ABSTRACT
Long COVID (LC), a new multiple-symptom syndrome, may occur in a large number of people after SARS-CoV-2. Most frequent symptoms include breathing problems, fatigue and cognitive impairments. LC needs to be in focus: research to understand its causes and develop appropriate therapies is needed. Yet, affected people have for long felt alone, with concerns and without guidelines. Altea Long COVID Network was developed to address these needs. The goal of Altea is to improve the quality of life of people with LC by providing science- and practice-based expertise, professional and empathetic support, and by enabling the free exchange of experiences between all target audiences. Altea was built with the contribution of those affected, health professionals and researchers, and provides practical tips for symptom management, information on the last updates regarding LC, as well as a Community, where all target audiences can communicate with each other in an interdisciplinary, respectful, and safe environment. Altea was launched in January 2021. The Website went live in April 2021. By now 1'496 people subscribed to the Newsletter, there were 50'000 visits, 221'000 page views, and 11'000 downloads. Countries where people visit from are CH, DE, IT, USA, AUT, FR, NL, GB, ES, and many others. In July 2021 the Altea Community was opened and has today 1146 subscribers. A survey is planned to examine to what extent Altea contributed to improve people's quality of life and develop therapies. Altea acts as mediator among the different target audiences that can use it to share knowledge and experiences. This accelerates the processes to develop therapies and treatments for people with Long COVID.
ABSTRACT
Background: We critically evaluated the risk of bias in published systematic reviews (SRs) and meta-analyses (MAs) pertaining to COVID-19 using ROBIS tool. Materials And Methods: MEDLINE and Cochrane Central Library were searched for SRs/MAs on 14th May 2020, including studies of all designs describing various facets of COVID-19 in humans;no restrictions were applied for interventions, comparators, and outcomes. Two reviewers independently assessed all the SRs/MAs with ROBIS. Result(s): Out of 204 identified records, 48 SRs/MAs were included. The most frequently reviewed topics were therapy outcomes, diagnosis, and comorbidities (15, 8, and 6 papers respectively). Only 29/48(60.41%) papers had made a mention of using PRISMA or other guidelines for drafting the SR/MA. Only 5/48(10.42%) of all included SRs/MAs had low overall risk of bias as per ROBIS tool;41/48(85.42%) had high risk of bias, 2/48(4.17%) had unclear risk of bias. The highest proportion of bias was found in data synthesis and findings (30/48, 62.50% of studies had high risk of bias), followed by study identification and selection (29/48, 60.42%). The IRR for methodological quality assessment was substantial, with the Cohen's kappa values being 0.64, 0.68, 0.62, and 0.75 for domains 1-4 of ROBIS tool, and 0.66 for overall risk of bias assessment. Conclusion(s): There are serious concerns about the methodology employed to generate the results of the SRs/ MAs pertaining to COVID-19, with 'quantity' seemingly being given more importance than 'quality' of the paper.Copyright © 2022 Bentham Science Publishers.
ABSTRACT
Objective: To investigate the outcome of COVID-19 in myasthenia gravis (MG) patients in 7 neuromuscular centers in the United States between March 2020 and September 2022. Background(s): As COVID-19 has spread worldwide with high capacity for mutation and infectibility, we need to investigate the relationship between COVID-19 and rare disease like MG. An informed decision-making process needs reliable data to prevent and treat complications during COVID-19 in MG patients. Design/Methods: We designed an IRB approved questionnaire to interview 144 MG patients from 7 neuromuscular centers in the United States, using phone calls and online Microsoft Forms. Ninety subject qualified for analysis, where qualification required informed consented subject, positive COVID-19 blood test, and confirmed MG before the onset of COVID. We used the CDC guidelines to categorize the severity of COVID-19, while we used MG quality of life 15r (MG-QOL15r) form to assess MG severity. Result(s): 52% of subjects were older than 65 years. Males constituted 58% of the cohort. Sixty-nine percent had at least one dose of COVID-19 vaccination. During the period of COVID-19, 57% of subjects were taking steroid, 17% took no medication, and the rest took immunotherapeutic, immunoglobulin, or plasmapheresis. Of the 90 subjects, 74% (n = 67) had mild COVID-19 symptoms, 9% (n = 8) moderate, 9% (n = 8) severe and 8% (n = 7) died from COVID-19 complications. During COVID-19 period of infection, 72% (n = 65) had mild MG, 18% (n = 16) moderate, and 10% (n = 9) severe MG symptoms. Conclusion(s): Our study showed that most MG patients had milder COVID-19 disease coarse and were less probable to suffer severe MG symptoms. There was no significant association between the severities of COVID- 19 and MG (P = 0.716) even after controlling for confounding factors. Moreover, we asserted that vaccination (P , 0.001) and younger age (P = 0.006) are associated with better COVID-19 outcome in MG patients.
ABSTRACT
Background: Financial toxicity (FT) is a multi-faceted construct, encompassing material hardship, psychological responses, and coping behaviors. FT adversely impacts patient-reported outcomes by decreasing mental health, affecting health-related quality of life (HRQOL), and deteriorating healthcare adherence. Few studies have assessed the relationship between financial toxicity, distress, coping, self-efficacy, and HRQOL within the context of cancer care disruptions resulting from the pandemic. Method(s): In the COVID-19 Breast Cancer Care Survey, 46 women with primary breast cancer were cross-sectionally evaluated for financial hardship (FACIT-COST), distress (Perceived Stress Scale), coping behaviors (Brief COPE), self-efficacy (Cancer Behavior Inventory-Brief) and HRQOL using the Functional Assessment of Cancer Therapy General (FACT-G) measure. Cancer care disruptions were measured with a series of questions investigating the impact of COVID-19 guidelines on access to healthcare services, treatment, and transition to telemedicine. Given the role of informal caregivers for patients' outcomes, social isolation was additionally included (PROMIS Social Isolation Scale). Descriptive statistics were computed, and bivariate correlations examined. Then, a subsequent regression model investigated predictors of FT in the present sample. Statistical analyses were performed using SAS 9.4 and significance level was set at p< 0.05. Result(s): Overall, participants were adult (Mage= 46.3+/-10.9) women diagnosed with early-stage breast cancer (75.61% Stage I/II). Approximately half of the participants were in active treatment (51.2%) and received multiple types of treatment (85.4% surgery;61% chemotherapy, and 36.5% radiation). Although all participants were insured at time of the study, the mean score of FT was 22.75 (SD=4.10, range: 0-44). Correlation analyses indicated that cancer care disruptions (r= -0.57, p<.001), health-related quality of life (r=-0.51, p=0.0007), coping behaviors (r=-0.33, p=0.037), well-being (r=0.56, p=0.0001), social isolation (r=-0.40, p=0.0096), and psychological distress (r=-0.42, p=0.0064) were significantly correlated with FT. That is, women who reported greater disrupted cancer care delivery, greater difficulties managing the illness, reduced physical and mental health, and those experiencing more social isolation reported worse financial toxicity. Results of the final regression model showed that women who experienced greater COVID19-related cancer care disruptions (beta=-2.82, p=0.0013) and isolation (beta=-0.44, p=0.0196) from supportive networks were more likely to indicate elevated FT scores. Conclusion(s): A multidisciplinary and patient-centered FT management approach can be implemented to extend current financial navigation models to address psychosocial and behavioral factors exacerbated by altered care delivery protocols.
ABSTRACT
Clinical practice guidelines are increasingly important to guide clinical care. However, they can vary widely in quality, and many recommendations are based on low-level evidence. The COVID-19 pandemic highlighted the need for new flexible formats for rigorously developed guidelines. Future guideline development should be standardised, graded, registered, and updated to ensure that they are 'living' works in progress.
Subject(s)
Anesthesia , COVID-19 , Humans , Pandemics/prevention & controlABSTRACT
Purpose of Study Over the last twenty years there has been an increase in the number of endotracheal intubations.1 In that same time period, palliative care has emerged with a focus on quality of life and alleviating suffering in patients with chronic, severe illness. More recently societal guidelines, including the American Society of Clinical Oncology, have recommended early integration of palliative care. 2,3 Hypothetically, earlier goals of care discussions could lead to less invasive interventions, such as intubation. With this focus on earlier intervention, we aim to study the correlation between inpatient palliative care consultation and intubations at our institution. Methods Used Utilizing a function of EPIC electronic medical record SlicerDicer, we were able to identify patients admitted to the University of Mississippi Medical Center with a cooccurrence of intubation and palliative care consult, examine patient demographics and calculate relative risk (RR). Summary of Results We first looked at intubations, which increased by 136% from 2012-2016 with the rate of change from 2017-2020 varying by only 1-2% a year. Next, we looked at palliative care consults. Since inpatient palliative care became available in 2017, the number of consults increased by 39% (264 to 367). We then analyzed 99,622 admissions from 2017-2020 to look for co-occurrences of intubation and palliative care consultation during the same admission. In the general population, excluding patients with a cancer diagnosis, co-occurrences increased by 86% from 2017-2020 (23 to 43). In cancer patients, co-occurrences increased initially by 600% from 2017-2019 (2 to 14), but then decreased by 35% in 2020. Based on this data, the RR of intubation and a palliative care consult during an admission was higher in non-cancer patients than cancer patients (RR 5.8, RR 2.3 respectively). The highest RR was seen in noncancer patients less than 30 and 50-70 years old (RR 13.6, RR 7.8 respectively). Conclusions Overall, there was an increase in co-occurrences of intubation and palliative care consultation. This could be attributed to a growing palliative care service, but the excess RR in younger, non-cancer patients may point to the palliative care team being increasingly utilized in the acute, critically ill patient. Notably, co-occurrences in non-cancer patients increased compared to cancer patients in 2020, likely due to Sars-Cov2. Though co-occurrences increased in cancer patients overall, the decreased RR compared to non-cancer patients is promising. This could point to more sub-specialist involvement in inpatient palliative discussions and/or earlier goals of care discussions. There is still work to be done to emphasize earlier goals of care discussions in chronic illnesses, which could ultimately lead to a decrease in the number of co-occurrences of intubation and palliative care over time. Further investigation is needed to follow this trend.