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1.
Hong Kong Medical Journal ; 28(4):335-337, 2022.
Article in English | EMBASE | ID: covidwho-2010501
2.
Journal of General Internal Medicine ; 37:S276, 2022.
Article in English | EMBASE | ID: covidwho-1995689

ABSTRACT

BACKGROUND: Pandemic related accommodations have provided direct barriers to accessing healthcare and changes to health-maintenance routines and disease management. We aimed to examine reported access to care and impact on health using data from a community engagement survey distributed online. METHODS: Data taken from the UC-COVID study includes 1,971 adults (mean age 49.2y, 75.7% female, 68.5% white non-Hispanic). Respondents were asked to report disruptions in access to care during the early pandemic (May- August 2020), followed by open-ended questions about the types of care that was disrupted and consequences. Qualitative data was coded by three independent coders and analyzed to identify common themes. RESULTS: 68%of respondents described disruptions in access to care during COVID-19, where a visit was canceled, rescheduled, or changed to telehealth since March 2020. Participants reported direct barriers such as clinic closures (“I am not able to access my PCP because of reductions in outpatient visits”), medication shortages, and cancelation or delays in elective procedures and imaging (“My left knee needs to have elective replacement surgery, or a pain shot and have not been able to get a shot. That means that my knee hurts more and restricts my desire to exercise”). 64% of patients facing disruptions had their visits changed to telehealth and despite accessing care, faced limitations in their experiences and cited decreased quality of care (“I typically saw about 20 doctors every three months or so?and now they are all telemedicine so it feels like I'm not really getting medical help”). Patients also reported changes in disease management routines due to social distancing mandates (“Severe exacerbation of mood disorder, both directly by social distancing/isolation and indirectly by interference with therapy”). Approximately 47%and 15% of patients experienced disruptions for a chronic condition and urgent health concern, respectively, with 6% reporting negative consequences from their delayed and/or forgone care. Patients reported downstream effects from barriers, such as uncontrolled disease (“I have had more roller coaster blood glucose levels due to stress, diet, and exercise”), medical uncertainty (“Since there is no way of knowing if the [cancer] cells have multiplied without the biopsies and procedures I am uncertain the grade of Dysplasia at this time”), and increased psychological stress (“My stress and anxiety have skyrocketed, including that for the first time in my life I'm taking a sleep aid every single night. I didn't cry very often, and now I cry at least once per week, sometimes multiple days in a row.”). CONCLUSIONS: Understanding the scope and associated health effects of COVID-related disruptions in access to care is critical for healthcare providers, policymakers, and hospital organizations to create system-wide safeguards and decisions that protect patient health and wellbeing in both acute and chronic care settings, especially as the COVID-19 pandemic continues.

3.
General Medicine ; 24(1):47-57, 2022.
Article in Bulgarian | EMBASE | ID: covidwho-1976272

ABSTRACT

Medicine shortages make medical professionals and governments unable to meet their moral obligations to patients and society to ensure access to adequate and timely medical care. The COVID-19 pandemic has put medicine shortages in the spotlight and exacerbated some situations of shortages of specific medicines used in the treatment regimen for coronavirus infection, but shortages have long been a challenge to health systems and a global phenomenon. The aim of this publication is to outline the scale of the phenomenon of “medicine shortages”, its impact on health care systems, as well as to review the causes of shortages and to identify possible solutions. A review of 49 scientific publications, databases, relevant regulations, official websites of drug agencies, professional and patient organizations was performed. The reasons for the shortage are considered, as well as the possible ways to deal with the phenomenon. The shortage of medicinal products is mainly due to production and marketing reasons. In the context of the measures taken by the EU countries to manage the shortage of medicinal products, Bulgaria does not apply the full available arsenal of measures. Professional organizations in the pharmaceutical industry have untapped potential for preventing and limiting shortages of many medicinal products.

4.
Pharmaceutical Technology ; 45(11):14-15, 2021.
Article in English | EMBASE | ID: covidwho-1955749
5.
Dermatitis ; 33(3):e38, 2022.
Article in English | EMBASE | ID: covidwho-1937764

ABSTRACT

Objectives: The COVID-19 pandemic might disproportionately impact patients with atopic dermatitis (AD). We aimed to investigate associations between COVID-19- related impact and AD severity among adults in the Dutch general population. Methods: This cross-sectional study was conducted within the Lifelines Cohort Study. A digital questionnaire was sent out to 135,950 adult participants to collect data on AD in 2020. COVID-19-related variables were collected by regularly sending out questionnaires to 139,735 adult participants betweenMarch 2020 and July 2021. Associations between AD severity and COVID-19-related impact were analyzed using binary logistic regression models. Results: In total, 53,545 subjects, who responded to the AD questionnaire and at least one COVID-19 questionnaire, were included. Multivariate analysis showed similar COVID-19 infection rates in all groups. Subjects with AD, regardless of disease severity, were more concerned about the COVID-19 crisis and more often chose to not contact a doctor when having health problems. Subjects with mild AD had a higher COVID-19 vaccination rate and more frequently covered mouth and nose in public. Moreover, subjects with moderate-to-severe ADestimated a higher chance of becoming infected and expected a more serious disease course. They were more worried about getting sick and a medication shortage, and tended to take other precautions. They also more often expected, reported, and were more afraid of COVID-19 vaccines side effects. Conclusions: The COVID-19 pandemic has a considerable impact on patients with moderate-to-severe AD, highlighting the need of more attention for their overall wellbeing in daily practice during the current pandemic.

7.
Prescrire International ; 31(236):100-102, 2022.
Article in English | EMBASE | ID: covidwho-1912842

ABSTRACT

Three new drugs, all based on messenger RNA or small interfering RNA technology, represented a major therapeutic advance in 2021. But the bigger picture is that most of the new authorisations that advanced patient care were adaptations of existing drugs. And that more than half of this year's new authorisations were not advances, and in fact about one-tenth represented a step backwards compared to existing options.

8.
Manuf. Chem. ; 92:20-21, 2021.
Article in English | EMBASE | ID: covidwho-1879964
9.
Journal of Oncology Pharmacy Practice ; 28(2 SUPPL):26-27, 2022.
Article in English | EMBASE | ID: covidwho-1868956

ABSTRACT

Background: All aspects of healthcare have been challenged during the COVID-19 pandemic. Cancer services adapted to reduce disease transmission while maintaining essential services. International and national guidelines emerged rapidly to support optimal delivery of cancer care during the pandemic. This review aimed to identify the impact of COVID-19 on the delivery of hospital oncology pharmacy services. Method: We searched multiple databases: PubMed, Medline, EMBASE and CINAHL to March 2021. These were supplemented with manual searching. The key search terms used were 'oncology' OR 'cancer' AND 'COVID-19' AND 'pharmacy'. Full text guidelines or recommendations for service adaptations and papers focusing on the impact of the pandemic on hospital oncology pharmacy services published in English were included. s were excluded. We identified the strategies for service adaptations and grouped them into themes. Results: Weidentified four guidelines, two from France and one each from England and Saudi Arabia, that made recommendations for service adaptations due to COVID-19. A further two global surveys assessed the impact of the pandemic on oncology pharmacy practice.1-6 All included papers were published within the first 6 months of the World Health Organisation declaring a global pandemic. The common modifications to services focused on four themes: reducing frequency of patient visits, reducing healthcare practitioner exposure to COVID-19, increasing use of digital technology and maintaining the supply of essential medicines. Several approaches were used to reduce the frequency of patient visits to healthcare settings, and included delaying treatment, switching intravenous treatment to subcutaneous or oral routes, using extended dosing schedules, home administration and discontinuation of some treatment e.g., clinical trials. Pharmacy practitioners applied distancing and safety rules in the workplace in line with government recommendations. Some services introduced remote and/or flexible working patterns. Hospital pharmacy teams used digital technologies to maintain communication within the pharmacy team, e.g., through holding virtual meetings, and with patients through the use of telephone and video consultations. Medicine shortages due to disruption of supply chains were described. Shortages were reported for several medicines e.g., drugs used to treat COVID-19, e.g., remdesivir, systemic anti-cancer therapies and supportive care medicines. To ensure continuity of supplies, additional staff were deployed to facilitate sourcing and procurement of essential medicines. Discussion: We collated the impact of COVID-19 on hospital oncology pharmacy practice across different countries. Despite disparate healthcare services, the approaches for safeguarding patients and practitioners against COVID-19 transmission were common. However, the impact of treatment changes on patient outcomes and service re-configurations is yet to be evaluated. Unsurprisingly, this review identified a small number of studies, likely due to prioritization of service delivery. Despite the challenges to healthcare, the pandemic has created opportunities for hospital oncology pharmacy teams to embrace technology and innovative ways of working.

11.
Epidemiology ; 70(SUPPL 1):S221, 2022.
Article in English | EMBASE | ID: covidwho-1854024

ABSTRACT

Background: The COVID-19 pandemic has exacerbated multiple barriers to healthcare for vulnerable seniors. They may experience more difficulties in meeting their basic needs for food, medicine, and social support. The objective of the project was to connect with seniors to show our care, to assess food security, medication possession, mental health, and to refer those needing services to appropriate providers. Methods: Using a computer-assisted telephone interview (CATI) approach, we called patients served by our primary care providers from April to December 2020. The CATI assessed their mental health by Personal Health Questionnaire-2 (PHQ2) and General Anxiety Disorder-2 (GAD2). The California Health Place Index (HPI) was used to measure social determinants of health associated with community resources. Descriptive analyses examined the proportion of patients needing follow-up services and being referred to services to address food insecurity (if had <3 days of food), medication needs (if had <30 days of medicine), and mental health services (PHQ2>2 or GAD2>2). Multivariable logistic regression analyses examined demographic and health factors associated with the odds for needing and being referred for follow-up services. Results: Of 1921 respondents, their average age was 76 years (SD11). 52% female and 48% non-female (including male, transgender, and other);74% White, 7% Asian, 7% Hispanic, 3% Black, and 8% other. Medication needs existed among 595 (31%) patients, 196 (10%) faced food insecurity, and 292 (15%) needed mental health services. Regression results suggest, Blacks (OR1.86, p<0.05) had higher odds of being at risk of medication shortage than Whites;Blacks (OR2.30, p<0.05) and Hispanics (OR 2.30, p<0.05) had significantly higher odds of food insecurity than Whites. Higher odds for food insecurity referral were found among non-females (OR7.56, p<0.05) and Blacks (OR10.33, p<0.05). Blacks (OR13.34, p<0.05) and those living in 2nd quartile of HPI (OR2.57, p<0.05) had higher odds for mental health referrals. Conclusions: Significant disparities existed across gender, race, and community resource groups in need for food, medications, and mental health services. Findings underscore the imperatives for health and social services organizations to systematize outreach and follow-up services for vulnerable seniors.

12.
Can J Anaesth ; 67(10): 1405-1416, 2020 10.
Article in English | MEDLINE | ID: covidwho-1777848

ABSTRACT

During the coronavirus disease (COVID-19) global pandemic, urgent strategies to alleviate shortages are required. Evaluation of the feasibility, practicality, and value of drug conservation strategies and therapeutic alternatives requires a collaborative approach at the provincial level. The Ontario COVID-19 ICU Drug Task Force was directed to create recommendations suggesting drug conservation strategies and therapeutic alternatives for essential drugs at risk of shortage in the intensive care unit during the COVID-19 pandemic. Recommendations were rapidly developed using a modified Delphi method and evaluated on their ease of implementation, feasibility, and supportive evidence. This article describes the recommendations for drug conservation strategies and therapeutic alternatives for drugs at risk of shortage that are commonly used in the care of critically ill patients. Recommendations are identified as preferred and secondary ones that might be less desirable. Although the impetus for generating this document was the COVID-19 pandemic, recommendations should also be applicable for mitigating drug shortages outside of a pandemic. Proposed provincial strategies for drug conservation and therapeutic alternatives may not all be appropriate for every institution. Local implementation will require consultation from end-users and hospital administrators. Competing equipment shortages and available resources should be considered when evaluating the appropriateness of each strategy.


RéSUMé: Pendant la pandémie mondiale du coronavirus (COVID-19), des stratégies urgentes pour réduire les pénuries sont nécessaires. L'évaluation de la faisabilité, de l'aspect pratique et du mérite des stratégies de préservation des médicaments et des alternatives thérapeutiques nécessite une approche collaborative au niveau provincial. Le Groupe de travail ontarien sur les médicaments à l'USI pendant la COVID-19 a reçu comme mandat d'élaborer des recommandations proposant des stratégies de préservation des médicaments et des alternatives thérapeutiques pour les médicaments essentiels utilisés dans les unités de soins intensifs courant un risque de pénurie pendant la pandémie de COVID-19. Des recommandations ont été rapidement élaborées en utilisant une méthode Delphi modifiée, puis évaluées selon leur facilité de mise en œuvre, leur faisabilité et les données probantes les préconisant. Cet article décrit les recommandations quant aux stratégies de préservation des médicaments et aux alternatives thérapeutiques aux médicaments possiblement à risque de pénurie fréquemment utilisés pour les soins des patients en état critique. Les recommandations sont identifiées comme 'à privilégier' ou 'secondaires' si moins souhaitables. Bien que la pandémie de la COVID-19 ait été l'impulsion incitant la création de ce document, ces recommandations devraient également être applicables pour réduire les pénuries de médicaments en contexte normal. Les stratégies provinciales proposées pour la préservation des médicaments et les alternatives thérapeutiques pourraient ne pas être adaptées pour toutes les institutions. La mise en œuvre locale nécessitera la consultation des utilisateurs et des administrateurs hospitaliers. Il faudrait tenir compte des pénuries de matériel concurrentes et des ressources disponibles lors de l'évaluation de la faisabilité de chaque stratégie.


Subject(s)
Coronavirus Infections/drug therapy , Intensive Care Units , Pharmaceutical Preparations/supply & distribution , Pneumonia, Viral/drug therapy , Advisory Committees , COVID-19 , Critical Illness , Humans , Ontario , Pandemics
13.
Open Forum Infectious Diseases ; 8(SUPPL 1):S167-S168, 2021.
Article in English | EMBASE | ID: covidwho-1746741

ABSTRACT

Background. The COVID-19 pandemic placed a strain on inpatient clinical and hospital programs due to increased patient volume and rapidly evolving data on best COVID-19 management strategies. However, the impact of the pandemic on ASPs has not been well described. Methods. We performed a cross-sectional electronic survey of stewardship pharmacy and physician leaders in 37 hospitals within the Duke Antimicrobial Stewardship Outreach Network (DASON) (community) and Duke/UNC Health systems (academic) in April-May 2021. The survey included 60 questions related to staffing changes, use of COVID-targeted therapies, related restrictions, and medication shortages. Results. Twenty-seven facilities responded (response rate of 73%). Pharmacy personnel was reduced in 17 (63%) facilities by an average of 16%. Impacted pharmacy personnel included the stewardship lead in 15/17 (88.2%) hospitals. Converting to remote work was rare and only reported in academic institutions (n=2, 7.4%). ASP personnel were reassigned to non-stewardship duties in 12 (44%) hospitals with only half returning to routine ASP work as of May 2021. Respondents estimated that 62% of routine ASP activities were diverted during the time of the pandemic. Non-traditional, pandemic-related ASP activities included managing multiple drug shortages, of which ventilator support medications (91%) were most common affecting patient care at 52% of facilities. Steroid and hydroxychloroquine shortages were less frequent (44% and 22%, respectively). Despite staff reductions, pharmacists often served as primary contact for remdesivir approvals either using a criteria-based checklist at dispensing or as part of a dedicated phone approval team (Figure). Most (77%) hospitals used a criteria-based pharmacist review strategy after remdesivir FDA approval. Restriction processes for other COVID-19 therapies such as tocilizumab, hydroxychloroquine, and ivermectin were reported in 64% of hospitals. Proportion of facilities implementing specific remdesivir allocation strategies from the time of the first US Food and Drug Administration (FDA) Emergency Use Authorization (EUA) through FDA approval Conclusion. Pandemic response diverted routine ASP work and has not yet returned to baseline. Despite the reduction in pharmacy personnel due to the pandemic, the ASP pharmacy lead took on a novel and critical stewardship role throughout the pandemic exemplified by their involvement in novel treatment allocation for COVID patients.

14.
European Journal of Oncology Pharmacy ; 5(1):E00036, 2022.
Article in English | EMBASE | ID: covidwho-1735700

ABSTRACT

Introduction: The SARS-CoV-2 pandemic stroke at the beginning of 2020, challenging the health systems worldwide. As hospitals became overwhelmed by the number of cases, and community pharmacies became one of the few non-stop operating services, and the work rhythm and workload of pharmacists changed importantly. Methods: To investigate which and how the changes occurred, especially among oncology pharmacists, the ESOP together with the EAHP developed a survey, translated to 9 languages, and distributed online. The questions were changed over the duration of the survey (August 2020 to March 2021), adapting to the global situation. The answers were analyzed with basic descriptive statistics. Results: Over 1000 health professionals, predominantly pharmacists (over 85%), from 64 countries participated in the monthly survey, providing information relevant to both the hospital and the community pharmacy. More than 50% of hospital pharmacists reported shortage of chemotherapeutics, while the availability of COVID-19 related medications had more fluctuations in the hospital pharmacy. Contrastingly, over 80% of community pharmacists reported medications shortages in April 2020. The survey showed the negative impact of the pandemic on chemotherapeutic preparations, with decreased productions during the first and second waves (February-May 2020, and November 2020 to January 2021). The survey also helped visualize the stress levels and workloads of pharmacists. More than 70% of participants reported in August 2020 to have needed to procure themselves with Personal Protective Equipment. Working hours increased for 43% of the respondents, and more than 60% reported to have felt emotionally stressed. Conclusions: Thus, the presented results give a broad, yet detailed overview of how the pandemic has affected health professionals both in the hospital and the community, how professionals and governments have reacted to the situation, and how the care of oncology patience and the practice of oncology pharmacy has changed and reacted during the first year of the SARS-CoV-2 pandemic.

15.
Critical Care Medicine ; 50(1 SUPPL):265, 2022.
Article in English | EMBASE | ID: covidwho-1691876

ABSTRACT

INTRODUCTION: As a result of the COVID-19 pandemic, this healthcare system enacted a critical care pharmacist emergency prescribing protocol allowing pharmacists to manage therapy in multiple domains. Interventions performed by tele-critical care (TCC) pharmacists across 8 ICUs were categorized into venous thromboembolism prophylaxis, glucose management, electrolyte management, stress ulcer prophylaxis, and general medication management. The purpose of this study was to further characterize TCC pharmacist medication management interventions. METHODS: This multi-center, multi-ICU, retrospective observational review evaluated TCC pharmacist interventions categorized as medication management for adult, ICU-status patients documented from January 4th, 2021, to June 30th, 2021. Descriptive statistics were reported. RESULTS: A total of 2331 medication management interventions were documented for 700 unique patients (mean 3.3 interventions per patient). The average age was 63.4 years and 54.7% of patients were male. An average of 388.5 interventions were performed per month. The most common activities included discontinuing medications (39.2%), adding medications (15.6%), order clarification (11.8 %), dose adjustment (7.7%), changing route/ formulation (5.7%), and laboratory management (5.7%). Sedation medications were the most commonly involved (25.2%) followed by bowel regimens (14.2%), vasopressors (8.2%), and antibiotics (5.8%). Updating sedation score goals (45.5%) and discontinuing orders (45.3%) accounted for the majority of sedation interventions. Other interventions included neuromuscular blockade management, drug shortage management, adding corneal abrasion and ventilator-associated pneumonia prophylaxis, and home medication management. Four of the 8 facilities covered accounted for 83.6% of interventions performed, with one facility accounting for 25.2% of interventions. CONCLUSION: An emergency prescribing protocol allowed TCC pharmacists to proactively optimize pharmacotherapy across multiple categories of medication management interventions. This data will be used to support clinical pharmacist practitioner status in the TCC setting.

16.
Critical Care Medicine ; 50(1 SUPPL):272, 2022.
Article in English | EMBASE | ID: covidwho-1691874

ABSTRACT

INTRODUCTION/HYPOTHESIS: Analgosedation is standard of care in management of patients on mechanical ventilation. Drug shortages before and during the COVID-19 pandemic presented unique challenges, particularly during surges. The purpose of this study was to evaluate the impact of a structured, daily huddle report on analgosedative medication use in mechanically ventilated MICU patients. METHODS: This retrospective, single-center analysis included 3 two-month epochs before (E1), during (E2) and after (E3) initiation of an interprofessional pre-round huddle. Two metrics presented included continuous infusion (CI) analgosedation and drug shortages in effort to identify opportunities for scheduled enteral or parenteral therapies to aid CI weaning. Adult patients admitted to the MICU and on CI analgosedation were included. The primary endpoint compared daily and cumulative scheduled parenteral, enteral, and CI analgosedation administered between epochs. Secondary endpoints included percent-time in goal RASS, Objective Pain Assessment Scale (OPAS), time without delirium, evaluation of drug costs, and effect on ICU outcomes between epochs. RESULTS: A total of 81 patients (E1: 27;E2: 23;E3: 31) were included. Mean age (E1, 65.9±15.4 vs E2, 59.7±10.3 vs E3, 56.3±12.6 years;p=0.021) and proportion COVIDpositive (E1, 0 [0%] vs E2, 6 [26.1%] vs E3, 3 [9.7%];p=0.013) were different between groups. Cumulative CI opioid requirements (E1, 719.5 (214.4-1874.5) vs E2, 641.9 (503.7-1675.9) vs E3, 430.4 (247.2-856.5) mg morphine equivalents;p=0.029) were significantly different. Time on CI fentanyl (E1, 85.9 (46.1-170.5) vs E2, 95.3 (47.2-161.7) vs E3, 41.4 (12.4-67.2) hours;p=0.003) was also decreased. Percent-time in goal OPAS, RASS, without delirium were similar between epochs. Drug cost for CI fentanyl (E1, 3842.1 [1144.9-100009.83] vs E2, 4019.7 [2607.3-8954.4] vs E3, 2208.1 [1321.7-4451.4];p=0.023) was reduced. CONCLUSIONS: This exploratory analysis of a structured approach in scheduling enteral and parenteral agents to wean off CI analgosedation during drug shortages may be effective. Time on, overall CI fentanyl requirements, and costs were significantly reduced while maintaining adequate analgesia and sedation. These results may introduce novel strategies to mitigate drug shortages while maintaining clinical outcomes.

17.
Value in Health ; 25(1):S151, 2022.
Article in English | EMBASE | ID: covidwho-1650298

ABSTRACT

Objectives: Between 2013 and 2019, the number of pharmaceutical supply chain disruptions declared by industry in France had been threefold increased. The covid-19 crisis amplified this rise including in 2020. Substitution procurement agreements (SPA) are formalized to overcome pharmaceutical shortages. These agreements are set up with costs to be paid by the defaulting holder. During the crisis, this additional cost was not charged to the defaulting suppliers. The aim of this study is to analyze retrospectively the development of supply chain disruption between 2016 and 2020 in our hospital structure and to quantify their impacts. Methods: Each SPA is analyzed: type of shortage drugs, substitute medications, amount used, disruption delays and financial impacts. Results: Between 2016 and 2019, 257 SPA are established including 68% of generics and 58% of oral solid forms, for an average period of time of 191 days [1 – 1026]. A 30% raise of SPA is observed between the first 6 months of 2019 and 2020 but the increase provides primarily from injectable medication (48%).The substitute drug unit prices excluding tax are always higher, this additional median annual cost represents 1 140 701€ between 2016 and 2019, and 2 617 626 € in the first half of 2020 (for a annual drug budget of around 1 billion euros). Conclusions: The covid-19 crisis increased the injectable drug shortage due to increased activity in intensive care unit. There is a correlation between low prices and medicine shortages. The additional cost is high for our institution, due to the fact that defaulting suppliers have not been requested to support the medication cost differences. This suggests that some drugs unit prices should increase in the future as it is already the case for immunoglobulins.

18.
Gastroenterology ; 160(6):S-678, 2021.
Article in English | EMBASE | ID: covidwho-1598926

ABSTRACT

INTRODUCTION: The COVID19 pandemic has been primarily mitigated with behavioralstrategies such as social distancing, mask wearing, increased hand washing, and stay athome orders. Negative consequences were increased isolation, lack of access to medicalservices, medication shortages, and scarcity of daily necessities;all of which can lead toadverse mental health consequences. The aim of the current international study was todescribe the effect of the pandemic on the well-being of people with gastrointestinal (GI)diseases. METHODS: In this cross-sectional study, participants were recruited through socialmedia ads, posted by patient organizations, opinion leaders, and the authors from May toOctober 2020, and asked to complete online surveys. Psychological distress was measuredwith the Depression, Anxiety and Stress Scale (DASS), GI symptoms with the GastrointestinalSymptoms Rating Scale (GSRS), and quality of life (QoL) with the World Health OrganizationQuality of Life scale (WHOQOL). All questionnaires were in English and answered byEnglish speakers only. Three separate regressions were run with psychosocial distress, QoL,and GI symptoms as dependent variables and self-reported impacts of the pandemic on GIdisease as the independent variables. All models controlled for gender and self-reported prepandemiclevels of the dependent variables. RESULTS: 831 people participated from 22countries (top five were: 37.7% England, 12.2% Australia, 9.5% Poland, 8.3% New Zealand,7.6% USA). Mean age was 49.3 years;82.3% female. The most common GI conditions wereinflammatory bowel disease (38.4%), celiac disease (33.6%), and irritable bowel syndrome(31.4%). Table 1 shows the self-reported impact of the pandemic on aspects of care fortheir GI condition(s). Table 2 shows significant correlations between all these challengesand ratings of psychosocial distress, GI symptoms, and QoL. Regression analyses indicatedthat increased GI symptoms during the pandemic (R2= 0.65) were associated with increaseddifficulties relayted to managing GI disease (ß=0.133, p=0.009), appointments with primarycare doctor (ß=0.152, p=0.013), and diet adherence (ß=0.143, p=0.016). Decreased QoLduring the pandemic (R2= 0.60) was associated with perceived difficulties in accessing toiletpaper (ß=-2.611, p=0.010). None of the variables were associated with psychological distressafter controlling for pre-pandemic levels. CONCLUSION: COVID19 pandemic is affectingGI patients by restricting access to care, medications, toilet paper, and usual diet. Qualityof life and GI symptoms were associated with these challenges, but no effect was found formental health. These findings indicate that the COVID19 pandemic is having adverse impactson GI patients that should be mitigated with future appropriate planning and preventionstrategies.(Table Presented) (Table Presented)

19.
Blood ; 138:2473, 2021.
Article in English | EMBASE | ID: covidwho-1582249

ABSTRACT

[Formula presented] Introduction: Combination of doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) is the standard of care in frontline therapy for classic Hodgkin lymphoma (cHL). Since 2018, bleomycin shortages have been reported in Brazil, with severe consequences for cHL patients. In the private setting, many institutions chose to use A+AVD, in which bleomycin is replaced by brentuximab-vedotin, or to import bleomycin from vendors not registered at the national drug agency. For public institutions, however, these costly strategies are largely unattainable. Methods: We conducted a single-arm open-label study to evaluate the substitution of bleomycin with etoposide 100 mg/m2 on days 1 and 15 of every 28-day cycle (AEVD) in previously untreated cHL, at Hospital Municipal São José, in Joinville, Brazil. Here we present preliminary data on the safety and efficacy of this combination in a scenario of lack of approved treatment options for this patient population. Results: Twenty-five patients aged 18 or more with cHL diagnosed between June 2018 and November 2020 were included. Fourteen patients (56%) were male, with median age of 27 years (range: 18-66). Most patients were stage II (60%, n=15), presented with B symptoms (56%, n=14) and high lactate dehydrogenase (LDH, n=13, 52%). For stage III-IV (n=5), high-risk IPS was present in 3 patients (score >2;60%). For localized disease (n=20), unfavorable features according to the GHSG were seen in 16 patients (n=80%). All patients received between 3 and 6 chemotherapy cycles, with no recorded adverse event requiring hospitalization, treatment interruption or discontinuation. PET-CT was performed solely outside of our institution. Eight patients had access to interim PET-CT, all with Deauville scores (DS) 1-3. Overall response rate was 96%, with one disease progression after 5 cycles. Seven patients had CT scan-alone end-of-treatment (EOT) assessment, with 5 complete responses (CR) and 2 partial responses (PR), with both PR patients sustaining remissions after 10 and 12 months. EOT assessment with PET-CT (n=18) resulted in DS 1-3 in 72% (n=13), 4 in 22% (n=4) and 5 in one (6%). All 5 patients with DS 4-5 underwent biopsy after EOT assessment, with confirmation of relapsed or refractory (RR) cHL in 4 cases (22 year-old, stage IV high-risk female with progressive disease;65 year-old, stage III low-risk male with relapse 11 months after EOT;26 year-old, stage II high-risk male with relapse 6 months after EOT;25 year-old, stage II high-risk female with relapse 4 months after EOT). Two RR cHL patients (50%) had treatment delays exceeding 30 days due to psychosocial or financial impacts emerging from the COVID-19 pandemic. All RR cHL patients had access to salvage treatments. At a median follow-up of 16 months (range: 8-36), no death was recorded and 12-month progression-free survival probability was 86% (95%CI: 72%-100%). Conclusions: Drug shortages impacting chemotherapy treatments have been a recurring problem worldwide, most noticeably among cytotoxic agents without in-class validated substitutions, as is the case with bleomycin. AEVD, as a novel approach to newly diagnosed cHL, appears to be safe, feasible and highly active in a population composed mostly of high-risk patients. [Formula presented] Disclosures: Boettcher: Novartis: Speakers Bureau.

20.
Journal of Pharmacy and Pharmacognosy Research ; 9(6):878-891, 2021.
Article in English | EMBASE | ID: covidwho-1553147

ABSTRACT

Context: Spain was at the epicenter of the pandemic. Health centers across Spanish territory were not able to respond to non-emergency enquiries, leaving community pharmacies as the first point of patient's contact. Aims: To investigate the impact of COVID-19 on the mental and physical health of community pharmacy teams across Spain. Methods: A cross-sectional observational study was performed with community pharmacy professionals throughout Spain. A questionnaire designed by our collaborator from the United Kingdom was adapted to the Spanish population and launched between October 2020 and February 2021. Results: A total of 98 participants responded to the questionnaire. The survey showed an 80% increase in workload. The pandemic had negatively impacted the well-being of community pharmacy professionals. The survey indicated a national shortage of medicines and personal protective equipment across Spain, particularly during the first peak. To adapt to this pandora's box of COVID-19, 96% of the pharmacies changed their settings to improve patients and staff's safety. Most of these changes were self-financed by the pharmacy owner. The pharmacists kept up to date with information released from the pharmacists' college, General Pharmaceutical Council and the Spanish Society of Community Pharmacists. The Public domain purchased more (79%) immune booster supplements. Conclusions: Community pharmacy professionals have faced tremendous mental, physical and professional pressure in providing adequate personal protective equipment and medication supply to their communities. They have provided more pharmaceutical services during the crisis, although they have not been recognized as essential workers by the healthcare system.

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