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Background: A survivorship care plan (SCP) is a detailed cancer care summary and future care plan that is generally given to a patient upon completion of adjuvant treatment for a cancer diagnosis. The initial goals of SCPs were to educate patients and other health care professionals about the treatments received, make them aware about potential long-term effects of therapy, and emphasize recommendations for future cancer screening and care (1). Due to numerous barriers-scheduling, staffing, and lack of awareness-SCPs are not delivered to all eligible patients. To address this unmet need our multidisciplinary breast clinic (MDBC) established an Advanced Practice Professional (APP) Survivorship Clinic. With the acute impact of the COVID-19 pandemic, survivorship referrals decreased. We, therefore, developed and implemented system solutions to address SCP access. Method(s): System solutions include partnering with the Cancer Registry to provide the list of patients potentially in need of survivorship visits, partnering with pharmacy to confirm patient eligibility, creating specifically designated telemedicine survivorship visits in our electronic scheduling system, prospectively scheduling persons identified, engagement of APPs across the MDBC, and establishing a single coordinating point. Numbers of SCPs delivered are tracked monthly and patient satisfaction is assessed through data collected Press Ganey surveys. Result(s): This presentation will share our process interventions and outcomes as they mature. Our early data demonstrate the efficacy of the workflow and appear promising. Conclusion(s): We anticipate that system-based solutions will provide more patients with SCPs and demonstrate patient satisfaction. Blaes AH, Adamson PC, Foxhall L, Bhatia S. Survivorship Care Plans and the Commission on Cancer Standards: The Increasing Need for Better Strategies to Improve the Outcome for Survivors of Cancer.
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Context: Prescription indication studies allow identifying the problems that arise during the use of the drug. Aims: To evaluate the treatments used in patients diagnosed with SARS-CoV-2 infection hospitalized in critical care service, through a prescription indication study.Methods: A longitudinal observational study of medication use of the indication-prescription type with elements of the therapeutic scheme and practical consequences was carried out. The sample was characterized from the sociodemographic, clinical, and pharmacotherapeutic points of view. The prescription was evaluated through the indicators: indication, therapeutic scheme, treatment individualization, and drug combinations. The detected adverse reactions were classified according to their causality by the Naranjo Algorithm, their severity, their clinical significance, and according to their mechanism by Rawlins and Thompson.Results: In the sample (n = 77), the male gender predominated (79%) between 27-59 years old (64%), alcohol consumer (62%), hypertensive (33%) with long hospital stay (51%). A total of 417 medications were analyzed, being antibiotics (50.6%) the most prescribed. 73.4% of the therapeutic schemes were correct;however, 26.6% had problems with the therapeutic schemes due to incorrect doses, intervals, duration of treatment, and risky interactions. According to Rawlins and Thompson, two probable adverse reactions were detected, mild, non-serious, and type A and B.Conclusions: The results obtained will allow the pharmaceutical professional to create risk matrices that guarantee a timely intervention in the health team to contribute to the rational and safe use of medicines in patients infected with SARS-CoV-2.
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Guillain-Barré syndrome and its variants are among the neurological complications induced by SARS-CoV-2. A 49-year-old woman with COVID-19. After 14 days of presenting respiratory symptoms, she started with paresthesias, facial and limb weakness, dysphagia, ataxia, and respiratory failure. An unusual picture of overlapping Guillain-Barré and Miller Fisher syndromes was diagnosed. Nerve conduction study showed myelin damage. IgEV was used, recovery started one week after starting treatment. Guillain-Barré syndrome and its variants are a complication of COVID-19 whose diagnosis can become more complex in cases of unusual presentation where different clinical subtypes overlap. © 2022 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
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Context: Prescription indication studies allow identifying the problems that arise during the use of the drug. Aim(s): To evaluate the treatments used in patients diagnosed with SARS-CoV-2 infection hospitalized in critical care service, through a prescription indication study. Method(s): A longitudinal observational study of medication use of the indication-prescription type with elements of the therapeutic scheme and practical consequences was carried out. The sample was characterized from the sociodemographic, clinical, and pharmacotherapeutic points of view. The prescription was evaluated through the indicators: indication, therapeutic scheme, treatment individualization, and drug combinations. The detected adverse reactions were classified according to their causality by the Naranjo Algorithm, their severity, their clinical significance, and according to their mechanism by Rawlins and Thompson. Result(s): In the sample (n = 77), the male gender predominated (79%) between 27-59 years old (64%), alcohol consumer (62%), hypertensive (33%) with long hospital stay (51%). A total of 417 medications were analyzed, being antibiotics (50.6%) the most prescribed. 73.4% of the therapeutic schemes were correct;however, 26.6% had problems with the therapeutic schemes due to incorrect doses, intervals, duration of treatment, and risky interactions. According to Rawlins and Thompson, two probable adverse reactions were detected, mild, non-serious, and type A and B. Conclusion(s): The results obtained will allow the pharmaceutical professional to create risk matrices that guarantee a timely intervention in the health team to contribute to the rational and safe use of medicines in patients infected with SARS-CoV-2. Copyright 2022 Journal of Pharmacy & Pharmacognosy Research
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Background: Estrogen receptor positive breast cancer (BC) is the most common type of breast cancer in postmenopausal women and aromatase inhibitors (AI) are the endocrine therapy of choice recommended for these patients. Up to 50% of those treated with an AI develop Arthralgia often resulting in poor adherence and decreased quality of life. Methods: This is a single arm longitudinal pilot study aiming to evaluate the safety, feasibility, acceptability and potential efficacy of TaiChi4Joint, a remotelydelivered 12-week Tai Chi intervention designed for the relief of AI-induced joint pain. Women diagnosed with stage 0-III BC who have been receiving an AI for at least 2 months and reporting arthralgia with a ≥ 4 score on a 0-10 scale for joint pain were eligible for study enrollment. Participants were encouraged to join Tai Chi classes delivered over ZOOM three times a week for 12 weeks. Program engagement strategies include the use of a private Facebook study group and box.com cloud for archiving live class recordings. The program utilizes Text messaging and emails with periodic positive quotes and evidence based information on Tai Chi for facilitating community bonding and class attendance. Participants were invited to complete the following assessments online at baseline, 1, 2 and 3 months intervals from study enrollment: Brief Pain Inventory (BPI), Western Ontario and McMaster University Osteoarthritis index (WOMAC), The Australian Canadian Osteoarthritis Hand Index (AUSCAN), Fatigue Symptom Inventory (FSI), Hot Flash Related Daily Interference Scale (HFRDIS), Pittsburg Sleep Quality Index (PSQI) and Center for Epidemiological Studies Depression (CES-D). Results: 55 eligible patients were invited to participate and 39 consented and completed the baseline assessments. 61% (median) Participants attended the classes, with no Tai Chi related adverse events reported. 22 of the 39 participants completed the 3-month follow up assessments with a 56% retention rate. Study participants reported improvement from baseline compared to 3 month as follows: For BPI (P = .000), AUSCAN pain subscale (P =.000), AUSCAN function subscale for 35 patients (P = .000), WOMAC (P = .000), CES-D (P = 0.001), FSI (P = 0.00) and PSQI (P = .000). However HFRDIS improved in 11 patients (P = 0.00) for the other 22 patients (P = 0.154). Conclusions: The COVID-19 global pandemic has resulted in the need to rethink how mind-body therapies can be delivered. This study demonstrated the feasibility, acceptability, and potential efficacy of a Telehealth based Tai Chi intervention for reducing AI-induced arthralgia. The intervention decreased patient reported pain, stiffness and improved sleep quality and depressive symptoms. With our promising findings, larger telehealth based trials of Tai Chi for AI-associated arthralgia are needed.
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Muchas de las personas que han sufrido COVID-19 persisten con síntomas semanas y meses después de la recuperación del proceso agudo, presentando un conjunto de manifestaciones muy heterogéneo del que se desconoce su fisiopatología. No existe una nomenclatura uniforme ni tampoco unos criterios diagnósticos consensuados. Uno de los principales factores de riesgo para su desarrollo es haber requerido ingreso en una Unidad de Cuidados Intensivos. Las manifestaciones más frecuentes son la fatiga y la clínica respiratoria, entre las que destaca la disnea. El abordaje diagnóstico está enfocado a descartar otras posibles causas responsables de dichas manifestaciones, por lo que realizaremos una valoración integral del paciente, seguida de un enfoque posteriormente dirigido a los síntomas específicos.
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Introduction: Management of workers' health in relation to psychological safety has emerged as an essential objective in coping with the COVID-19 pandemic. Training provided to senior hospital management is a preventive action that should be included in the management of the current pandemic. Objective: To develop a psychological safety training program for senior hospital management as part of the primary prevention actions provided in the Psychological Safety Management Protocol for Health Personnel Working Directly with COVID-19– Affected Patients. Methods: A development study was carried out, which included a narrative bibliographic review and the use of theoretical research methods. Results: A training program was created, which includes three topics for working at the organizational level: psychological safety in emergencies and disasters, leadership and communication, and organizational management. Conclusions: The training program developed includes contents that contribute to the development of psychological safety of the healthcare personnel and to the integrated management of processes. It was useful to prepare senior hospital management to cope with COVID-19. © 2021, Editorial Ciencias Medicas. All rights reserved.
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Introduction: Cancer clinical trial conduction during the COVID-19 pandemic required a rapid move to virtual engagement to support participant and research team safety. We were faced with the challenge of translating our approach from in-person to virtual engagement for recruitment, enrollment, and delivery of the study intervention. We present our strategies to conduct cancer clinical trials focused on cancer risk reduction during the COVID-19 pandemic. Subject Recruitment: Our multimodal approach utilized online platforms and established approaches like posters, flyers, and collaborating with community health workers to recruit participants. Our virtual engagement strategies include direct outreach to potential participants via email, the electronic medical record (EMR), and social media. Contact via email and the EMR was guided by study-defined eligibility criteria. Social media outreach was through institutional Twitter, Facebook, and video channel accounts. Twitter posts and chats were employed. Enrollment: e-consenting and remote consenting processes were instituted via REDCAP. Delivery of the Educational Risk Reduction Intervention: We also conducted the intervention using the Zoom platform and through a recorded video of the educational risk reduction intervention, which is shared with the participant via REDCAP. Challenges: As documented by others, the greatest challenge to virtual engagement is lack of internet access and lack of digital literacy. These factors have a greater impact on underserved populations, including the elderly, those with low socioeconomic status, those located farther from the cancer center, and racially/ethnically diverse populations. Conclusion: By translating study outreach and processes to virtual engagement, we were able to facilitate clinical trial access across diverse community subgroups and support subject participation in clinical trials during the COVID-19 pandemic.
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Background: The COVID-19 pandemic has come to change our way of life, completely modifying even the form of coexistence, which can lead anyone to suffer from anxiety, stress or depression, either out of fear of getting infected, losing a loved one or simply because of the limitation to go outside. Objective: To determine the presence of symptoms of depression, anxiety and stress in the face of the COVID-19 pandemic in the beneficiaries of a family medicine unit of first level of care and to establish their relationship with age. Material and methods: Observational, relational, crosssectional study, in 185 beneficiaries of a family medicine unit from June 15th to August 15th, 2020. Sociodemographic data were requested, and the DASS-21 scale was applied to search for symptoms of depression, anxiety and stress. Univariate analysis was performed with measures of central tendency and dispersion. For the bivariate analysis, Pearson's correlation coefficient was used to identify the relationship between age and stress. Results: Symptoms of depression were found in 11.9%, anxiety in 22.7% and stress in 14.5% of the participants. A weak negative relationship (r = -0.199, p = 0.007) was found between age and stress. Conclusion: There are symptoms of depression, anxiety and stress, with a weak, statistically significant negative relationship between age and stress.
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Introduction: The Society for Integrative Oncology (SIO) Online Task Force was created in response to the challenges facing continuity of integrative oncology care resulting from the COVID-19 pandemic. The Task Force set out to guide integrative oncology practitioners in providing effective and safe online consultations and treatments for quality-of-life-concerns and symptom management. Online treatments include manual, acupuncture, movement, mind-body, herbal, and expressive art therapies. Methods: The SIO Online Practice Recommendations employed a four-phase consensus process: (1) literature review and discussion among an international panel of SIO members, identifying key elements essential in an integrative oncology visit;(2) development, testing, and refinement of a questionnaire defining challenges and strategies;(3) refinement input from integrative oncology experts from 19 countries;and (4) SIO Executive Committee review identifying the most high-priority challenges and strategies. Results: The SIO Online Practice Recommendations address ten challenges, providing practical suggestions for online treatment/consultation. These include overcoming unfamiliarity, addressing resistance among patients and healthcare practitioners to online consultation/treatment, exploring ethical and medical-legal aspects, solving technological issues, preparing the online treatment setting, starting the online treatment session, maintaining effective communication, promoting specific treatment effects, involving the caregiver, concluding the session, and ensuring continuity of care. Conclusions: The SIO Online Practice Recommendations are relevant for ensuring continuity of care beyond the present pandemic. They can be implemented for patients with limited accessibility to integrative oncology treatments due to geographic constraints, financial difficulties, physical disability, or an unsupportive caregiver. These recommendations require further study in practice settings. Keywords: Integrative oncology. Telemedicine. Practice guidelines. Supportive care. Doctor-patient communication
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The aim of this research is to analyze the economic, political and cultural expressions of the women who make up the self-managed, feminist and dissident Tianguis in the city of Oaxaca, Mexico. The research is qualitative and is based on the techniques of ethnographic studies. The tianguis is formed by the loss of jobs brought about by the COVID-19 pandemic and recovers the original form of market organization by physically concentrating producers and buyers, where money as a means of exchange is gradually being replaced by barter. The hegemonic, capitalist and patriarchal system extends its domination in a subtle and imperceptible way in society, is built from the bottom up, but it also shows the intolerant and repressive nature of institutional power. This is the only way to explain why the authorities of the municipality of Oaxaca de Juárez violently evicted and recovered the public space occupied by the tianguistas. The study shows that women have had to resist and take a political stance in the absence of agreements with the municipal authorities to be able to continue trading and selling their goods. © 2021, Universidad del Zulia. All rights reserved.
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Background: Burnout amongst healthcare professionals has been well-documented as a phenomenon that compromises the quality and viability of patient-centered care, particularly in oncology. Due to the extraordinary demands of the pandemic, burnout has emerged as a public health crisis that warrants immediate attention to preserve the wellbeing of healthcare staff. At the onset of the pandemic, The Sidney Kimmel Cancer Center (SKCC) at Jefferson, an urban NCI-designated cancer center, translated its support offerings to virtual events. Initially, healthcare providers (HP) sought support by attending patient programs. In response, SKCC initiated virtual programming to support the well-being and needs of the HP team. Methods:Within weeks of the state shutdown due to the pandemic, programs were initiated to address HP self-reported distress: Coping Effectively and Mindfulness Moments Each 30-minute session was facilitated by a licensed psychologist and social worker. Coping Effectively offers strategies from evidence based treatment including Dialectical Behavior Therapy, Acceptance and Commitment Therapy, and Cognitive Behavioral Therapy, to cope with distress and burnout. Mindful Moments draws from Mindfulness Based Stress Reduction practices including observing breath and guided meditations. These programs have been offered consistently throughout the pandemic. Schwartz Rounds, geared towards supporting the human side of healthcare, provided 'hot' topic moderated discussions, four of which focused on the pandemic These discussions allow for HP to come together to discuss difficult topics and emotions impacting a variety of professionals. All programming was evaluated with a single question to measure the impact of the session on reducing distress. Each program began and ended with a poll asking, 'How distressed do you currently feel?' Attendees respond on a Likert scale from 0 to 10, in which10 indicated the highest level of distress. Results: Since March 31 , 340 staff have attended Mindful Moments and 236 staff have attended Coping Effectively. From March 2020- February 2021, 382 attendees measured their distress before and after attending a staff program. Schwartz Rounds hosted 471 HP from a variety of disciplines. Participants were asked to complete an evaluation following rounds. 31% of program participants' completed an evaluation form and 89% rated the program exceptional/very good. Conclusions: Despite the challenges of COVID-19, the pivot to virtually create programs to support staff during the pandemic was swift and thoughtful. The increased attendance and the feedback from evaluations are promising indicators of decreasing burnout amongst HP. How Distressed do you Currently Feel? (Average Score scale 1-10).
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Background: Supportive care is considered essential to standard care for patients with a history of cancer. The interdisciplinary team at Sidney Kimmel Cancer Center (SKCC) of Thomas Jefferson University, an NCI-designated cancer center in Philadelphia, offers a robust variety of supportive care services including support groups, educational and wellness programs. SKCC includes four academic hubs across the Greater Philadelphia region. With the onset of the COVID- 19 pandemic and the subsequent statewide shutdown of services, SKCC quickly pivoted to virtual offerings, to address patients' supportive care needs. Recent research has shown patients self-reporting higher incidence of anxiety and loneliness due to the pandemic. Direct patient feedback identified programs of greatest need, the preferred times and format. Methods: At the beginning of the pandemic SKCC offered a program 'Coping with Cancer and Covid-19: as You Navigate Cancer Treatment.' This program helped patients understand their risk of COVID-19 and provided emotional support as patients and caregivers began facing loneliness. Additional virtual offerings included Mindfulness Sessions, Yoga, Stretching for Stress Relief, Healing through Humor. SKCC began evaluating the impact of the programming beginning in June 2020. Attendees completed surveys evaluating the presentation, their level of psychological distress, perceived quality of life, and feelings of hope, loneliness, and connection. Participants were asked if they would attend another program and were asked to rate the program on a Likert scale. Results: In 2019 SKCC offered 273 programs and attracted 984 participants. Only 90 of the 984 participants attended virtually prior to the pandemic. Since the start of the pandemic, SKCC has hosted 334 programs, all virtually, with 3,346 participants. Surveys were sent electronically and completed immediately after the completion of all support programs offered at SKCC. 40% of program participants' completed an evaluation form and 94% rated the program exceptional or very good. Overall, 88% of participants in virtual wellness, support groups and educational programs indicated they would attend another program offered by SKCC. Conclusions: Virtual supportive care offerings have engaged more patients and caregivers than ever across SKCC hubs and have proven an effective means to continue to support patients during the pandemic. It is important to continue to evaluate and create meaningful programs to match the ongoing needs of patients and caregivers.
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The tourism industry joins the digital era driving to an increase in the offer of home sharing for tourist use. The analysis of the negative externalities associated with this phenomenon supports this work in five keys. It synthesizes the regulations in two representative destinations: Balearic Islands and Madrid. Presents a quantification of economic impacts at national level, with Table Input-Output of Spain 2015, noting that a change of behavior pattern tourists associated with habits in housing for tourist, generates impacts of various signs from the perspective of national accounting.
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This article aims to analyze the communicative capacity of clothing, especially face masks with the arrival of COVID-19. To achieve this, information and examples on certain items of clothing from an extensive interdisciplinary bibliography, written, audiovisual and digital media pieces were first collected as well as direct observation of the street and on the Internet. Then these have been selected, ordered and classified to describe and explain what these outfits say. The work shows that clothes speak out by themselves, of us and the society in which we live. This repeats with face masks too. Since the arrival of the pandemic, they have become a new way of communicating and transmitting messages of all kinds. The masks stand out because they veil a part of the face, but at the same time they reveal numerous details about our identity. © 2021 Universidad Pompeu Fabra. All rights reserved.
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Information overload, misinformation and false news have led to the need to strengthen media literacy. With the global health emergency decree produced by the appearance of CoViD-19, users of traditional and digital media are in a constant search for information on the subject. This study analyzes the communication practices of media users and their perception of the information they receive about the coronavirus. To this end, quantitative research was done with the help of a self-administered questionnaire to a total of 2,090 Ecuadorians. In addition, use is made of the technique of reverse engineering of data to analyze the topics and traditional and digital platforms that citizens frequently access to get information. The results indicate that there is a preference for the information published on Web 2.0 platforms: topics related to health guidelines and a possible vaccine to face the disease. Also, a loss of confidence in traditional media and government sources is identified, while citizens give greater credibility to news shared by friends and family. Therefore, it is concluded that it is necessary to develop strategies focused on the diversity of social groups. This can be done by working among health organisms, scientists from Ecuadorian universities, media (traditional - digital) and citizen participation (prosumer) through interactive communicational proposals. These will make it possible to counteract the infodemic through media literacy and digital responsibility to position information based on scientific evidence.