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Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S151-S153, 2022.
Article in English | EMBASE | ID: covidwho-2058337


Background: The rapid spread and recurrent infections of SARS-CoV-2 has led to increased use and availability of at-home antigen testing, but widespread testing of antibodies against spike and nucleocapsid to monitor vaccine-induced immunity and exposure to the virus is lacking. Most serological tests require a serum sample from a venous blood draw, increasing risk of exposure to COVID-19 and limiting availability and scalability of testing for many patients. This is especially the case for individuals who are immunocompromised, such as those with inflammatory bowel diseases (IBD), which are frequently on medications that might alter their immune response and impact vulnerability to SARS-CoV-2. Use of easily acquired and stably stored dried fingerstick blood serves a promising specimen source for at-home, remote testing for SARS-CoV-2 antibodies. Aim(s): Validate the use of fingerstick blood (dried and then eluted) versus serum as a specimen for the measurement of quantitative spike and nucleocapsid antibodies to SARS-CoV-2 in a diverse cohort of healthy and immunocompromised patients. Method(s): Patients were consented and enrolled into the Pediatric Gastrointestinal Tissue, Stool, Saliva and Blood Registry prior to having an endoscopic procedure. Five mL of blood was obtained by venipuncture and 10 muL of fingerstick blood was collected and dried on a Neoteryx Mitra device. Blood was eluted from the Neoteryx Mitra samples in 200 muL of dilution buffer (1% BSA, 0.05% Tween-20, 140 mM NaCl, 50 mM Tris (pH 8.0), 0.025% sodium azide) and placed on an orbital shaker at a speed of 500 RPM for 3 h. Paired serum and fingerstick blood eluate specimens were run on the quantitative Roche Elecsys SARS-CoV-2 spike antibody assay and the qualitative Roche Elecsys SARS-CoV-2 nucleocapsid antibody assay. Linear regression were performed on each assay with exclusion of values that were above the upper limit of detection of the assay. Result(s): We observed an excellent correlation in both SARS-CoV-2 antibody assays when comparing fingerstick blood eluates and serum. The linear regression for the nucleocapsid antibody assay had a slope of 15.5, intercept of 4.05, and R2 of 0.92, indicating that a Neoteryx value of 1.00 COI (cut-off index) equates to a serum value of 19.6 COI. The linear regression for the spike assay had a slope of 13.6, intercept of 953, and R2 of 0.95, indicating that a value of 1,000 U/mL from a fingerstick sample equates to a serum value of 14,544 U/mL. Conclusion(s): These data demonstrate that fingerstick blood collected on Neoteryx Mitra devices can be used as a specimen source in Roche Elecsys SARS-CoV-2 antibody assays to calculate the serum levels of spike and nucleocapsid antibodies. This can serve as a platform to remotely and reliably monitor the durability of antibody responses to natural infection with and immunization against SARS-CoV-2 in patients. Chart comparisons of nucleocapsid (top) and spike (bottom) protein antibody levels detected via remote fingerstick collection (Neoteryx, x-axis) and venous blood serum (y-axis).

International Journal of Workplace Health Management ; ahead-of-print(ahead-of-print):20, 2022.
Article in English | Web of Science | ID: covidwho-1684992


Purpose The health and well-being of healthcare staff came into focus during the coronavirus disease-2019 (COVID-19) pandemic as already strained workforces responded to new and additional challenges. Organisational support services made efforts to adapt staff support provision. However, most literature and recommendations are centred on surveys of medical and clinical staff. The present study included staff across clinical and non-clinical workforces within a mental health trust over the course of the COVID-19 pandemic to date, and aimed to understand workforces' access to and experiences of organisational support. Design/methodology/approach The current study was a qualitative one using convenience and purposive sampling. Semi-structured individual and group interviews were conducted using a topic guide. Reflexive thematic analysis was used in a phenomenological framework to analyse data. Findings 35 staff, broadly representative of the trust workforce, were recruited. Six global themes summarised the experiences of staff in relation to work practices, personal well-being and support access over the first year of the COVID-19 pandemic: COVID-19 disease, interpersonal relationships, individual considerations, change, working environment and support. Practical implications The findings from the study have implications for organisational support provisions for healthcare workers and the dissemination of these services. Originality/value Acknowledging the multi-various experiences of different workforces within National Healthcare Service organisations and how these change over time will facilitate innovative changes to staff support provision.

Journal of Clinical Oncology ; 39(15 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1339285


Background: Immunotherapy (IO) has transformed the landscape for melanoma. Checkpoint inhibitors (CPI) are now routinely given to older patients. The impact of performance status (PS) and age on the immune response remains unclear. During the COVID-19 pandemic, most older patients elected to continue their cancer therapy. Meta-analysis from trial data thus far has not demonstrated any association with cancer immunotherapy survival. This abstract reports on real -world experience of older patients with melanoma treated during the global pandemic. Methods: Real world data of all patients over 70 years of age receiving IO for melanoma, was collated at a tertiary cancer centre from Oct 2019 - Dec 2020. The objective was to see how these older patients tolerated CPI, in both the adjuvant and palliative settings, during a global pandemic. Information on demographics including age at diagnosis, intention, sites of metastases, PS, co-morbidities, toxicity, impact of COVID-19 and the patient outcomes were collected. During the pandemic the majority of patients on CPI treatment were assessed and followed up by telephone call rather than face to face. Results: Fifty-six patients over 70 years,were identified to have received CPI during the time period. There were 36 male and 22 female patients. Median age was 74 (range 70-88 years). Sixteen patients (29%) were treated with adjuvant intent;the remaining 40 patients (71%) were treated with palliative intent. Most patients with metastatic disease had 1-3 sites. All patients were PS0-1, except for one patient who was PS2. There were 19 patients (34%) who developed significant grade toxicities. No patients were treated on a clinical trial during the pandemic. Three patients (5%) elected to stop treatment during the pandemic. Calls to triage were taken as normal and the majority of patients had toxicity managed as an outpatient. No patients received the vaccine by the end of the study period. Conclusions: Real-world data explored the use of CPI in older patients and the impact of the COVID-19 pandemic on their management. Older patients were able to continue on CPI during the pandemic and it was given safely in adjuvant and palliative settings. Comprehensive geriatric assessments are planned to be integrated however the current demands on medical colleagues has delayed the introduction. However clinicians working in partnership with patients ensured the safe delivery and no patients died from toxicity of therapy or COVID-19 during this time. These findings suggest that shared decision-making during a pandemic with older patients is essential to support patients and optimise outcomes. We suggest cancer therapies should not be restricted to patients based on age and IO can be given safely if precautions are taken during a global pandemic. Patients have now received first COVID-19 vaccinations and ongoing assessement of the impact of the vaccination is in progress.