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1.
Osteopathic Family Physician ; 14(1):29-34, 2022.
Article in English | EMBASE | ID: covidwho-1822747

ABSTRACT

Context: America is in the midst of a substance use disorder (SUD) epidemic, which has only worsened in the current COVID-19 pandemic. SUD is a public health crisis that affects an ever-increasing proportion of the population and is extraordinarily difficult to treat. Misused substances induce neuroplastic changes that not only predispose individuals to relapse but also persist after completing treatment recommendations. Objective: To establish the phenomenon of neuroplasticity in relation to SUD and summarize non-invasive neuroplastic therapies designed to return the brain to its pre-dependency state. Methods: On October 29, 2019, the search term “neuroplasticity addiction” was entered into PubMed. Articles were selected based on description of neuroplastic changes occurring in SUD and treatment modalities that foster neuroplastic improvements for SUD treatment. Results: 1241 articles were excluded based on irrelevance to the specific topic, language or redundancy. 41 articles met inclusion criteria, with 18 illustrating neuroplastic effects induced by SUD and 23 describing therapeutic interventions. Conclusions: SUD induces neuroplastic changes that predispose an individual to relapse and persist after completing SUD recommendations. Transcranial magnetic stimulation, environmental enrichment and exercise are shown to affect altered brain composition and reduce SUD-related negative behavior, while motor training appears to block neurophysiological changes normally caused by substance use. This illustrates that therapies targeting neuroplastic changes reduce adverse behaviors in those with SUD. The implementation of these modalities with current standard-of-care treatment may increase treatment success. Additional research into these modalities and their potential to enhance current treatments is warranted.

2.
Journal of Acute Care Physical Therapy ; 13(2):61, 2022.
Article in English | EMBASE | ID: covidwho-1821994
4.
Osteopathic Family Physician ; 13(2):8, 2021.
Article in English | EMBASE | ID: covidwho-1820571
5.
Pneumon ; 35(1), 2022.
Article in English | EMBASE | ID: covidwho-1818859

ABSTRACT

INTRODUCTION In Greece, higher morbidity and mortality due to COVID-19 pandemic were recorded during the third pandemic wave. Only a small percentage of the population was fully vaccinated at the beginning of the third pandemic wave. Our effort was multi-level, from the emergency room department to the ward. The aim of this article is to communicate a single secondary center’s experience during the third pandemic wave in Greece. METHODS A retrospective cohort study was conducted at the regional Agios Andreas General Hospital of Patra, Greece, including 360 hospitalized COVID-19 patients. A standard of care protocol was applied in all cases and its outcomes are examined. RESULTS The median age of the patients was 64.2 years (IQR: 18–100) and the median duration of hospitalization was 8 days. The overall case fatality rate was 8.1%. Of the 360 patients, 12 (3.3%) needed to be intubated. Most of the hospitalized patients (n=316;87.8%) were treated with nasal canula or Venturi mask. Twenty-six patients (7.2%) were supported with HFNC and 18 (5%) received any available type of non-invasive mechanical ventilation. CONCLUSIONS An articulate protocol and coordinated collaboration among specialists were the cornerstone of proper, immediate, and individualized treatment. The international recommendations in force at that time proved to be efficient in reducing progress to SRF and intubation. Full vaccination of the medical staff ensured long and dedicated presence in the patients’ rooms.

6.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:72-73, 2021.
Article in English | EMBASE | ID: covidwho-1817115

ABSTRACT

Introduction: Each year over 3,700 patients over the age of sixty were hospitalised with a hip fracture in Ireland. The recognition of the growing burden of fragility fractures on the health service needs to be factored into the future development of hospital services. The IHFD is a clinically led, web based audit of hip fracture casemix, care and outcomes. The National Office of Clinical Audit (NOCA) provides operational support and governance for the IHFD. All 16 eligible hospitals in the Republic of Ireland are now entering data. It is clinically supported by the Irish Gerontological Society (IGS) and the Irish Institute of Trauma and Orthopaedics (IITOS). The IHFD has been recording data since 2012 and has captured over 25,000 cases to date. Methods: Data is collected through the Hospital In-Patient Enquiry (HIPE) portal in collaboration with the Healthcare Pricing Office (HPO). The IHFD audit was based originally on the six standards of care as published by the British Orthopaedic Association and British Geriatric Society in the "Blue Book", the Care of Patients With Fragility Fracture (2007), but in 2017 the IHFD published the Irish Hip Fracture Standards (IHFS), in 2018 these standards formed the basis of a Best Practice Tariff (BPT), that is, a payment of €1000 per case that meets the IHFS. In 2021 a new standard for early mobilization will become part of the BPT. Results: 33% of patients were admitted to an orthopaedic ward or went to theatre within four hours, 75% of patients received surgery within 48 hours, 3% of patients developed a pressure ulcer, 56% of patients received a nutritional risk assessment to identify risk of malnutrition, 82% of patients were seen by a geriatrician, IHFS 5: 91% of patients received a bone health assessment, 85% of patients received a specialist falls assessment, 78% of patients were mobilised by a physiotherapist on the day of or day after surgery, 28% of patients were discharged directly home. Median of length of stay: 11 days. Conclusion: The coverage has improved consistently year on year and 99% was achieved in 2020. There has been an improvement in all IHFS with a minor disimprovement in 2020 due to COVID. The focus of the audit going forward will be support the hospitals to recover from the impact of the COVID pandemic, to increase the number of patient care meeting the BPT, to support the hospitals to adopt a culture of quality improvement using the IHFD data and to develop a longer term outcome dataset.

7.
Blood Purification ; 50(SUPPL 1):28, 2021.
Article in English | EMBASE | ID: covidwho-1816959

ABSTRACT

Background: SARS-CoV-2 is a highly pathogenic and transmissible coronavirus that primarily spreads through respiratory droplets and close contact. A cytokine storm is associated with COVID-19 severity and is also a crucial cause of death from COVID-19. This study aims to evaluate whether the early application of HA330 improves oxygenation, cytokine storm markers, and SOFA score in COVID-19 patients. Methods: Retrospective, interventional, open label study included a total of 52 patients, age > 18 yrs and < 75 yrs, with moderate and severe ARDS from covid-19 pneumonia requiring intubation or HFNC/NIV with high FiO2 requirements (>70%) and having cytokine storm. The patients divided into two groups, group A (HA330 group), n1 = 26 patients who received 3 sessions of HA330 hemoperfusion + regular standard of care, group B, n2 =26 patients who received regular standard of care. Results: The results showed a statistically significant difference (p <0.0001) between the groups, with progressively better oxygenation aiding in rapid decrease in fio2 requirement in the hemoperfusion group (group A). Comparison of mean of cytokine markers between the groups demonstrated significant decrease in the cytokine storm marked by a massive drop of pro-inflammatory markers in the HA330 group, with more significance from the second session of HA330 onwards. The results also showed significant difference in SOFA scores between the 2 groups, with high significance from day 3 onwards in the group A. However;secondary bacteremia, VAP, pulmonary embolism, pneumothorax, pneumomediastinum from the severe ARDS and stiff lung, caused delay in weaning from mechanical ventilator and thus did not decrease the lenth of ICU stay and all cause mortality. Conclusion: Early use of HA330 showed a significant difference from the regular standard of care to combat life threatening and refractory hypoxemia, profound cytokine storm, MODS and preventing from initiating costly and cumbersome therapies like ecmo and saving ICU costs significantly. It can be thus extrapolated to bacterial and viral ards and sepsis with proinflammatory surge and MODS to help protect from rapid clinical decline. .

8.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816884

ABSTRACT

The COVID-19 pandemic brought with it TX changes for many patients (pts) with AMEL, as it did for other pts with cancer. The long-term impacts of mandated area lockdowns, social distancing, medical society guidelines, and patient preference will not be fully understood for some time. The first step to learning from the pandemic is to assess how AMEL care was rendered in 2020. We performed a retrospective analysis of systemic TX for AMEL in KPNC, an integrated community healthcare system with approximately 4 million pts and about 150 de novo diagnoses of AMEL annually. We performed a chart review of pts with AMEL who were treated with standard of care systemic therapy, either immune-checkpoint inhibitors (ICI) or BRAF/MEK inhibitors (BRAF/MEKi), from January 1 to March 15, 2020, as a control group, and between March 15 and May 20, during the first wave of the COVID-19 pandemic in California with follow-up through November 4, 2020. Between January 1 and March 15, 26 pts started palliative ICI of whom 11 started combination PD1 (PD1i) and CTLA4 inhibitors. Among 15 pts who started on single-agent PD1i, 14 pts received short-interval TX (SIT), while 1 started long-interval TX (LIT). All 21 pts who started perioperative PD1i pre-pandemic, started on SIT. Between March 15 and May 20, 21 pts started palliative ICI, of whom only 3 started combination TX. Among pts who started palliative single-agent PD1i 40% started on LIT in this initial phase of the pandemic. 27 pts started perioperative ICI during this time. We found 3 started with neoadjuvant therapy and 78% started on LIT. Among 78 pts who were already on palliative single-agent ICI at the start of the COVID-19 pandemic, 15% remained on SIT and 24% changed to LIT. Sixteen pts (21%) also interrupted palliative ICI between March 15 and April 15 after a median time on TX of 45 weeks and for 63% the cited reason for interruption on chart review was the COVID 19 pandemic. Three of these pts who stopped ICI changed to BRAF/MEKi, the remainder continue in active follow-up as of November 2020. Among 72 pts already receiving perioperative ICI in March 2020, 19% remained on SIT, 35% changed to LIT, and 11% were already on LIT. 39% of pts interrupted perioperative ICI after a median time of 20 weeks on TX and 46% of these cited COVID 19 as the reason for interruption. Three pts have since resumed peri-operative TX, but the others remain in active follow-up off therapy. Between 3/15 and 5/30/2020, we noted a 325% increase in pts started on BRAF/MEKi;69% of pts received therapy for palliative intent. The start of the COVID-19 pandemic saw many different changes in AMEL TX in KPNC, with increased use of single-agent ICI, LIT, and oral therapy, in line with public health guidance, oncology societal guidelines and patient preference. It will be important to assess the long-term outcomes relating to these changes, including the impact of early discontinuation of ICI, to help guide future Melanoma care during and after the pandemic.

9.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816876

ABSTRACT

Introduction: More than 200 treatments have been tested for COVID-19 in over 7000 clinical trials. Most of these treatments are repurposed generic drugs, many of which have been studied extensively for the treatment of cancer. As cancer patients are particularly vulnerable, there is a need to understand how COVID-19 treatments might affect a patient's cancer. As part of the Reboot: COVID-Cancer Project, a living and freely available resource of clinical studies that report outcomes for cancer patients, we have developed a semi-automated pipeline to identify all relevant published clinical studies and registered clinical trials where COVID-19 drugs were tested for the treatment of cancer. Methods: Published clinical studies were assembled using targeted search queries in PubMed, rule-based approaches, and machine learning models. Machine learning models applied to natural language processing tasks were used to predict the drug, cancer type, study type, and therapeutic association. We used domain-specific rules and post-processing steps to further refine results, including determining whether a drug was used alone or in combination. Registered clinical trials were compiled from clinicaltrials.gov using targeted search queries, automated mapping, and rule-based screening. We extracted key information about each trial, such as the drug, cancer type, phase, location, trial status, age, gender, and availability of results. We applied our pipeline to a curated set of 202 drugs being tested for the treatment of COVID-19 in at least two interventional clinical trials worldwide, of which 27 are FDA-approved drugs that are standard of care for cancer, and 115 are FDA-approved drugs primarily used for non-cancer indications. Results: We found 28,138 published clinical studies and 9,118 registered clinical trials where the 202 drugs were tested for cancer. The published clinical studies include 5,286 case studies, 2,559 randomized controlled trials (RCTs), and 20,294 non-RCT clinical trials or observational studies. In 37% of the cases, the drug was used alone and not in combination. Lymphoid cancers were the most commonly tested, comprising 30% of studies. Possible benefit of the drug was found in 64% of publications. Of the 115 FDA-approved non-cancer drugs being tested for COVID-19, there is at least one published clinical study for 84 (73%) drugs. An additional 12 FDA-approved non-cancer drugs have been tested for the treatment of cancer in clinical trials, but have no results reported. Of the registered clinical trials, 39% are currently active, 66% are Phase 2 or later, and lymphoid cancers are again the most common, representing 29% of the trials. Discussion: Given the interconnection between COVID-19 and cancer, it is essential to understand how drugs used for COVID-19 might impact a patient's cancer. We have created a living resource for rapid review of information. The datasets are updated monthly and are freely available via an interactive dashboard.

10.
Respirology ; 27(SUPPL 1):192, 2022.
Article in English | EMBASE | ID: covidwho-1816640

ABSTRACT

Introduction/Aim: The Respiratory Nursing Service (RNS) at The Queen Elizabeth Hospital (TQEH) uses various review modes including telephone, home or outpatient visits to provide support with disease and exacerbation management. Sars-COV-2 has seen telehealth access fast tracked to provided alternatives to face to face review for continuation of personalized management. Aim: To assess the feasibility and cost of using telehealth in a respiratory outreach nursing program as an alternative to home visiting for face to face patient review for disease management and support during exacerbation. Methods: Respiratory Chronic Disease clients of the TQEH RNS were invited to participate. Requiring an electronic device and internet connection, participants were supported in downloading and testing the telehealth platform. An oximeter and thermometer were provided if participants did not already have at home to enable an objective vital sign assessment of exacerbation should they become unwell. Service utilization, patient satisfaction and staff reported practicality of using telehealth were assessed. Results: Nineteen participants were enrolled, four failed to complete the 6-month study (2-withdrew and 2-died). A total of 51 telehealth episodes occurred with 21 patientreported exacerbations, 76% of these were managed at home. Projected savings on bed days, admission costs and service utilization timings for varying review modes were reported. Eighty percent of patients reported that telehealth provided the same standard of care as face to face. Sixty-seven percent said technology was easy to use, 80% would use telehealth again. Staff reported issues included variable sound and video quality, timeliness of patient to call in and technical issues resulting in platform failure. Conclusion: Telehealth presents opportunities for efficiencies in time and potential cost savings from hospital avoidance strategies for managing exacerbations in the community. Reliability of the platform and the confidence of patients using technology are challenges.

11.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-333897

ABSTRACT

Background ACEi/ARB medications have been hypothesized to have potential benefit in COVID-19. Despite concern for increased ACE-2 expression in some animal models, preclinical and observational-retrospective and uncontrolled trials suggested possible benefit. Two RCTs of the ARB losartan from University of Minnesota showed no benefit yet safety signals for losartan in outpatient and hospitalized COVID-19 patients. COVID MED, started early in the pandemic, also assessed losartan in a RCT in hospitalized patients with COVID-19. Methods COVID MED was a double-blinded, placebo-controlled, multicenter, platform randomized clinical trial (RCT). Hospitalized COVID-19 patients were randomized to receive standard care and hydroxychloroquine, lopinavir/ritonavir, losartan, or placebo. Hydroxychloroquine and lopinavir/ritonavir arms were discontinued after RCTs showed no benefit. We report data from the losartan arm compared to combined (lopinavir-ritonavir and placebo) and prespecified placebo-only controls. The primary endpoint, the mean COVID-19 Ordinal Severity Score (COSS) slope of change, was compared with the Student's t-test. Slow enrollment prompted early termination. Results Of 448 screened patients, 15 (3.5%) were randomized/enrolled, 9 to receive losartan and 6 to receive control (lopinavir/ritonavir [N=2], placebo [N=4]);1 patient who withdrew prior to study drug was excluded yielding 14 patients for analysis (losartan [N=9] vs. control [N=5] [lopinavir/ritonavir [N=2], placebo [N=3]]). Most baseline parameters were balanced. Treatment with losartan was not associated with a difference in mean COSS slope of change in comparison with combined control (p=0.4) or placebo-only control (p=0.05) (trend favoring placebo). 60-day mortality and overall AE and SAE rates were numerically but not significantly higher with losartan. Conclusions In this small blinded RCT in hospitalized COVID-19 patients, losartan did not improve outcome vs. control comparisons and was associated with adverse safety signals.

12.
Cochrane Database of Systematic Reviews ; 2022(4), 2022.
Article in English | EMBASE | ID: covidwho-1800404

ABSTRACT

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the efficacy and safety of nirmatrelvir/ritonavir (Paxlovid®) plus standard of care compared to standard of care with or without placebo, or any other proven intervention for treating COVID-19 and for preventing SARS-CoV-2 infection.

13.
Antibiotics ; 11(4), 2022.
Article in English | EMBASE | ID: covidwho-1798908

ABSTRACT

Background: Rapid and accurate identification of healthcare associated pathogens is crucial for early diagnosis and treatment of infections. This study aimed to assess the performance of a point-of-care multiplex polymerase chain reaction (PCR) in diagnosis of pathogens and their antibiotic resistance genes in bloodstream infections, pneumonia and meningitis/encephalitis in a pediatric intensive care unit (PICU). Methods: A retrospective cross-sectional study was conducted on pediatric patients diagnosed with healthcare associated infections at Alexandria University PICU, Egypt. A total of 111 samples from 98 patients were subjected simultaneously to standard-of-care microbiology testing (SOCMT) and molecular testing by BioFire multiplex PCR. Results: In comparison to SOCMT, the BioFire FilmArray® had a better diagnostic yield with broncho-alveolar lavage (BAL) (45 vs. 21) and cerebrospinal fluid (CSF) samples (five vs. none) (p ≤ 0.0001). Klebsiella pneumoniae was the most common pathogen in BAL (n = 19 by BioFire, n = 9 by SOCMT) and blood (n = 7, by SOCMT and BioFire) samples, while Streptococcus pneumoniae was the most common in CSF samples. BioFire showed 95.8% overall percent agreement, 100% positive percent agreement and 95.6% negative percent agreement with SOCMT. All phenotypically confirmed resistant isolates had resistance genes by the BioFire FilmArray® (100%). The turnaround time (TAT) of positive results by the FilmArray panels was 1–1.5 h in comparison to 48–72 h by SOCMT (p ≤ 0.001). Conclusions: The results of the current study confirm the utility of the BioFire FilmArray® in making early decisions regarding patients’ diagnosis and management of infection in the PICU, in terms of rapid TAT and appropriate antimicrobial use.

14.
Journal of Heart and Lung Transplantation ; 41(4):S424-S425, 2022.
Article in English | EMBASE | ID: covidwho-1796808

ABSTRACT

Purpose: Telemedicine has been successfully employed in a wide range of specialties. We hereby present the results of a pivotal study we ran in our centre just before the COVID19 pandemic. Methods: This was a prospective study including all adult cystic fibrosis patients who underwent lung transplant (LuTx) from September 2017 to August 2019. Patients were randomized into two groups;patients assigned to the first arm (intervention) received a home medical assistant (HMA) system device, to which a pulse oximeter and a spirometer with reusable turbine were integrated;they were asked to perform a spirometry and register their SpO2 at rest and on effort on a twice-weekly basis. All the data were digitally transmitted to our centre, where physiotherapists and physicians were able to analyse them real-time. Both the groups received traditional hospital-based follow-up. Results: 32 patients were enrolled, 16 in each group. No statistically significant difference was found between the two groups (see Table 1).With reference to the telemonitoring group:- Adherence to telemonitoring significantly decreased during the 12months period of follow up (see figure 1).- Hospital reported data were consistent with the last being registered with the HMA device.- Of note, two patients were requested to anticipate their hospital routine visit because of a FEV1 decrease being reported on their HMA device, in order to rule out possible acute lung allograft dysfunction.- 13 out of 16 patients reported a high degree of satisfaction with the telemonitoring experience. Conclusion: The COVID19 pandemic highlighted the necessity to investigate alternative practices to treat chronically ill individuals. In our study, telemonitoring proved to be a valuable tool to improve quality health care to LuTx recipients, especially for those who live far from the transplant centre. We are now implementing this approach scheduling online video consultations. Further research should be focused on standardizing quality of telemedicine services.

15.
Oncology Issues ; 37(2):10-11, 2022.
Article in English | EMBASE | ID: covidwho-1795512
16.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793879

ABSTRACT

Introduction: A subgroup of critically ill COVID-19 patients develops pulmonary fibroproliferation (PF), which is associated with worse outcomes. We explored the kinetics of fibrosis markers and ventilatory parameters prior to and following use of steroids to treat suspected PF. Furthermore, we investigated the effects of early dexamethasone (DEXA) treatment, the current standard-of-care for COVID-19, on the incidence and time to development of PF and clinical outcomes. Methods: We included 191 critically ill COVID-19 patients spanning two treatment cohorts: no DEXA treatment (pre-DEXA cohort, n = 67) and dexamethasone treatment as standard-of-care (DEXA cohort, n = 124). Kinetics of circulating fibrosis markers and ventilatory parameters were analyzed in suspected PF patients prior to and following initiation of steroid therapy as well as in patients in whom PF was not suspected. Furthermore, associations between PF and clinical outcomes were explored. Results: Patients with suspected PF exhibited higher circulating fibrosis markers, lower lung compliance and PaO2/FiO2 ratios, and increased dead space ventilation. Incidence of suspected PF was 28% in the pre-DEXA cohort and 25% in the DEXA cohort (p = 0.61), and time to development of suspected PF was also similar between cohorts (16 [12-21] vs. 19 [14-23] days from ICU admission, p = 0.11). Time on ventilator, LOS in ICU and mortality were significantly higher in suspected PF patients than in no suspected PF patients, with no differences between the cohorts (Fig. 1). Conclusions: Increased circulating fibrosis markers reflect development of PF in critically ill COVID-19 patients, which is associated with prolonged ICU length of stay and high mortality rates. Introduction of dexamethasone as standard-of-care is not associated with altered incidence of PF or improved clinical outcomes in patients with PF. (Figure Presented).

17.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779479

ABSTRACT

Background: During the COVID pandemic, we designed and implemented a program, called BQual-D, to maintain high quality care for patients with HR+, HER2 negative MBC who were taking oral anti-cancer therapy and needed to shelter at home. This program augmented available clinical resources with (1) trained nurse coaches to manage side effects, improve adherence, monitor for cancer progression and screen for psychological distress via telehealth, and (2) a care coordinator to arrange blood testing at local labs to facilitate timely medication dose adjustments. BQual-D served patients from August, 2020 through April of 2021. Here, we describe survey results assessing provider satisfaction with BQual-D. Methods: Surveys assessing provider satisfaction were distributed in December, 2020 (Survey#1) and in April, 2021 (Survey#2). Provider demographics were collected with Survey#1. Eight questions assessed satisfaction with different aspects of the BQual-D program, including content of the nurse coach notes, communication with the program, timeliness of communication, frequency of notes, ease of reading the notes, ease of Sreferring patients, and turnaround time for labs, which were rated on a Likert scale of 1 (strongly dissatisfied) to 10 (strongly satisfied), with an additional response choice of 0 (unable to assess). Providers were also asked if BQual-D led to changes in patient management (yes/no), the degree to which BQual-D supported the medical management of the patient (from 1=not at all to 7=significantly), the influence of BQual-D on patient wellbeing (positive effects, no change, negative effects), and the overall quality of care delivered by the program (from 1=excellent to 4=poor). Finally, we asked providers if they would continue to recommend their patients to BQual-D (yes, in the same way as the program has been deployed;yes but with improvements;or no). Results are described by frequencies and means. Results: Nineteen providers responded to Survey#1. Providers were physicians (31.6%), advanced practice providers (31.6%), nurses (31.6%) and a clinical pharmacist (5.3%). Respondents were 89.5% female, 94.7% White, and had a mean age of 44 years and mean 11 years in practice. Providers rated the quality of care provided by the BQual-D program as excellent (44%) or good (57%), all providers surveyed indicated that they would continue to recommend the program to patients, and 95% of providers indicated that the program had a positive effect on patients' well-being. Half of the respondents indicated that BQual-D resulted in changes in or addition to patient management and 90% indicated that BQual-D significantly supported medical management. Providers were strongly satisfied (scores of 8-10 on the Likert scale) with overall communication with the BQual-D team (74%) and timeliness of communications (79%). Providers were also strongly satisfied with the content (68.4%), frequency (74%), and ease of reading (68%) program notes. Seven providers completed Survey#2, in which providers rated the overall quality of the program as excellent (57%) or good (43%);86% indicated that they would continue to recommend the program to patients, and 86% indicated that the program had a positive effect on patients' well-being. Conclusions: During the COVID pandemic, when sheltering at home was encouraged, provider satisfaction with BQual-D, which provided additional health resources (nurse coaches, care coordinator) to support patients on oral therapy for HR+ MBC, was high. Resources needed to implement BQual-D should be explored as a way of providing additional support for patients and providers in order to minimize the requirement for in-person visits.

18.
Front Surg ; 9: 853441, 2022.
Article in English | MEDLINE | ID: covidwho-1776104

ABSTRACT

Aim: Limited data are available on the impact of the coronavirus disease 2019 (COVID-19) pandemic on patient-reported outcome measures (PROMs) in patients who underwent spine surgery. In this study, we aimed to investigate the associations between the COVID-19 outbreak in Taiwan (May 2021) and PROMs in patients who underwent spine surgery. Method: We retrospectively identified patients who underwent spine surgery during identical defined 6-week time-intervals (May 16 to June 30) in 2019, 2020, and 2021. PROMs, including visual analog scale (VAS) score for pain, Oswestry disability index (ODI), and EuroQol-5D (EQ-5D), were investigated before surgical intervention and at a 1-month follow-up. Relevant clinical information was collected from the electronic medical records of patients. Linear regression analysis was used to examine the association between the pandemic in 2021 (vs. 2019/2020) and the PROMs after adjusting for age, sex, and relevant clinical variables. Results: The number of patients who underwent spine surgery at our hospital during the identical defined 6-week time-intervals in 2019, 2020, and 2021 was 77, 70, and 48, respectively. The surgical intervention significantly improved VAS, ODI, and EQ-5D of the patients (1 month after surgery vs. before surgery, all p < 0.001) in all three study periods. However, there was a significant between-group difference in change from baseline in VAS (p = 0.002) and EQ-5D (p = 0.010). The decrease in VAS and increase in EQ-5D after surgery in 2021 were not as much as those in 2019 and 2020. The associations between the pandemic in 2021 (vs. 2019/2020) and changes in VAS (ß coefficient 1.239; 95% confidence interval [CI] 0.355 to 2.124; p = 0.006) and EQ-5D (ß coefficient, -0.095; 95% CI, -0.155 to -0.035; p = 0.002) after spine surgery were independent of relevant clinical factors. Conclusion: There was less improvement in short-term PROMs (VAS and EQ-5D) after spine surgery during the COVID-19 pandemic. Assessment of PROMs in surgical patients during a pandemic may be clinically relevant, and psychological support in this condition might help improve patients' outcomes.

19.
Acta Med Port ; 2022 Mar 31.
Article in Portuguese | MEDLINE | ID: covidwho-1771994

ABSTRACT

INTRODUCTION: The COVID-19 pandemic led to the cancellation of healthcare appointments and to lower demand, which generated unmet healthcare needs. The aim of this study was to evaluate their prevalence and distribution in Portugal. MATERIAL AND METHODS: Data came from the "Survey of Health, Ageing and Retirement in Europe". Between June and August 2020, 1118 Portuguese individuals aged 50 or over were inquired about unmet healthcare needs due to: i) fear of getting infected; ii) cancellation by the doctor/healthcare services; iii) unsuccessful consultation request. The analysis of the prevalence of unmet needs was complemented by the calculation of the concentration indices as a function of the variables: income, education and health status. RESULTS: About 60% of respondents reported at least one unmet need, which was almost twice the European average. Motive ii) cancellation by the doctor/healthcare services was the most frequent. The prevalence of unmet needs differed depending on income level and health status. The indices evidence the concentration of unmet needs in individuals with the worst health status, although for the reason fear of infection the concentration occurred in those with higher levels of income and education. CONCLUSION: Our study showed a high prevalence of unmet needs and their concentration in individuals with worse health status. Given the association between unmet needs and the subsequent deterioration of health, these results should raise concerns about the near future.


Introdução: A pandemia por COVID-19 conduziu ao cancelamento de cuidados de saúde e à diminuição da sua procura resultando em necessidades de cuidados de saúde não satisfeitas. O objetivo deste trabalho foi avaliar a sua prevalência e distribuição, em Portugal. Material e Métodos: Os dados provêm do Survey of Health, Ageing and Retirement in Europe. Foram inquiridos 1118 portugueses com 50 ou mais anos, entre junho e agosto de 2020, sobre necessidades de cuidados de saúde não satisfeitas por: i) receio de ser infetado; ii) cancelamento por parte dos serviços de saúde; iii) solicitação de consulta não atendida. A análise de prevalência de necessidades não satisfeitas foi complementada pelo cálculo de índices de concentração em função das variáveis: rendimento, educação e estado de saúde. Resultados: Cerca de 60% dos inquiridos reportaram pelo menos uma necessidade não satisfeita, quase o dobro da média europeia, sendo o motivo ii) cancelamento por parte dos serviços de saúde o mais frequente. A prevalência de necessidades não satisfeitas diferiu consoante o nível de rendimento e o estado de saúde. Os índices comprovaram a sua concentração nos indivíduos com pior estado de saúde, embora para o motivo Receio a concentração ocorresse nos que têm maior rendimento e nível de educação. Conclusão: O nosso estudo revelou uma elevada prevalência de necessidades de cuidados de saúde não satisfeitas e a sua concentração em indivíduos com pior estado de saúde. Dada a associação entre necessidades não satisfeitas e a subsequente deterioração da saúde, estes resultados constituem um alerta para o futuro próximo.

20.
Blood ; 138(SUPPL 1):4020, 2021.
Article in English | EMBASE | ID: covidwho-1770432

ABSTRACT

Background Yttrium-90 ibritumomab tiuxetan [(90)Y-IT;Zevalin] is a radio-immunoconjugate (RIC) which targets CD20. This study evaluates the utilization and cost-effectiveness of (90)Y-IT in the first line treatment for patients with previously untreated low-grade FL (UFL) and marginal zone lymphoma (UMZL) treated at our institution with (90)Y-IT. Methods We utilized the Advanced Text Explorer (ATE) and the Lymphoma SPORE databases to identify two groups of patients with UFL, WHO grade 1-2, and UMZL who received treatment with either (90)Y-IT or bendamustine plus rituximab (BR) at Mayo Clinic Cancer Center between January 2003 and December 2019. We excluded all patients who had >25% bone marrow involvement with lymphoma for the BR group as this was a requirement for (90)Y-IT treatment. Inverse propensity weighting was utilized to balance the groups for baseline patients and disease characteristics. We use progression-free survival (PFS) as a denominator for the cost effectiveness/utilization evaluation. We identified meaningful and retrospectively measurable outcomes to compare between the groups. we extracted the following data;number of clinic visits in the first year after therapy, emergency room visits, number of hospital admissions, number of hospitalization days, numbers of days on the floor and ICU, number of infections, number of neutropenic fever hospitalizations, number of C-difficile events, number of blood products transfusions, overall use of growth factors due to therapy induced neutropenia, average number of times a growth factor was used, and the number of therapeutic use days. We defined days of therapeutic use as the number of days a treatment was administered on. We also calculated the average cost of the induction treatment when utilizing either (90)Y-IT or BR. The therapeutic cost included only the cost of the medications/therapies and their administration. Results Our cohort consists of a total of 143 patients - 64% (92/143) received BR and 36% (51/143) received (90)Y-IT (see Table-1 for clinical characteristics).The median follow-up from the time of therapeutic administration for the (90)Y-IT group was 5.3 years (95% CI;4.2, 6.2) with one death and 4.7 years (95% CI;3.9, 4.9) for the BR group with 6 deaths. The ORR was 100% in (90)Y-IT group with 94% achieving complete response (CR) while ORR in the BR group was 98% with 95% achieving CR. Rituximab maintenance was utilized in 33% of BR patients compared to only 6% in patients who received (90)Y-IT, p=0.002. After utilizing inverse propensity weighting (Figure-1), 5 years PFS was 76% for the (90)Y-IT group and 75% for the BR group, p=0.63 (Figure-2). We evaluated the average treatment effect of (90)Y-IT compared to BR on utilization outcomes, Table-2. (90)Y-IT required an average of 4.5 clinic visits less within the first year after treatment compared to BR group, p<0.001. (90)Y-IT patients had an average of 10 days less of therapeutic use days compared to the BR group, p<0.001. Patienta had similar admission rates to the hospital in both groups. However, when patients were admitted to the hospital in the first year after treatment, those who received (90)Y-IT spent an average of 1.5 days less in the hospital compared to the BR group, p=0.046. The overall use of growth factors was 40% less in the (90)Y-IT group as compared to the BR group, p<0.001. The therapeutic cost of induction of (90)Y-IT was 54% less than that of 6 cycles of BR. Transformation to a high grade of lymphoma was seen in 4 patients in the BR group and 2 patients in the (90)Y-IT group. There was only one case of myelodysplastic syndrome in the BR group and none in the (90)Y-IT group. Conclusion Radio-immunoconjugate therapy with (90)Y-IT is a very convenient and cost-effective treatment for low-grade UFL and UMZL. This is especially important amidst the COVID-19 pandemic as it requires less contact with the health system with decreased number of therapeutic days, clinic visits, use of growth factors and number of hospitalization days. The cost of the therapeutic agents and heir administration was also significantly lower for the (90)Y-IT which could help reducing the burden on the health system. (Figure Presented).

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