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2.
Journal of Clinical Oncology ; 40(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1700453

ABSTRACT

Background: During the COVID19 pandemic, many centres in the UK, shifted towards utilising hypofractionated radiotherapy (RT) to pancreas. We aim to report the UK experience hypofractionated (3-5 fractions) RT to the pancreas from 7 centres in the UK. Rates of toxicity, progression, death and potential prognostic factors were assessed. Univariate and multivariate Cox proportional hazards analyses were performed. Results: 92 patients from 7 centres were included in the analysis (median age 71 (range 49-88). 90% had performance status of 0-1. 66% had locally advanced disease. 53% had RT delivered over 3- 5 fractions (n = 49, median: 30Gy/5f, range:30- 40Gy in 3-5f). The rest had 15-fraction RT with or without concurrent chemotherapy (n = 43, median: 45Gy/15f, range: 36-45Gy/15f). Induction chemotherapy (CT) was used in 64% (FOLFIRINIOX -42/59). Median follow-up was 13 months from first treatment (induction CT or RT). Median overall survival (OS) among all patient was 17 months, (95% CI-14.5-19.5 months). On multivariable analysis, induction CT was the only predictor of improved PFS (median survival (MS) 12 vs 5 months;hazard ratio [HR] 0.23;95% confidence interval [CI]: 0.12-0.44, p < 0.001) and OS (MS 24 vs 11 months;HR 0.15;95% CI: 0.07 - 0.34, p < 0.001). There were no deaths. 4 patients had grade 3+ toxicities (transaminitis, cholecystitis and gall bladder perforation, small bowel obstruction and diarrhoea) -all had concurrent CT. Conclusions: Our survival outcome appears to be comparable with published data from CT + concurrent chemoradiotherapy. Induction CT appears to improve outcome. Careful selection of patients can help maximise advantage in this patient population.

4.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1638304

ABSTRACT

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has influenced epidemiology through direct and indirect effects, yet the impact on out-of-hospital cardiac arrest (OHCA) is unclear. We aimed to evaluate the impact of the pandemic on the incidence, characteristics, and clinical outcomes of OHCA. Hypothesis: We hypothesized that compared to the pre-pandemic period, the COVID-19 pandemic period was associated with increased incidence and case fatality rate (CFR) of OHCA, as well as decreased rates of intermediate clinical outcomes (termination of resuscitation [TOR], return of spontaneous circulation [ROSC], survival to hospital admission, and survival to hospital discharge). We further postulated that there was a change in the etiologies of OHCA during the pandemic as well as a decline in the rate of shockable rhythm as the initial presenting rhythm. Methods: In this systematic review and meta-analysis, five scientific databases were searched from inception to May 3, 2021. Meta-analyses were performed for the primary outcomes, secondary outcomes, and clinical characteristics. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253879). Results: The search yielded 966 articles. 20 articles were included for analysis. The COVID-19 pandemic was associated with a 39.5% increase in pooled annual OHCA incidence (p<0.001). Pooled CFR was increased by 2.65% (p<0.001), with an odds ratio (OR) of 1.95 for mortality (95% confidence interval [95%CI] 1.51-2.51). There was increased field TOR (OR=2.46, 95%CI 1.62- 3.74). There were decreased ROSC (OR=0.65, 95%CI 0.55-0.77), survival to hospital admission (OR=0.65, 95%CI 0.48-0.89), and survival to discharge (OR=0.52, 95%CI 0.40-0.69). There was decreased shockable rhythm (OR=0.73, 95%CI 0.60-0.88) and increased asphyxial etiology of OHCA (OR=1.17, 95%CI 1.02-1.33). There was moderate-to-high statistical heterogeneity. Findings were robust to sensitivity analyses, with no publication bias detected. Conclusions: The COVID-19 pandemic was associated with significant changes in OHCA epidemiology. Compared to the pre-pandemic period, the pandemic period was associated with increased OHCA incidence and worse outcomes.

5.
British Journal of Surgery ; 108:1, 2021.
Article in English | Web of Science | ID: covidwho-1539557
6.
British Journal of Surgery ; 108:1, 2021.
Article in English | Web of Science | ID: covidwho-1539556
7.
Multiple Sclerosis Journal ; 27(2 SUPPL):715, 2021.
Article in English | EMBASE | ID: covidwho-1496046

ABSTRACT

Introduction: During the 1st wave of the COVID-19 pandemic in Spring 2020, restrictions and 'lockdowns' impacted how healthcare was provided to many patients in Europe and the US. Objective: To understand the impact of COVID-19 on consultations between neurologists and Relapsing-Remitting Multiple Sclerosis (RRMS) patients in Europe and US during the 1st wave of the pandemic. Methods: A multi-centre online retrospective chart-review study of patients with MS was conducted in Q2 2020 (04/2020-06/2020) and Q4 2020 (10/2020-12/2020) in Europe (UK, FR, DE, IT, ES) and US amongst neurologists (MS Nurses included in the UK). Respondents screened for duration of practice in specialty (≥3yrs) and caseload (≥15 MS patients/mo). De-identified patient charts were recorded for the next 10 eligible patients seen during the consultation period. Descriptive statistics were used to analyse the data. Results: 321 and 101 (Q2), 324 and 101 (Q4) respondents were recruited in Europe and US respectively, reporting on 2244 and 709 (Q2), 2264 and 704 (Q4) RRMS patients, respectively. In Q2 2020, 39% (Europe) and 31% (US) reported RRMS patients saw their neurologist (or MS Nurse in the UK) in person, compared to 50% (Europe)/19% (US) where the consultation was conducted by phone, 6% (Europe)/ 42% (US) by telemedicine and 6% (Europe)/ 8% (US) via internet. By Q4 2020, the proportion of reported RRMS patients seen in person significantly increased to 71% in Europe and 68% in the US [p<0.01]. Reported patients seen in person were directionally more likely to have active or highly active MS and be suffering from a relapse vs those seen virtually (active or highly active: Europe: Q2 51% vs 35%, Q4 44% vs 36%;US Q2 47% vs 39%;Q4 46% vs 42%. Currently suffering a relapse: Europe: Q2 18% vs 6%, Q4 15% vs 8%;US: Q2 16% vs 7%;Q4 16% vs 5%). In Europe, consultations were significantly more likely [p<0.01] to be in person vs. virtual for reported patients who had initiated or switched disease-modifying therapy in the previous 12 mo. (Q2 36% vs 26%, Q4 30% vs 22%). Conclusions: In the sample surveyed, in person consultations were significantly lower [p<0.01] in the first wave of the pandemic vs. the latter half of 2020. Reported patients with more active disease who started treatment recently were directionally more likely to be seen in person. Further research is needed to understand the impact of virtual appointments on the care of RRMS patients with lower disease burden.

8.
Pakistan Journal of Medical and Health Sciences ; 14(3):1354-1356, 2020.
Article in English | Scopus | ID: covidwho-931997

ABSTRACT

Covid-19 remains a worldwide pandemic. This is obviously due to new cases increasing and made worse by co-existing medical problems including death. The main issues in the management are movement control order and screening of the disease at an early stage in order to prevent transmission, complications and treat them early. The incidence of Covid-19 in Malaysia is on a relentless march superseding any previous projections made by WHO. From December 2009 till March 2020 the rate of infection in the number of patients with Covid-19 has stayed high. Every effort should be made to slow and flatten this transmission and what better way than to focus on Malaysians' health. In the meantime society and the country as a whole has to bear the immense health and economic burden of the disease. The aim of the review was to describe the acceptance on Covid-19 in Malaysia. An extensive literature review of acceptance, knowledge, attitude, practice and decision making was performed to highlight the issues related with Covid-19. It is hoped that with the evidence, can facilitate us for better understanding. © 2020 Lahore Medical And Dental College. All rights reserved.

9.
Tourism Geographies ; 22(3):455-746, 2020.
Article in English | CAB Abstracts | ID: covidwho-827661

ABSTRACT

This special issue is a reflection by tourism scholars on the initial impacts of the COVID-19 pandemic on the world, with travel and tourism being among the most significant areas to bear those impacts. However, instead of an analysis of the impacts of COVID-19 on tourism places and sectors, the papers in this issue focus on visions of how the pandemic events of 2020 are contributing to a possibly substantial, meaningful and positive transformation of the planet in general, and tourism specifically. This is not a return to a 'normal' that existed before - but is instead a vision of how the world is changing, evolving, and transforming into something different from what it was before the 2020 global pandemic experience.

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