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The proceedings contain 78 papers. The topics discussed include: work disability, indirect costs and risk factors in patients with Crohn's disease in a Rio De Janeiro tertiary care center;proton pump inhibitors are associated with less severe periodontal disease: considerations for IBD patients;impact of COVID-19 pandemic in treatment adherence in inflammatory bowel disease patients;impact of COVID-19 in a cohort of patients with inflammatory intestinal disease;utilization of biologic therapy in patients with microscopic colitis not responding to standard therapy;restrictive eating symptoms may persist in children adolescents with treated IBD: case series;power calculations in randomized controlled trials of inflammatory bowel disease;measuring patient-reported outcomes in Crohn's disease patients during the outbreak of COVID-19;Tofacitinib and ileal pouch anal anastomosis. a single-center case series;corticosteroids, aminosalicylates and gastrointestinal symptoms are associated with the need of hospitalization in patients with inflammatory bowel diseases and COVID-19;and manometric study and the role of the perianal disease and the clinical activity in anorectal dysfunction in Crohn's disease.
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BACKGROUND: SARS-CoV-2 ribonucleic acid (RNA) has been detected in feces, but RNA is not infectious. This systematic review aims to answer if fecal SARS-CoV-2 is experimentally infectious and if evidence of human fecal-oral SARS-CoV-2 transmission exists. METHODS: On September 19, 2022, we searched PubMed, Embase, Web of Science, medRxiv, and bioRxiv. Biomedical studies inoculating SARS-CoV-2 from feces, rectal, or anal swabs in cells, tissue, organoids, or animals were included. Epidemiological studies of groups differing in exposure to fecal SARS-CoV-2 were included. Risk of bias was assessed using standardized tools. Results were summarized by vote counting, tabulation, and a harvest plot. PROSPERO registration no. CRD42020221719. RESULTS: A total of 4,874 studies were screened; 26 studies were included; and 13 out of 23 biomedical studies (56.5%) succeeded in infection. Two (66.7%) epidemiological studies found limited evidence suggesting fecal-oral transmission. All studies had concerns about the risk of bias. CONCLUSIONS: It is possible to experimentally infect cell cultures, organoids, and animals with fecal SARS-CoV-2. No strong epidemiologic evidence was found to support human fecal-oral transmission. We advise future research to study fecal infectivity at different time points during infection, apply appropriate controls, use in vivo models, and study fecal exposure as a risk factor of transmission in human populations.
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Background: Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). Method(s): This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Result(s): Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 +/- 11.4. The average resting pressure decreased in response to treatment;however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001). Conclusion(s): Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.Copyright © 2023 The Author(s).
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In 2020, a new type of coronavirus (SARS-CoV-2) whose disease is called Coronavirus disease 2019 (COVID-19) has been reported. This virus was first discovered in Wuhan, China and has infected 90,308 people per March 2, 2020. As of the end of October 2020, more than 40 million people have been infected, with the death toll reaching 1,150,000 worldwide. Apart from respiratory tract infections, patients infected with this virus may exhibit other symptoms, such as diarrhea, abdominal pain, nausea, or vomiting. This means that the virus can be found in feces and anus, hence the anal swab can be used as a diagnostic tool for COVID-19 infection. The results of the specimen test show that the sensitivity of the nasopharyngeal swab positive detection rate is the highest and remains the gold standard for diagnosis. This sensitivity can also be influenced by the course of the disease that can infect the gastrointestinal tract so that anal PCR is performed for the diagnosis to detect the COVID-19 virus in patients.
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Introduction: Covid-19 was the cause of a pandemic that claimed thousands of human lives. The pandemic has caused health professionals mental health problems that influence emotional, psychological and social well-being, which affects the way they think, feel and act in daily life. Objective(s): To de-termine the quality of life of health personnel during the Co-vid-19 pandemic in public institutions in the city of Cuenca. Material(s) and Method(s): Descriptive, cross-sectional and observational study. The study sample was 338 health professionals belonging to the Ministry of Public Health of the Canton Cuenca, province of Azuay-Ecuador, doctors, nurses, dentists, psychologists, assistants and biochemists who work at differ-ent levels of care were included. Two WHOQOL surveys and the Lazarus and Folkman scale of coping modes were used, for the tabulation of the data the RStudio statistical program was used. Result(s): In the psychological domain, no significant destructuring was found in the personnel studied. In the field of health, it should be noted that the personnel studied reported the inability to carry out the activities they need and the diffi-culty in moving from one place to another. Conclusion(s): When investigating the relationship of health personnel with the envi-ronment, no statistically significant alteration was found, but it was evidenced that social support is a protective factor for the mental health of personnel.Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.
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The COVID-19 pandemic has disrupted sexual health services among those most vulnerable to HIV acquisition, such as adolescent men who have sex with men (AMSM). We sought to characterize the changes in sexual-risk behaviors, HIV and other STI testing, and pre-exposure prophylaxis (PrEP) use among a longitudinal cohort of AMSM aged 13 to 18 years before and during the COVID-19 pandemic. We observed a significant decline in HIV testing and a marginal decrease in other STI testing since the pandemic began in March 2020. Outreach efforts and innovative remote delivery of sexual health services are needed to support access to healthcare services among AMSM as the pandemic persists.
RESUMEN: La pandemia de COVID-19 ha afectado la prestación de servicios de salud sexual para los más vulnerables, tales como los hombres adolescentes que tienen relaciones sexuales con hombres (AMSM; por sus siglas en ingles). En una cohorte longitudinal de AMSM de 13 a 18 años, examinamos los cambios en comportamientos sexuales de alto riesgo, la prueba de VIH, las pruebas de otras enfermedades de transmisión sexual, y el uso de Profilaxis Preexposición (PrEP) para el VIH antes y durante la pandemia. Desde el inicio de la pandemia en marzo de 2020, observamos una disminución significativa en la frecuencia de pruebas de VIH y una disminución marginal en la frecuencia de pruebas de otras enfermedades de transmisión sexual. Mientras persista la pandemia, serán necesarios más esfuerzos de divulgación e innovaciones en la prestación remota de servicios de salud sexual para apoyar el acceso a dichos servicios por parte de AMSM.
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BACKGROUND: To meet the increasing demands for colorectal pelvic floor services, a dedicated telephone triage assessment clinic (TTAC) was set up to establish a more efficient pathway, and reduce waiting times and patient's visits to the hospital. The primary aim of this study was to review TTAC in patients suffering from pelvic floor dysfunction and assess its feasibility. Secondary aims include measurement of waiting times for TTAC, main presenting complaints, and main treatment outcomes, including the need for review by a consultant surgeon. METHODS: Review of data collected retrospectively in a single tertiary referral center collected from an institutional database. KEY RESULTS: Between January 2016 and October 2017, 1192 patients referred to our pelvic floor unit were suitable for TTAC. Of these, 694 patients had complete records. There were 66 without follow-up after the initial TTAC, leaving 628 patients for analysis. In all, 86% were females and 14% were males, with a mean age of 52 years (range: 18-89). The median waiting time for TTAC was 31 days (range: 0-184). The main presenting complaint during the TTAC was obstructive defecation in 69.4%, fecal incontinence in 28.5%, and rectal prolapse in 2.1%. In our study, 611 patients had conservative management (97.3%), with a median of three sessions per patient (range: 1-16), while 82 patients (13.1%) needed a surgical intervention. Only 223 patients (35.5%) were reviewed by a consultant at some stage during the study period. CONCLUSIONS AND INFERENCES: To optimize resources, an adequate triage system allowed us to streamline the pathway for each individual patient with pelvic floor dysfunction according to their symptoms and/or test results with the aim of reducing waiting times and expediting treatment.
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PURPOSE: To develop a predictive index model, integrating both clinical and high-resolution anoscopy (HRA) features to further personalize the decision making process in anal canal carcinoma in COVID19 era. METHODS AND MATERIALS: We assess HRA parameters after definitive chemoradiotherapy in patients with anal canal malignant lesions. RESULTS: HRA features could be important to assess the effect of CRT and a risk stratification system should be introduced in clinical practice to better allocate therapeutic interventions. CONCLUSION: To our knowledge this is the first proposal for HRA findings in anal canal cancer after definitive CRT. We believe that a risk score can be useful to estimate the risk of treatment failure (in term of persistence disease and/or recurrence) and its clinical relevance should not to be underestimated.
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BACKGROUND: Telemedicine is emerging as an easy way to communicate between patients and surgeons. Use of telemedicine increased during the coronavirus disease 2019 (COVID-19) pandemic. WhatsApp is one of the most common smartphone applications for user-friendly telemedicine. The aim of this study was to evaluate patient perception of health quality and positive outcomes using a diary sent by the patient to the surgeon via WhatsApp during the first post-discharge week after proctologic surgery. METHODS: Ninety-eight patients discharged after proctologic surgery at the Israelite Hospital of Rome and the AOU Policlinico Umberto I of Rome in 1 January-31 December 2019 were divided into two groups: the WhatsApp group (group A), (n = 36) and the no WhatsApp group (group B) (n = 62). Group A patients received a protocol to follow for the day-by-day diary during the first post-discharge week and sending it by WhatsApp to the surgeon. Group B patients only received recommendations at discharge. The tool's usefulness was assessed by a questionnaire one month after the intervention. RESULTS: The two groups were homogeneous for age, sex, schooling, employment, and proctologic pathology. Group A patients had less difficulty keeping a diary (p < 0.0001). Group A patients had the perception of better follow-up post-discharge (p = 0.002). The use of the diary sent by WhatsApp significantly improved the perception of positive post-intervention outcomes (p = 0.007). WhatsApp was the only independent predictor of perception of post-surgical positive outcomes (odds ratio = 4.06; 95% CI 1.35-12.24; p = 0.01). CONCLUSIONS: The use of WhatsApp in the post-discharge period improves the lifestyle quality of the patients and their perception of the safety and quality of care received.
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Aim/Introduction: Pulmonary emboli (PE) have conventionally been reported in a binary fashion without quantification. Following development and phantom validation of a Pulmonary Parenchymal Burden (PPB) quantification method to measure the percentage of lung parenchyma affected by PE, we wanted to explore whether the %PPB is clinically pertinent, specifically whether it correlates with the development of long term sequelae and so may be helpful in outcome prediction and triaging patients to different management pathways. Material(s) and Method(s): : A retrospective single centre study carried out on patients scanned before the COVID pandemic. Patients with pre-existing cardiorespiratory disease were excluded. 40 patients who had PE and had undergone V/Q SPECT between January 2018- May 2020 with documented clinical follow up of >20 months were included. All patients had undergone simultaneous V/Q SPECT with 81mKr, 99mTc-MAA according to the departmental clinical protocol. Images were reconstructed according to a prevalidated V/Q quantification optimised protocol and PEs were quantified using a SPECT viewing platform with volumetric quantification. %PPB was calculated as the total parenchymal PE volume divided by the total lung ventilation volume. Clinical outcome was assessed using NHS trust electronic clinical documentation. Note was made of presence or absence of 2 parameters: persistent dyspnoea/impaired exercise tolerance (DIETT) with 3 months of anti coagulation and presence or absence of chronic thromboembolic pulmonary hypertension (CTEPH). Statistical analysis was performed by Graphpad prism 9.3.1 version for windows. Result(s): :21 females and 19 males with a mean age of 45.2(range 19-72years). There was a statistically significant difference in %PPB with the presence or absence of DIETT (mean%PPB:34.5%, standard deviation (SD):18.92 vs mean%PPB:10.81%, SD:14.03%;t-test p=0.001). There was a statistically significant difference in %PPB with the presence or absence of CTEPH (mean%PPB:51%, SD= 10.12 vs mean PPB = 20.76, SD: 17.4% ;t-test p=0.0002). Conclusion(s): In patients with known persistent PE, %PPB can discriminate long term sequelae of DIETT and CTEPH following PE. A quantitative %PPB tool may therefore be a useful addition to standard imaging to help triage patients into different clinical management groups.
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Category: Chemoradiotherapy Background to the audit: We aimed to review a five-year clinical practice of radical chemoradiotherapy (CRT) in anal cancers at our centre. Standard: Seven key quality indicators were tested against the referenced standards from RTOG 8704/RTOG 8911, ACT II, RCR guidance and departmental protocols.3,4,5 1. 75% and 100% acquisition of computed tomography simulation (CT SIM) within seven and 14 days of consent taking. 2. 100% commencement of CRT within 28 days of CT SIM. 3. 100% start of CRT within 28 days of CT SIM. 4. Overall CRT duration of 38 days in 100% cases, with radiotherapy (RT) interruptions for >2 days in <2%. 5. Completion of concurrent chemotherapy in 75% of cases. 6. Colostomy rate for CRT morbidity <2%. 7. 30-days mortality rate <2%. Indicator: AA. Target: Primary anal cancers received curative CRT between 2016 and 2021. The audit took place from October to December of 2021. Methodology: The data source consisted of electronic medical records using the Welsh Clinical Portal (WCP), MOSAIQ radiation oncology and chemocare CIS oncology. Results of first audit round: A total of 80 anal cancers received CRT. 75% of CT SIM was acquired within seven days, and in 95% of patients within 14 days of consent. The observed slight deviation was related to the COVID pandemic in 2020. About 96.3% started CRT within 28 days of CT SIM. The mean duration of CRT was 37.9 days. RT interruptions >2 days were about 5%, and 67.5% started CRT within 28 days of consent. 92.5% and 76.2% completed mitomycin and capecitabine without breaks. The colostomy rate was 1.2%, and the 30-day mortality was 1.2%. First action plan: A sustained plan execution to ensure 100% acquisition of CT SIM within seven days of consent. New referrals are seen same day after the multidisciplinary team decision. A 14-day deadline from CT SIM to CRT delivery has been introduced for physicists and oncologists for target and organs at risk (OAR) delineation, peer review, planning/approval. An additional CT simulator has been requested. References: 1. Kang YJ, Smith M, Canfell K. Anal cancer in high-income countries: increasing burden of disease. PLoS One 2018, 13(10): e0205105. 2. Glynne-Jones R, Meadows H, Wan S et al. National Cancer Research Institute Anal Sub Group and Colorectal Clinical Oncology Group. EXTRA - a multicenter phase II study of chemoradiation using a 5 day per week oral regimen of capecitabine and intravenous mitomycin C in anal cancer. Int J Radiat Oncol Biol Phys 2008, 72: 119-26. 3. Edgar B-J, Moughan J, Ajani JA et al. Impact of overall treatment time on survival and local control in patients with anal cancer: a pooled data analysis of Radiation Therapy Oncology Group trials 87-04 and 98-11. J Clin Oncol 2010, 28: 5061-6. 4. James RD, Glynne-Jones R, Meadows HM et al. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2 x 2 factorial trial. Lancet Oncol 2013, 14(6): 516-24. 5. The Royal College of Radiologists. The timely delivery of radical radiotherapy: guidelines for the management of unscheduled treatment interruptions, fourth edition. London: The Royal College of Radiologists, 2019. Copyright © 2022
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Purpose: Since the corona pandemic, the use of video consultation has increased markedly. For vulnerable groups such as oncological patients, the advantages seem obvious. But how, compared to face-to-face consultation, does video consultation potentially change the doctor-patient relationship? Which barriers may hinder the effective use of this consultation format in practice? We are presenting first results from a study, funded by Federal Ministry of Health, which will provide the basis for a hands-on guide for both physicians and patients on how to improve the video consultations. Method(s): We use a quasi-experimental mixed-methods design to analyze qualitative and quantitative differences between face-to-face and video consultations. Data collection will be completed by June 2022. We will record N = 64 videos (n = 32 for each consultation format) with gynecological and urological cancer patients. After the consultation, all patients answer a questionnaire with questions about their consultation experience. For quantitative analyses, the counseling sessions will be systematically compared in terms of verbal and nonverbal communication patterns. Relative frequencies of eye contact and the information exchanged will be compared using chi2 -tests. The validated questionnaire MAPPIN'Obsdyad will be used to assess the quality of shared decision-making parameters. In addition, semi-structured interviews will be conducted with n = 10 physicians and n = 10 patients experienced with video consultation, for which a qualitative content analysis will be conducted. Expected results: We present a complex methodological approach we used to approach the comparison of video vs. face-to-face consultations. We will also present first evidence on how video consultations change the doctor-patient interaction. Discussion(s): We show possible limitations and barriers of video consultations. Within the framework of a Delphi process, we will use the results to develop recommendations outlining best practices of video consultations for both physicians and patients.
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As the global pharmaceutical market continues to expand, the demand for pharmaceutical supply chain is increasing. In the context of "Industry 4.0”, the pharmaceutical supply chain sector needs to accelerate digital construction. Pharmaceutical companies need to strengthen risk management in order to cope with supply disruptions. From the perspective of sustainable development, the pharmaceutical supply chain can achieve sustainable supply performance in social, economic and environmental dimensions through digital transformation. There is a lack of research on digital transformation of pharmaceutical supply chain management. Further research is needed on what specific digital management pharmaceutical companies need to enhance to improve supply performance. This study uses empirical analysis to examine the impact of digital transformation on sustainable supply chain performance and to explore the role of information sharing and traceability as mediators. The aim is to guide the pharmaceutical supply chain to clearly manage the development of digital transformation and obtain sustainable supply performance. This study presents hypotheses based on cutting-edge theoretical findings. In total, 298 Chinese pharmaceutical company supply chain managers were surveyed and Structural equation analysis was conducted using SPSS26.0 and AMOS24.0. The results show that digital transformation significantly and positively impacts sustainable supply chain performance. Traceability plays a mediating role. The mediating role of information sharing is not significant. However, information sharing and traceability as two separate trends can have synergistic effects that together affect sustainable supply performance. The conclusion is that the pharmaceutical supply chain should accelerate digital construction, eliminate the uneven development of digital technology among supply chain members, and reduce the impact of technological uncertainty on performance. Companies are enhancing supply chain security management through information sharing and traceability systems, and are continuously focusing on the role of digital transformation as a driver for sustainable development.
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Purpose> Micro, small and medium enterprise (MSME) is the kingpin of Indian economy. It contributes to 48% of India's exports and provides employment to 110 million people. As a result, it is critical to evaluate the obstacles, expose them and find a way to overcome the crisis due to the pandemic. The study aims to analyse the impact of financial and non-financial measures for the revival of MSME and its impact on firm sustainability and future opportunity as perceived by MSME owners/heads during the COVID-19 outbreak.Design/methodology/approach>This study, based on a cross-sectional survey of 197 export-oriented Indian MSMEs, attempts to investigate covid crisis mitigation strategies/measures in the context of the COVID-19 crisis. The confirmatory factor analysis (CFA) model was applied to check model fit, and structural equation modelling (SEM) was employed for data analysis.Findings>The results of this study show the financial and non-financial revival measures such as firm revival, marketing training, customer relationship management (CRM), financial incentive and firm support, extending worker social security and financial access and price control positively impact MSMEs' business sustainability and future opportunity as perceived by the respondents that lent good support to the hypothesis.Research limitations/implications>The study emphasizes management in association with government and financial institutions to design short-term as well as long-term strategies that may enhance their sustainability in the market. MSMEs are being forced to reassess their business strategy and modify their operating model as a result of the uncertain/unpredictable climate. Many levels of strategy aid in revitalizing the company and providing future possibilities to move forward if the government schemes positively impact the perception of entrepreneurs. Further, the study identifies the immediate measures to tide over the crisis over this sector and then furnishes recommendations for closing the identified gaps in the present understanding.Originality/value>The impact of COVID-19 on Indian MSMEs and how these MSMEs are dealing with it are highlighted in this paper, which is quite scarce and insufficient to cover the gap. It also provides a comprehensive view of firm sustainability and perceived opportunity among MSMEs.
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Background. Infectious disease exposure investigations in the hospital are labor-intensive for the infection prevention and control (IPC) team and vulnerable to healthcare personnel (HCP) recall bias. We developed an electronic health record (EHR) algorithm to identify and rank patient-HCP interactions based on the likelihood and intensity of exposure. Methods. We compared conventional and EHR-based findings from seven exposure investigations conducted between November 1, 2020 and February 1, 2022 at The Johns Hopkins Hospital (JHH), a 1095 bed academic tertiary center in Baltimore, MD. Conventional exposure investigations were conducted for hospitalized patients who tested positive for SARS-CoV-2 while not in COVID-19 isolation precautions. IPC contacted department managers to identify and report potentially exposed HCPs to occupational health. The EHR-based method identified HCP-patient interactions based on clinical data such as documentation in the flowsheet, medication administration, etc. A score was calculated for each HCP based on the estimated duration and intensity of the contact. Genomic sequencing of available samples was performed to investigate transmission events. Results. Overall, the EHR-based system identified 75% (59/79) of the HCPs identified by conventional exposure investigations and 100% of those who document in the EHR. In contrast, it was unable to identify any potentially exposed individuals who do not document in the EHR (Table 1). All patient-HCP COVID-19 transmissions identified by conventional investigation and confirmed through genomic sequencing were identified by the EHR-based system, and all had high-intensity scores (i.e., top quartile of the list of exposed individuals). Conclusion. We found clinical EHR data was highly sensitive and specific in identifying potentially exposed HCPs compared with conventional exposure investigations. The inability to detect interactions with support staff or others who do not document in the EHR was a limitation and suggests that EHR data can augment but not replace conventional exposure investigations. The system's speed, ease, and lower resource requirements make it a promising tool to more efficiently complete exposure investigations in healthcare settings.
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IntroductionThe use of telemedicine services has increased worldwide during recent years because of national strategies for digitalization of health care and the coronavirus disease 2019 (COVID-19) pandemic. However, healthcare professionals often express uncertainty regarding the effectiveness of telemedicine interventions. The TELEMED database (https://telemedicine.cimt.dk/) was introduced by the Centre for Innovative Medical Technology (CIMT) at Odense University Hospital to ensure that hospital managers, healthcare professionals, and other stakeholders have access to scientific studies of telemedicine interventions.MethodsThe database constitutes a structured literature search in PubMed for randomized and non-randomized controlled trials on the use of telemedicine for treating somatic diseases in the hospital setting. The search was conducted by staff members in the health technology assessment unit at CIMT. Identified studies were sorted by first screening titles and s and then by reading full-text versions. The data extracted from the studies included setting, intervention, patient group, type of telemedicine, clinical effect, patient perception, and implementation challenges. The value of each study was also assessed with respect to effectiveness.ResultsA total of 510 articles were selected for data extraction and assessment. The database provides results from 22 different specialties and can be searched using the criteria of medical specialty, country, technology, clinical effect, patient experience, and economic effect. The database serves as an information platform for clinical departments who wish to implement telemedicine services. It has great potential for supporting digital transformation during COVID-19 by providing accessible evidence-based information on patient groups and relevant technologies and their effects. More than 95 percent of the studies in the database that compared telemedicine with a control group showed either statistically significant improvements in clinical outcomes with telemedicine or no statistically significant difference between the two groups.ConclusionsThe TELEMED database provides an easily accessible overview of existing evidence-based telemedicine services. The database is freely available and is expected to be continuously improved and broadened over time.
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Category: Outcomes of treatment (including chemotherapy, chemo-RT and RT) Purpose: To describe the five-year treatment outcomes of patients with anal squamous carcinoma treated with concurrent chemoradiotherapy (CRT) specified with volumetric modulated arc radiotherapy (VMAT) at a Welsh tertiary referral centre. Methods and materials: A total of 80 anal cancer patients received radical CRT between 2016 and 2021. CRT consisted of 50.4 Gy/28 fractions (1.8 Gy daily) to the gross tumour volumes (GTV), and the elective nodes were prescribed 40 Gy/28 fractions (1.42 Gy/daily) for patients having a cT1/2N0M0. Patients with cT3-T4/N0-N1a-cM0 were prescribed 53.2 Gy/28 fractions (1.9 Gy daily) to the GTV;gross nodal volumes were prescribed 50.4 Gy/28 fractions (1.8 Gy daily) if sized <=3 cm or 53.2 Gy/28 fractions (1.9 Gy daily) if >3 cm;elective nodal areas were given 40 Gy/28 fractions (1.42 Gy daily). Mitomycin and capecitabine were administered concurrently. The primary outcome was colostomy-free survival (CFS). Secondary outcomes were cancer-specific survival (CSS), disease-free survival (DFS), overall survival (OS) and adverse effects. Result(s): Median follow-up was 31.3 months (3-61). The five-year CFS was 94.3% (95% CI: 50.0%-96.5%). The five-year CSS, DFS and OS were 92% (95% CI: 60.5-95%), 86.7% (95% CI: 58-89%) and 67.9% (95% CI: 56.6-75.1%) respectively. A total of four (5%) local recurrences and one (1.3%) regional recurrence was observed. A total of seven patients (8.7%) had distant metastasis (liver was a frequent site;57.1%);three patients (3.7%) died of COVID pneumonia. Late toxicities were as: vaginal stenosis (6.3%), sexual dysfunction (1.25%) and urine incontinence (1.25%). Second malignancies were as: lung (2.5%), gastric (1.3%), pancreatic cancer (1.3%) and cholangiocarcinoma (1.3%). Conclusion(s): Our experience supports the use of VMAT on a routine basis for the CRT of anal squamous cell carcinoma. Copyright © 2022
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Background: COVID-19's physical distancing mandates have increased the likelihood of experiencing social isolation and loneliness for residents in long-term care (LTC), especially those living with dementia. Social isolation correlates with health risks, including depression and cognitive decline. Telepresence robots can be remotely driven and facilitate social interactions through videoconferencing. Researchers have begun to explore opportunities of using these robots in the healthcare field;however, there is a research gap on examining factors influencing their implementation in LTC from the perspectives of key stakeholders. This qualitative descriptive study focuses on exploring LTC staff and leadership teams' perspectives on facilitators and barriers to implementing telepresence robots. Method(s): We employed purposive and snowballing methods to recruit 22 participants from two LTC homes in British Columbia, Canada: operational and unit leaders, and interdisciplinary staff including nursing staff, care aides and allied health practitioners. Consolidated Framework for Implementation Research (CFIR) guided our data collection and analysis. Semi-structured interviews were conducted by virtual meetings. Thematic analysis was performed to identify themes. Result(s): Analysis of the data produced three themes: (a) perceived needs and values for family-resident connections, (b) engagement through conversation and partnership, and (c) confidence with training and timely support. Based on the findings and CFIR guidance, we offer a preliminary conceptual tool "START": Share benefits and successes;Tailor policies and plans with staff partners;Acknowledge and address staff concerns;Repeated training and demonstrations;and Timely technical support. Conclusion(s): This study offers pragmatic insights into staff and leadership teams' perceptions of facilitators and barriers of implementing telepresence robots in LTC. The complexity of technology implementation will require executive and leadership teams to consider additional factors beyond the Plan-Do-Study-Act (PDSA) cycle. Copyright © 2022 the Alzheimer's Association.
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Background: The endothelial glycocalyx (eGLX), a proteoglycan-and glycoprotein-rich layer covering the endothelial cells, has been shown to play an important role during infectious diseases. It regulates vascular permeability, prevents thrombosis, and modulates leukocyte adhesion and inflammatory response. Aim(s): The aim of this study was to investigate eGLX degradation during COVID-19. Method(s): GlycoCheck is a non-invasive test where a video microscope is placed under the tongue. From the measurements, eGLX thickness can be quantified. The eGLX damage is measured through the Perfused Boundary Region, (PBR), which is the zone where erythrocytes penetrate the protective eGLX. 40 patients with COVID-19 were included at the Umea University Hospital after written informed consent. GlycoCheck measurements were performed during the acute phase of disease and were compared to follow up. Statistical analysis with related-samples Wilcoxon signed rank test was performed. Result(s): 23 out of 40 patients have to this date completed 1 follow up GlycoCheck measurement, 1-2 months after the acute phase of disease. Among these 23 patients, the PBR was significantly increased during the acute phase of disease compared to follow up 1-2 months later (p < 0.01). Mean PBR among first visits during the acute phase was 2.32 mum (SEM 0.05), compared to the mean PBR of follow up visits, which was 2.12 mum (SEM 0.04). Conclusion(s): Our preliminary results show significant differences between the thickness in eGLX between patients during the acute phase of COVID-19 compared to follow up measurements of the same patients 1-2 months after, thus indicating a degradation of eGLX during the acute phase of COVID-19. (Figure Presented).
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Background: Coronavirus-2 (SARS-CoV- 2) infection causes a sustained prothrombotic state driven by a massive Tissue Factor (TF) expression in circulating platelets, leukocytes and microvesicles (MVs). Whether also circulating small extracellular vesicles (sEVs), in addition to large MVs (MVs), can contribute to this hypercoagulable scenario through TF expression is not yet known, mainly due to methodological issues in detecting and sizing the smallest vesicles. Aim(s): To characterize TF expression and activity in circulating sEVs, compared to that of MVs, of COVID-19 patients during acute phase infection and after symptom remission. Method(s): MVs and sEVs were isolated by plasma differential centrifugation from 10 COVID-19 patients enrolled at acute phase infection (T0) and at six-month- follow- up (T1). Ten healthy subjects (HS) were analyzed as controls. sEVs were counted by Nano Tracking Assay. In sEVs TF expression was analyzed within CD9/CD63/CD81pos events by imaging flow cytometry (IFC) and ExoViewTM microarray, while TF activity by FXa generation assay. TF expression and activity in MVs were evaluated for comparison. Result(s): By IFC analysis COVID-19 patients at T0 have about 1.5-and 4-fold higher number of TFpos-sEVs and -MVs, respectively, compared to HS, with a trend toward reduction to physiological levels at T1. By microarray analysis sEVs behaved similarly (36 +/- 12 and 25 +/- 10 TFpos-spots at T0 and T1, respectively;p = 0.0281). sEVs-associated TF is functionally active thus able to partially support FXa formation as sEVs preincubation with TF-neutralizing antibody reduced FXa generation by ~30%. However, although sEVs number is significantly higher compared to that measured for MVs (~600-fold in HS), functional activity of sEV is one-third lower compared to that of MVs. Conclusion(s): These data suggest that, in COVID-19 patients, the altered procoagulant phenotype could also be supported by TF carried by sEVs, although their functional activity is significantly lower than that of MVs.