyclics: Membership on an entity's Board of Directors or advisory committees.

20.
Blood ; 138:1973, 2021.
Article in English | EMBASE | ID: covidwho-1582172

ABSTRACT

Background/objectives: The COVID-19 pandemic impacted healthcare visit trends, propelling healthcare systems to reduce in-person visits and hospital admissions and increasingly rely on telemedicine;whether there are differences in these trends across racial groups is unknown. This study investigated potential racial disparities in visits during the pandemic for patients with documented active treatment for hematologic malignancies. Methods: We used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database to select patients with confirmed diagnosis of AML, DLBCL, FL, MCL, CLL or MM, at least 18 years old at initial diagnosis, and documented race in the EHR as Black/African American or White were included. Patients were categorized into treatment types within lines of therapy: Orals (orals + outpatient infusions with orals) vs. Inpatient treatments (chemotherapy, hematopoietic transplants & CAR-T cell therapy). Monthly visit rates were calculated as the number of visits (telemedicine or in-person [in-clinic treatment administration, vitals, and/or labs]) per active patient per 30-day standardized month, except for months in which the patient was considered not active (e.g. no documented therapy, surveillance). We used time-series forecasting methods on pre-pandemic monthly visit rate data (March 2016 - February 2020) to estimate projected counterfactual monthly visit rates (expected rates if the pandemic did not occur) between March 2020 - February 2021 for all diseases combined, for each disease, each treatment type, and each race. Differences between projected and actual monthly visit rates during the pandemic period were considered significant and related due to the pandemic if the actual visit rate was outside of the 95% prediction interval (PI) surrounding the projected estimate. We used cross-correlation analysis to test for significant differences in visit rates between Black and White patients. Results: The analysis included 17,621 patients (2,225 Black, 15,396 White): 3,041 AML, 2,715 DLBCL, 1,558 FL, 1,511 MCL, 3,813 CLL and 5,244 MM (1,166 Black, 4078 White). Across all diseases and treatment categories, Black patients had no significant reductions in in-person visit rates throughout the pandemic period compared to the projected rates. There was, however, an 18% statistically significant reduction (95% PI 9.9% - 25%) in in-person visit rates for White patients on orals during early pandemic months (March - May 2020) from a projected visit rate of 2.0 (95% PI 1.8 - 2.2) visits per patient per month to an actual visit rate of 1.61. There was no significant reduction in in-person visit rates for White patients on inpatient treatments. Telemedicine uptake was significantly higher for White patients compared with Black patients for all diseases combined across all treatment categories (Figure A & B) (t = 9.5, p < 0.01), AML inpatient treatments (t = 2.4, p = 0.04), MM orals (Figure C) (t = 6.0, p < 0.01) and MM inpatient treatments (Figure D) (t = 2.3, p = 0.04). Conclusions: A tradeoff in reductions in in-person visits and uptake of telemedicine use was observed overall. White patients had significantly higher telemedicine uptake compared with Black patients for both oral and inpatient treatments. In-person visit rates for Black patients were unchanged regardless of treatment category. These in-person visit rates reflect documented telemedicine use disparities, which requires further study into possible compound causes, including economic and societal factors. Figure. Trends over time in telemedicine visit rates for White patients (blue line) and Black patients (black line) [Formula presented] Disclosures: Neparidze: Eidos Therapeutics: Membership on an entity's Board of Directors or advisory committees;GlaxoSmithKline: Research Funding;Janssen: Research Funding. Lau: Flatiron Health Inc: Current Employment;Roche: Current equity holder in publicly-traded company. Wang: Flatiron Health: Current Employment;Roche: Current equity holder in publicly-traded company. Davidoff: Amgen: Consultancy;AbbVie: Other: Family member consultancy. Huntington: Bayer: Honoraria;Servier: Consultancy;Pharmacyclics: Consultancy, Honoraria;Thyme Inc: Consultancy;Genentech: Consultancy;AbbVie: Consultancy;SeaGen: Consultancy;Celgene: Consultancy, Research Funding;Flatiron Health Inc.: Consultancy;DTRM Biopharm: Research Funding;TG Therapeutics: Research Funding;AstraZeneca: Consultancy, Honoraria;Novartis: Consultancy. Calip: Flatiron Health Inc: Current Employment;Roche: Current equity holder in publicly-traded company;Pfizer: Research Funding. Shah: AstraZeneca: Research Funding;Seattle Genetics: Research Funding;Epizyme: Research Funding. Stephens: Adaptive: Membership on an entity's Board of Directors or advisory committees;Celgene: Consultancy;Abbvie: Consultancy;CSL Behring: Consultancy;Novartis: Research Funding;Karyopharm: Membership on an entity's Board of Directors or advisory committees, Research Funding;JUNO: Research Funding;Mingsight: Research Funding;AstraZeneca: Consultancy;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;Beigene: Membership on an entity's Board of Directors or advisory committees;TG Therapeutics: Membership on an entity's Board of Directors or advisory committees;Epizyme: Membership on an entity's Board of Directors or advisory committees;Arqule: Research Funding. Miksad: Flatiron Health Inc: Current Employment, Current holder of individual stocks in a privately-held company;Roche: Current equity holder in publicly-traded company. Parikh: Onc.AI: Current holder of individual stocks in a privately-held company;Humana: Honoraria, Research Funding;Flatiron Health Inc: Honoraria;Thyme Care: Honoraria;Nanology: Honoraria;GNS Healthcare: Current holder of individual stocks in a privately-held company. Takvorian: Genentech: Consultancy;Pfizer: Research Funding. Seymour: Janssen: Membership on an entity's Board of Directors or advisory committees;Roche: Current equity holder in publicly-traded company;Pharmacyclics: Membership on an entity's Board of Directors or advisory committees;Flatiron Health Inc: Current Employment;Karyopharm: Honoraria, Membership on an entity's Board of Directors or advisory committees.

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