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1.
European Psychiatry ; 65(Supplement 1):S542, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2154110

RESUMO

Introduction: Since the beginning of the COVID-19 pandemic, sanitary context and e-learning has greatly modified students' lifestyles. An increase of sedentary behaviors, a reduction in physical activity (PA) and a stronger tendency to move towards unhealthy diet have been demonstrated. Most of the research is largely descriptive and to date, no interventional studies have been conducted to prevent the deterioration of students' health. Objective(s): The objective of the present research aims to evaluate the effects of an intervention program on the lifestyle and psychological state of student. Its primary objective is to promote PA among students, to improve both physical condition and motivation to engage in physical activity for one's health by promoting motivational levers. Its second objective is to reduce and/or prevent the deterioration of the health of university students. Method(s): Students from University of Nimes were recruited and randomly assigned to one of the two following conditions: an experimental group and a control group. The experimental group participated to an 8-weeks program of PA (co-constructed by users during design-based innovative workshops) whereas the control group did not. For each group, measures of PA, sedentary time, anthropometric data, sleep, physical condition and psychological variables (anxiety, depression, motivation, body appreciation, perceived control, well-being,.) were carried out before (T1: october 2021) and after (T2: December 2021) these 8-weeks in order to evaluate the benefits from the PA program. Result(s): These assessments were performed in October 2021 (T1) and December 2021 (T2). Conclusion(s): Data are still being collected and will be presented in April 2022.

2.
Asia-Pacific Journal of Clinical Oncology ; 18(Supplement 3):86, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2136597

RESUMO

Aim: Peoplewith cancer living in regional Victoria are less likely to participate in a clinical trial than metropolitan patients.We established a new geographically based trials network with the gaol of increasing the number of regional cancer patients recruited to clinical trials. Method(s): Initially six regional services and Cancer Trials Australia (CTA) collaborated to form Regional Trials Network Victoria (RTNV). Two more sites, Latrobe Regional Hospital and Mildura Public Hospital were added in 2021. This network represents a population of 1.9 million people and approximately 8000 new cancer diagnoses each year. Access to cancer clinical trials at regional sites was achieved by: Building capacity of regional clinical trial units Improving the efficiency of clinical trial conduct Implementing the COSA teletrial framework Investing in the capability of staff Increasing the number of clinical trials Results: In 2017, the CCV Clinical Trial Management Scheme (CTMS) recorded 1587 Victorians recruited to cancer clinical intervention trials. 428 resided in regional Victoria, but only 81 of these participated at a regional site, with others needing to travel. In 2017, 135 patients were recruited to RTN sites (regional plus Geelong) across 55 trials. By 2021, despite the impacts of the COVID19 pandemic the number of recruiting clinical trials increased by 54% and the number of regional patients recruited to CTMS studies in the network increased to 179. Driven by uptake of teletrials and registry trials total recruitment increased to 620 patients. RTNV leveraged funding to sustain core activity and was awarded $18.5 million from the Medical Research Future Fund to conduct health services research over the next 5 years. Conclusion(s): The RTNV is a successful implementation of a regionally based clinical trials network, improving access and participation of regional patients. Much of the increase was driven by the use of COSA Teletrials methodology.

3.
Proceedings of the Nutrition Society ; 81(OCE5):E188, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2133056

RESUMO

Sarcopenia is the reduction of muscle mass and strength associated with ageing(1). Resistance exercise alone and in combination with protein is thought to lead to increased muscle protein synthesis and may help combat sarcopenia(2). Resistance exercise is traditionally undertaken in a gym setting, using fixed-machines and free weights, however, this environment can be unappealing to middle-older age adults. Access to gyms was also prohibited during COVID-19 UK lockdowns leading us to explore alternative approaches to delivering nutrition and exercise intervention trials. The aim of this study was to evaluate the feasibility of remote delivery of a homebased resistance exercise and protein intervention. This was a six week, 3-arm parallel intervention trial. Participants aged between 40-65 years were recruited via a social media advertising campaign and randomised to one of 3 treatment arms: i) resistance exercise, ii) resistance exercise and 15 g of protein/day (taken alongside lunch) or iii) resistance exercise and 30 g of protein/day (15 g taken alongside breakfast and 15 g taken alongside lunch.) The home-based resistance exercise intervention was conducted using resistance bands and consisted of 50-minute exercise sessions delivered live via videoconferencing. Participants were asked to participate in two exercise sessions per week. Protein was consumed as a gel supplement (Pro-source Plus) supplied by Nutrinovo (www.nutrinovo.com). Participants were asked to record their engagement and experience in a trial logbook and took part in semi-structured interviews at the end of the intervention period. In-person assessments of muscle strength and function, physical activity and diet were made at baseline and end of the intervention. Thirty-two individuals responded to the recruitment campaign within a three-week timeframe and a final total of eleven volunteers were eligible to participate and gave informed consent (all female, age range 40-61). No participants dropped out of the trial;however, one participant engaged in only 3 out of the 12 exercise classes and the same participant consumed only 14% of the protein supplement supplied. The remaining 10 participants had good compliance with both the exercise and protein intervention, and overall, there was 87% adherence to exercise sessions (2 or more classes a week) and adherence of 68% and 88% to the protein supplement in the 15 g and 30 g protein intervention arms respectively. Acceptability and adherence were in line with the study requirements for most participants. These findings are encouraging and support the feasibility of a remote exercise and protein intervention trial. Qualitative analysis of the semi-structured interviews will provide further information to inform the design of a larger intervention trial.

4.
Tumori ; 108(4 Supplement):164-165, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2115065

RESUMO

Following the new health needs emerged during the covid pandemic, in June 2021, the Cancer and Research Center of Marches Region, CORM (www.corm-marche.it) was instituted at the Department of Oncology of the Academic Hospital Ospedali Riuniti, Ancona (IT) with the Italian Ministry of Health patronage. The CORM includes:-The digital platform for telemedicine to offer the ability to admit de novo diagnosis of solid tumors, as well as provide second opinions and to promote continutiy of care between hospital and territory-The Molecular Tumor Board, a multidisciplinary board including clinicians, pathologists and biologists to recommend personalized therapy in the "Precision Medicine" era. High throughput genomic profiling tests may be indicated by MTB team: foundation one cdx/liquid biopsy/ heme, 16 genes DNA panel and other panels that are relevant in different types of tumors, NTRK evaluation and PDL1 test. The molecular profiles are useful to indicate new treatment strategies, but also to understand the mechanism of resistance otherwise not justificable with a standard approach.-The Clinical Trial Unit which performs about 40 interventional trials/year and includes a phase 1 unit, certified by AIFA. Every year, 100 patients are enrolled in clinical trials, about 10/year in phase 1 trials.-The Regional Center of High Specialization in Oncological Genetics. In December 2004, the Regional Center of High Specialization in Oncological Genetics was instituted and we developed an increasing expertise in genetic counseling and tests for hereditary syndrome (hereditary breast and ovarian cancer syndrome and Lynch syndrome). Last year, we conducted 3166 genetic counseling, consisting of collecting genetic information and drawing pedigree, making or validating diagnosis, communicating clinical and genetic information and supporting the family to reach a decision and take appropriate actions. From January 2022, we activate the telemedicine platform also for genetic counseling to select patients who deserve genetic testing and come from distant territories. We aim to create a technological network between the oncology departments and general practitioners, patient associations and all the other specialists to guarantee the continuity of care and to overcome the disparities in oncological health services, simplifying cancer clinical management.

5.
Acta Phlebologica ; 23(2):59-62, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2067521

RESUMO

BACKGROUND: Venous insufficiency has well-defined symptoms with repercussions at the socioeconomic level. The covid pandemic decreed in March 2020 the confinement of the population, leading society to a sedentary lifestyle and weight gain, with aggravation of venous symptoms. Objective(s): To treat patients who did not respond to medical treatment in times of covid, with echo-guided foam ablation of the lesser saphenous vein. METHOD(S): It is an observational, prospective and intervention study. Patients were studied from June to September 2020. Inclusion criteria: all patients who presented symptoms and who presented reflux in the small saphenous vein during the venous Doppler study, greater than 0.5 s and a diameter greater than 4 mm and less than 7 mm. Exclusion criteria: patients who refused to participate in the study, presence of insufficiency of the great saphenous vein with transfer of reflux to the system of the small saphenous vein and those who had an ABI<0.8. RESULT(S): Four hundred patients were studied, 74% were women, with an average age of 57.6. The insufficiency of the lesser saphenous vein was found in 122 (29%), 68% were female;14.7% of the patients did not respond to treatment, and ultrasound-guided sclerosis was performed with foam. At seven days control, 83.3% of patients had the lesser saphenous vein occluded;at fourteen days, 93% of patients had the vein occluded;and 73.3% had the vein with total occlusion at one-year ultrasound control. CONCLUSION(S): Athermal ablation has been found to be a good method for treating small saphenous vein insufficiency, it can be performed in the office without complications. Copyright © 2022 EDIZIONI MINERVA MEDICA.

6.
Pharmaceutical Journal ; 304(7938), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2064892

RESUMO

The novel coronavirus (SARS-CoV-2) infection, more commonly referred to as COVID-19,has rapidly developed into a worldwide pandemic with a significant health burden. At the time ofpublication (23 June 2020) there are no approved pharmacological treatments or preventativetherapeutic strategies in place to combat the infection. However, globally, hundreds of clinical studiesthat aim to discover effective COVID-19 treatments are ongoing. This article summarises the rationalebehind several of these interventional trials, including evidence from in vitro studies, and early resultsto provide an insight into the global response. As patients are being enrolled in clinical trials across theUK, some of the safety and practical considerations for the investigational medicines that pharmacistsare most likely to encounter in practice are discussed as part of this review. Copyright © 2020 Pharmaceutical Press. All right reserved.

7.
American Journal of Transplantation ; 22(Supplement 3):406, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2063381

RESUMO

Purpose: This study aims to compare the immunogenicity of a third dose of the heterologous BNT262b2 mRNA vaccine versus the homologous inactivated wholevirion CoronaVac vaccine in adult kidney transplant recipients (KTR). Method(s): This prospective, single-center, phase 4 interventional study included KTR aged 30-69 years, with more than 30days of transplantation, and no previous confirmed COVID-19. The patients received the 3rd heterologous (BNT162b2 mRNA) or homologous dose, at least four weeks after the standard two-dose schedule of CoronaVac vaccine, at the transplant center. Antibody response immediately before and after the 3rd dose was assessed by the AdviseDx SARS-CoV-2 IgG II assay. For those positive assays, neutralizing anti-SARS-CoV-2 antibodies were assessed through the cPassTM SARS-CoV-2 Neutralization Antibody Detection Kit. Result(s): There were 307 patients in the heterologous group and 777 patients in the homologous group. KTR in the heterologous group were older (median age 54 vs. 50 years,p<0.0001), with a lower prevalence of diabetes (7% vs. 11%,p=0.032), lower percentage of deceased donors (60% vs. 68%,p=0.006) and longer time since transplant (median 11 vs. 6 years,p< 0.0001).Immediately before the 3rd dose, seroprevalence for IgG antibodies (36% vs. 34%,p=0.597) and the median antibody titers among those seroprevalent (246 AU/mL vs. 268 AU/mL,p=0.279) were similar. At a median of 25 days after the heterologous and 35 days after the homologous 3rddose vaccine, seroconversion rate was higher in the heterologous group (49% vs. 32%,p<0.0001), resulting in a higher seroprevalence rate (67% vs. 55%,p=0.0003). Overall, 42% remained seronegative after the third dose. The median antibody titers after booster among those seroprevalent patients was higher in those in whom the 3rd heterologous vaccine was administered (7,771 AU/mL vs 599 AU/mL,p<0.0001). The analysis of the neutralizing activity is ongoing. Conclusion(s): This prospective interventional study suggests that a 3rd heterologous dose is associated with a higher seroconversion rate and median antibody titers compared to a homologous dose in kidney transplant recipients fully vaccinated with inactivated whole-virion CoronaVac vaccine. In addition, 42% of subjects did not produce humoral immune response after the third dose, urging the development of alternative strategies.

8.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S277-S278, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2058223

RESUMO

Purpose: The COVID-19 pandemic affected children and families in multiple ways- schools closed and migrated online and parents altered work schedules and childcare. Our randomized controlled intervention trial for parents of children with Functional Abdominal Pain Disorders (FAPDs) was underway when the pandemic began. This provided the opportunity to examine how the pandemic and mitigation efforts might affect our research. We evaluated differences in recruitment rates and data completion before vs. during the pandemic, hypothesizing that recruitment would be lower and it would take longer for participants to complete baseline measures. Method(s): The number of participants screened, consented, and randomized to the study was captured from February 2019 to November 2021. At baseline, parents of children with FAPD completed a 14-day pain and stool diary, 3-day food diary, and several psychosocial questionnaires. Based on the date of consent, participants were categorized into two groups: before or during the COVID-19 pandemic (beginning March 2020). A series of independent sample t-tests was conducted to evaluate differences between the two groups on the number of participants screened, consented, and randomized per month and the number of days it took participants to complete the baseline measures. Result(s): A total of 272 parents of children ages 7-12 years who met Rome IV criteria for FAPD were screened for participation in the study. Of these, 110 eligible parents consented to participate, and 92 were randomized to treatment. There were no differences between the before and during COVID-19 groups on the number of participants screened per month and the number of days to complete the pain and stool diary. We found significant differences between the two groups for the number of participants consented and randomized per month and the number of days to complete the food diary and psychosocial questionnaires (Table 1). Conclusion(s): Our findings indicate that rate of recruitment and baseline data collection differed significantly from before to during the COVID-19 pandemic. While there were no significant differences in the number of families screened, significantly fewer of those eligible agreed to participate and were randomized during the pandemic, as we expected. For those who consented, however, it took significantly fewer days for them to complete several study measures, contrary to our hypotheses. While the overall recruitment rate for the trial did decrease during the COVID-19 pandemic (possibly due to parents feeling overwhelmed by the pandemic), data collection became more efficient for those who were enrolled (perhaps reflecting more time spent at home and online). Overall, our findings suggest that conducting studies involving parents of school-age children during the COVID-19 pandemic may face greater challenges, primarily in recruitment. (Table Presented).

9.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S117-S118, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2057997

RESUMO

Purpose: The COVID-19 pandemic has the potential to influence the well-being of families and children with Functional Abdominal Pain Disorders (FAPDs). Given the known relationship between stress and abdominal pain in children with FAPDs, we hypothesized pandemic-related changes (e.g., reductions in family finances, social interactions) could affect health outcomes. Our aim was to examine the potential impact of the pandemic on abdominal pain, quality of life, psychological and physiological symptoms, and functional disability in children with FAPDs. Method(s): Ninety-one parents of children ages 7-12 who met the Rome IV criteria for a FAPD completed baseline questionnaires as part of an ongoing randomized controlled intervention trial on their child's Quality of life (PedsQL), Pain Behavior and Response (PBQ, PBCL, PRI), Pain Catastrophizing (PCS), Psychological Symptoms (SCL-90), Functional Disability (FDI), and sleep habits (CSHQ). Heart rate was also measured. Participants were categorized into two groups, based on the date of entry into the original study, as before or during the COVID-19 pandemic, allowing us to take advantage of a naturally occurring opportunity to assess potential impacts of the pandemic. Result(s): Sixty-one participants were consented before, and 30 participants were consented during the COVID-19 pandemic. Parents in the latter group reported their children to have more days of abdominal pain, higher pain frequency, pain behavior, disability, helplessness, and depression, and significantly lower quality of life, compared to the before COVID group (Table 1). Finally, child sleep anxiety and overall sleep difficulty were significantly higher during COVID. Children also had a significantly higher mean heart rate during the COVID-19 pandemic. Conclusion(s): Our findings suggest that the COVID-19 pandemic has impacted children with FAPDs in multiple domains. Of concern, parents of children with FAPDs reported greater child pain frequency, disability, and pain behaviors during the pandemic than before the pandemic. Parents also reported significant increased child emotional distress during the COVID-19 pandemic and impacts on quality of life during COVID-19;in fact, most scores on the PedsQL were lower than those previously reported for children receiving cancer treatment. Child sleep anxiety and overall disordered sleep also worsened during the pandemic. Additionally, physiological changes (mean heart rate) were observed during the pandemic (Figure 1). Possible explanations for these findings could include increases in child and family stress, and greater parental awareness of child symptoms due to increased time at home together, or parents' own increased stress levels. Clinicians and researchers should be aware of the potential impact of COVID-19 pandemic on these areas to inform research as well as treatment of children with FAPDs.

10.
Australian Journal of Primary Health ; 28(4):xxii-xxiii, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2057968

RESUMO

Background: Primary health care nurses (PHCNs) deliver women's sexual and reproductive health (SRH) services, and telehealth services are within their scope of practice. Despite the WHO resolution about eHealth in 2005 and increased use of telehealth during COVID-19, the extent to which PHC nurses have used telehealth technology to deliver SRH care in the international literature is not clear. Aim/Objectives: To explore how telehealth is used by PHCNs in the delivery of women's SRH care. Method(s): A scoping review of peer-reviewed primary research papers was undertaken following a Joanna Briggs Institute approach. Seven databases were searched including papers from 2005-December 2021 and published in English language. A grey literature search was used to identify current national or international policy or strategy documents about nurse roles in telehealth. Extracted data were then entered in NVivo and conceptual categories were mapped from descriptive summaries. Finding(s): Our database search yielded 745 papers and of these, eight papers met our inclusion criteria and were included in the review. The search of grey literature yielded 21 documents that met our inclusion criteria. Papers were largely from the United Kingdom (n=5), part of interventional trials (n=5) or used synchronous telehealth methods (n=5). Papers about patient perspectives described acceptability of SRH telehealth services (n=4). Grey literature revealed policy support for telehealth implementation as an approach to improving patient-centred care, were largely from the northern hemisphere (n=15) or outlined case studies of nurse use of telehealth (n=11). From all included documents, SRH care most commonly addressed pregnancy (n=6), cervical cancer screening (n=4), sexual health (n=3), and abortion (n=2). Implications: Evidence about the use of telehealth by PHCNs for SRH care is lacking. Opportunities exist to address women's health policy and service gaps, and better describe and optimise PHCN involvement in telehealth care.

11.
Annals of the Rheumatic Diseases ; 81:371, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2009157

RESUMO

Background: Patients with rheumatoid arthritis (RA) on methotrexate have reduced vaccine responses. Temporary discontinuation has improved immuno-genicity of anti-infuenza vaccine, but this strategy has not been evaluated in anti-SARS-CoV-2 vaccines. Objectives: To evaluate the effect on immunogenicity and safety of 2-week methotrexate (MTX) discontinuation after each dose of the Sinovac-CoronaVac vaccine versus MTX maintenance in rheumatoid arthritis (RA) patients. Methods: This was a single-center, prospective, randomized, investigator-blinded, intervention study (#NCT04754698, CoronavRheum), including adult RA patients (stable CDAI≤10, prednisone ≤7.5mg/day), randomized (1:1) to withdraw MTX (MTX-hold) for 2 weeks after each vaccine dose or maintain MTX (MTX-maintain), evaluated at D0, D28 and D69. Co-primary outcomes were anti-SARS-CoV-2 S1/S2 IgG seroconversion(SC) and neutralizing antibody (NAb) positivity at D69. Secondary outcomes were geometric mean titers (GMT) and fare rates. For immunogenicity analyses, we excluded patients with baseline positive IgG/NAb, and, for safety reasons, those who fared at D28 (CDAI>10) and did not withdraw MTX twice. Results: Randomization included 138 patients with 9 exclusions (5 COVID-19, 4 protocol violations). Safety evaluation included 60 (MTX-hold) and 69 (MTX-maintain) patients. Further exclusions: 27 patients [13 (21.7%) vs. 14 (20.3%), p=0.848] with positive baseline IgG/NAb and 10 patients (21.3%) in MTX-hold with CDAI>10 at D28. At D69, MTX-hold (n=37) had a higher rate of seroconversion than MTX-maintain (n=55) group [29 (78.4%) vs 30 (54.5%), p=0.019], with parallel augmentation in GMT [34.2 (25.2-46.4) vs 16.8 (11.9-23.6), p=0.006]. No differences were observed for NAb positivity [23 (62.2%) vs 27 (49.1%), p=0.217]. At D28 fare, rates were comparable in both groups (CDAI, p=0.122;DAS28-CRP, p=0.576), whereas CDAI>10 was more frequent in MTX-hold at D69 (p=0.024). Conclusion: We provide novel data that 2-week MTX withdrawal after each Sinovac-CoronaVac vaccine dose improves anti-SARS-CoV-2 IgG response. The increased fare rates after second MTX withdrawal may be attributed to the short-term interval between vaccine doses. This strategy requires close surveillance and shared decision making due to the possibility of fares.

12.
Annals of the Rheumatic Diseases ; 81:1807, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2008982

RESUMO

Background: Patients with chronic infammatory rheumatic diseases (CIRD) remain underrepresented in receiving vaccinations despite being disproportionately affected by infectious complications. Objectives: To systematically review the literature regarding vaccination willingness and vaccination hesitancy in CIRD patients with focus on the perspective of patients and physicians. Methods: A scoping review was conducted in PUBMED, EMBASE and the Cochrane Library through 2021. Study selection was performed by two independent reviewers, data were extracted using a standardized form and risk of bias was assessed using instruments from the McMaster University. Identifed barriers and hurdles were synthesized by categorizing them into the WHO's Measuring Behavioural and Social Drivers of Vaccination (BeSD) conceptual model. Results: The search yielded 1,644 hits, of which 30 were included (cross-sectional studies (n=27) based on interviews and 3 intervention studies). The majority of studies reported barriers to infuenza and pneumococcal vaccination (n=11), or infuenza vaccination only (n=9) from the patients perspective. Two studies assessed the attitudes towards COVID-19 vaccinations. Only one study assessed the view of rheumatologists. Patients mainly mentioned behavioral and social factors that negatively influence their willingness to be vaccinated while physicians see defcits in the organization and lack of time as a major barrier. Coverage of domains matched to the BeSD model suggests a lack of awareness of infection risk by both patients and physicians (Figure 1). Conclusion: The view of vaccination in CIRD patients diverges between patients and rheumatologists. Our results show that in-depth counseling on vaccines is important for patients, whereas physicians need support in implementing specifc immunization recommendations. The themes identifed provide a starting point for future interventions to improve vaccine rates in CIRD patients.

13.
Annals of the Rheumatic Diseases ; 81:1096, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2008960

RESUMO

Background: Fatigue in SLE has a multifactorial origin and disease activity seems to contribute only minimally to its genesis. Therefore, non-pharmacological therapeutic strategies should also be considered in the management of fatigue. There is some evidence on the effectiveness of aerobic exercise programs in improving fatigue, without a negative impact on disease manifestations. Objectives: the aim of this study was to analyze fatigue and Health Related Quality of Life (HRQoL) in a monocentric cohort of patients with SLE, in a condition of stable remission or low disease activity, before and after a program of physical exercise, through the administration of validated Patient Reported Outcomes (PROs). Methods: this is a cross-sectional interventional study which included patients with SLE, aged between 18 and 55 years, in a condition of stable (≥12 months) remission (DORIS)1 or low disease activity (LLDAS)2. Patients enrolled had a FACIT score ≤40 in the previous 6 months. Patients with other possible causes of fatigue (e.g.: anemia, hypothyroidism, severe vitamin D defciency), active arthritis or physical disabilities were excluded. For each patient, demographics, comorbidities, treatment, clinical and laboratory data were collected. Disease activity was evaluated with the SELENA-SLEDAI and organ damage with the SLICC/DI. Each patient completed the following PROs before and after the interventional program: SF-36, FACIT-Fatigue, LIT, HADS. Due to the limitations related to the COVID-19 pandemic, the physical exercise sessions were carried out using the Google Meet digital platform. Patients were asked to participate to at least 70% of the lessons. The physical exercise program included moderate intensity aerobic exercises (muscle strengthening, joint mobility, breathing, static and dynamic stretching, balance and neuro-dynamics);workouts were performed 3 times a week, consisting of 60 minutes each. The program lasted for 12 weeks. Results: we enrolled 12 female patients, regularly followed at the Rheumatology Unit of Pisa;only 9 of them completed the study (mean age 38.56 ± 9.1 years;median disease duration 7 years (IQR 5,25-9,75)). 8/9 were in stable remission, while 1/9 was in LLDAS for the presence of leukopenia. 2/9 patients presented organ damage, one for cataract and one for renal insufficiency, while none presented damage in the musculoskeletal system. 33.3% of patients had fbromyalgia. 88.8% was on treatment with Hydroxy-chloroquine, 55.5% was on low dose steroids (2±1.9 mg/daily), 33.3% was on Mycophenolate Mofetil;only 1 patient was on Belimumab. All PROs showed a trend to improvement at the end of the 12-week program of physical activity (Table 1). We demonstrated a statistically signifcant improvement of: FACIT, LIT, depression score of the HADS and MCS of the SF-36. The items of role physical (RP), vitality (VT) and mental health (MH) of the SF-36 also showed a signifcant improvement. Conclusion: In a small cohort of SLE patients in remission but with severe fatigue, in the difficult context of COVID-19 pandemic, we demonstrated that an online program of physical exercise may determine a signifcant improvement of fatigue, perception of disease burden and mental health. In the context of a multidisciplinary management, fnding effective intervention programs to improve fatigue and HRQoL in SLE patients appears of utmost importance, with the fnal aim of improving patients' health status.

14.
Annals of the Rheumatic Diseases ; 81:1093-1094, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2008816

RESUMO

Background: Physical activity (PA) is an important component in the management of people with rheumatoid arthritis (RA) (1). Interventions incorporating Behaviour Change (BC) theory are needed to target physically inactive people with RA. The study Physiotherapist-led Intervention to Promote Physical Activity in Rheumatoid Arthritis (PIPPRA) was designed using the Behaviour Change Wheel (BCW) and a pilot study of feasibility undertaken (ClinicalTrials.gov Identifer: NCT03644160). Objectives: To obtain reliable estimates regarding recruitment rates;participant retention;protocol adherence and possible adverse events, and to producing estimates of the potential effect sizes of the BC intervention on changes in outcomes of physical activity;fatigue;disability and quality of life. Methods: Participants were recruited at University Hospital (UH) rheumatology clinics and randomly assigned to control group (physical activity information leafilet) or intervention group (four BC physiotherapy sessions in eight weeks). Inclusion criteria were diagnosis of RA (ACR/EULAR 2010 classifcation criteria), aged 18+ years and classifed as insufficiently physically active. Ethical approval was obtained from the UH research ethics committee. Participants were assessed at baseline (T0), 8-weeks (T1), and 24-weeks (T2). Descriptive statistics and t-tests were used to analyse the data with SPSS v22. Results: 320 participants were identifed through chart review with direct contact then with people meeting the inclusion criteria at rheumatology clinics. Of the clinic attendees n=183 (57%) were eligible to participate and n=58 (55%) of those consented to participate. The recruitment rate was 6.4 per month and refusal rate was 59%. Due to impact of COVID-19 on the study n=25 (43%) participants completed the study (n=11 (44%) in intervention and n=14 (56%) in control). Of the 25, n= 23 (92%) were female, mean age was 60 years (sd 11.5). Intervention group participants completed 100% of BC sessions 1 & 2, 88% session 3 and 81% session 4. No serious adverse events were reported. Secondary outcome measures data is Table 1. Conclusion: The PIPPRA study designed using the BCW to improve promote physical activity was feasible and safe. This pilot study provides a framework for larger intervention studies and based on these fndings a fully powered trial is recommended.

15.
Indian Journal of Critical Care Medicine ; 26:S120-S123, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2006411

RESUMO

Aim: To prevent endotracheal intubations in the COVID wards with early awake proning, allowing time for lung to recover, and decrease mortality in COVID-19 patients. Objectives: 1. To assess the effect of prone positioning on the requirement for invasive mechanical ventilation. 2. To calculate PaO2/FiO2 before prone position. 3. To measure PaO2/FiO2 after prone position. 4. To assess how much increase in PaO2 during prone. 5. To assess the length of time tolerating prone positioning. Materials and methods: Inclusion criteria: (1) Age >18 years. (2) Patient with confirmed COVID with or without chest X-ray infiltrates. (3) Isolated hypoxemic respiratory failure without substantial dyspnea (the paradoxically well appearing hypoxemic patient). Requiring >2 L of O2 to maintain SpO2 >92%. A reasonable candidate might meet the following criteria: • not in multi-organ failure, • expectation that patient has a fairly reversible lung injury and may avoid intubation, • no hypercapnia or substantial dyspnea, • normal mental status, able to communicate distress, • no anticipation of difficult airway. (4) Patients who do not wish to be intubated (DNI). The main risk of awake proning is that it could cause excessive delays in intubation. In the DNI patient who is failing other modes of ventilation, there is little to be lost by trialing awake proning. Exclusion criteria: (1) Signs of respiratory fatigue (RR > 40/minute, PaCO2 > 50 mm Hg/pH< 7.30, and obvious accessory respiratory muscle use), (2) immediate need for intubation (PaO2/FiO2 < 50 mm Hg, unable to protect airway or change of mental status), (3) unstable hemodynamic status, and (4) inability to collaborate with prone position with agitation or refusal. Also, it is observed that the mean O2 requirement is slightly higher in females (Baseline-7.74 L) as compared to males (Baseline-6.06 L), however, this difference is not statistically significant when observed using an independent sample t test (t value = -1.728, df = 48, p > 0.05). The mean reduction of O2 requirement from baseline to Day 3 post proning amongst male patients is 4.53 L, while in females it is 5.16 L. There is no statistically significant mean reduction of O2 requirement in males and females which was observed using independent sample t-test (t value = -0.675, df = 47, p > 0.05). SpaO2 increase after awake proning Overall, a total of 21 patients were followed up until Day 3 post proning and an increase in SpaO2 was observed in these patients. It is seen that the Mean Baseline SpaO2 in these 21 patients was 68.43 ± 2 (14.172) and after 3 days of awake proning it increased to 77.24 + 2 (17.023). However, this difference is not statistically significant using the paired sample t-test (t value = -1.819, df = 20, p > 0.05). Conclusion: It can be concluded from the study that 3 out of 50 patients (6.0%) required NIV or intubation after giving awake proning. The SpaO2 increases after awake proning but the increase is not statistically significant. However, the O2 requirement is reduced 4 to 6 times after awake proning and this reduction is statistically very highly significant. Thus, awake proning significantly helps in the reduction of the requirement of O2.

16.
Journal of Clinical Oncology ; 40(16), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2005680

RESUMO

Background: In the face of the COVID 19 pandemic, goal-concordant care has been gaining further significance. Discussions about the care goals are best when they are exploratory, conversational, and longitudinal. Complex information processing is best done outside of a crisis. Ideally, these conversations should start with the primary care clinician who has a longitudinal clinical relationship with the patient. Methods: A quality initiative project was conducted at the Internal Medicine Residency Clinic located in Northwestern Medicine Woodstock Hospital. Review of order entry in electronic medical records and charts for code status was assessed for data gathering. Patients above the age of 65 years presenting for their annual physical visit were included in the study. Various interventions were done, including educating residents through didactic lectures, sending electronic reminders to the residents and formatting a template note including code status documentation. Pre and post-intervention data was gathered. Results: A total of 104 patients were in the pre-intervention group and 94 patients in the post-intervention group. Pre-intervention, code status was addressed in 33% of total patients interviewed during their annual physical visit. Post intervention, code status was addressed in 48% of the patients. Conclusions: This project was undertaken to increase awareness on a crucial aspect of the addressing code status in outpatient setting. Post intervention studies showed that addressing code status significantly increased. In order to fill the gap, we propose that addressing code status be a mandatory process or a reminder be generated in electronic health records.

17.
Journal of Clinical Oncology ; 40(16), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2005678

RESUMO

Background: Oncologists and advanced practice providers (APPs) routinely work as part of a team to provide quality cancer care in today's healthcare environment. However, this does not always translate into the realm of clinical research. It is estimated that only 2-8% of the adult oncology population enrolls in a clinical trial, with more than 20% of current trials failing to meet accrual goals. These numbers are projected to be even worse due to the impact of the COVID pandemic. Our Oncologist/APP team in conjunction with a clinical research coordinator (CRC) set out to develop a workflow to approach and offer clinical trials to patients in our practice with the goal of increasing clinical trial accrual and improving clinical trial conduct. Methods: Between 1/1/19-12/31/21, a community breast oncology focused practice in the Hawaii M/U NCORP implemented a plan with the goal to increase accrual to clinical trials. Building on the prior experience of both clinicians, the practice developed a comprehensive team approach between the Oncologist, APP, and CRC. This approach included four components: 1) Clinic workflow for clinical trial screening, introduction, and follow-up of potential participants;2) Shared clinical trial visits between MD & APP;3) Protocol reviews by MD who reviewed treatment protocols & APP who reviewed symptom management and cancer care delivery research (CCDR) protocols. All clinical trial reviews were discussed with CRC for coordination input;4) Protocol leadership between MD serving as local primary investigator (PI) on treatment trials, APP serving as local PI and/or site champion on symptom management and CCDR protocols. Results: From 2019- 2021, our practice was able to accrue over 23% of our patients to clinical trials in a community practice setting, despite the COVID-19 Pandemic. Of the 149 unique accruals during this period, 59% of accruals were interventional trials and 41% were observational trials. Clinical trial accrual was racially diverse and mirrored the patient population. During this period, there were minimal protocol deviations observed based on review of shadow charts on this group of clinical trial patients. Conclusions: Through this team approach, our practice has been successful in having a high rate of clinical trial accrual while maintaining excellent clinical trial conduct even during the pandemic. We believe our team approach that utilizes the APP to the full scope of practice along with CRC empowerment in addition to the engaged oncologist is key to our success. Oncology practices and healthcare systems must value and engage all potential members of the team to maximize their clinical trial ability and to continue to offer/ enroll patients in clinical trials as the standard of care.

18.
Journal of General Internal Medicine ; 37:S169, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1995589

RESUMO

BACKGROUND: Timely follow-up of abnormal cancer screening test results (“abnormal screens”) is critical but often not achieved. As part of an NCI funded intervention trial (mFOCUS: multilevel Follow-up of Cancer Screening, ClinicalTrials.gov NCT03979495), we report on abnormal screens that were identified and tracked to identify eligible patients overdue for study inclusion. While not anticipated when this study was conceived, the COVID-19 pandemic resulted in a larger than anticipated backlog of patients in need of follow-up of abnormal screens. METHODS: Patients in two primary care practice networks affiliated with Mass General Brigham who had an abnormal screen for breast, cervical or lung cancer were identified using computerized algorithms and then tracked for completion of appropriate follow-up based upon the cancer type and the severity of the abnormal result. Since the intervention was designed as a “fail safe” system, additional time (2-6 months depending on the severity of the abnormal screen) was added after the recommended follow-up interval. We report the number of abnormal screens by cancer type and severity of the abnormality and the number of patients who completed follow-up based upon guideline and expert recommendations. RESULTS: Patient tracking and enrollment started with abnormal screens for breast and lung on 8/24/2020 and cervical cancer on 10/16/2020. Enrollment ended for all abnormal screens on December 15, 2021. Over the study period, 4003 abnormal breast, 5214 abnormal cervical, and 478 abnormal lung screens were identified. High risk abnormalities were most common for cervical (51.7%, recommended colposcopy or endometrial biopsy), lung (22.6%, LRADS 4B, 4X or 5), and lowest for breast (0.4%, BIRADS 5). Rates of completing recommended follow-up of abnormal screens by cancer type and severity of the result are shown in the table. CONCLUSIONS: Maximizing the benefits of cancer screening requires the timely follow-up of abnormal screening results. Though likely exacerbated by the COVID-19 pandemic, we identified that timely completion of abnormal screens is often not achieved. Rates of completion varied by cancer type and the severity of the abnormal result but highlight the need for systems based, multi-level interventions to identify, report and track abnormal results.

19.
Int J Environ Res Public Health ; 19(15)2022 08 02.
Artigo em Inglês | MEDLINE | ID: covidwho-1994060

RESUMO

Background: Problematic gaming (PG) has become an increasing mental health issue among adolescents during the preceding years. The role of parents and the family environment in the development of PG has been repeatedly emphasized. However, the structured involvement of parents in the therapy is still largely insufficient. Resource-strengthening training for parents of adolescents with PG (Res@t-P) is a new parent-centered 8-week group intervention to fill this substantial gap. The present pilot study aimed to collect first information on its potential effectiveness in improving parental and family factors. Methods: The study was conducted in a clinical setting with N = 43 parents of adolescents with PG, applying a pre- and post-follow-up design. Standardized questionnaires on psychological stress perception, family communication, family functioning, media rules, and adolescent PG symptoms were applied at three measurement points (before, at the end of, and 6 weeks after the training). Conditional growth models were estimated. Results: Over time, an improvement in parental and family aspects as well as a reduction in adolescent PG symptoms could be observed. Conclusions: The results of the present pilot study on the effectiveness of Res@t-P are promising. No causal inferences can be drawn at this stage. A randomized-controlled intervention study is highly warranted.


Assuntos
Jogos de Vídeo , Adolescente , Humanos , Projetos Piloto , Inquéritos e Questionários , Jogos de Vídeo/psicologia
20.
Heart Lung and Circulation ; 31:S293, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1977304

RESUMO

Background: An important stage of process evaluation in community-based interventions is assessing recruitment and engagement. Such an evaluation is being conducted alongside the FirstCPR cluster-randomised trial, which aims to increase community-level training and willingness to respond to cardiac arrests by providing education and training to members of community-based organisation. FirstCPR’s process evaluation sought to: (1) examine recruitment and understand barriers and enablers to organisation participation;and (2) examine the intervention’s fidelity and reach, including contextual factors related to participant engagement. Methods: A mixed-methods evaluation, integrated data collected during organisation recruitment comprising both quantitative record-keeping and qualitative coding. Quantitative data included recruitment rates, reasons for refusal, and organisational features;qualitative codes emerged from study-team observations. Descriptive analyses were used for quantitative data and thematic analyses for qualitative data. Results: In total, 220 (constituting 55% social/faith groups, 39% sports organisations, 6% workplaces/businesses) of 385 eligible organisations declined to participate. Lack of sufficient time to facilitate the project at their organisations, difficulties prioritising the program given competing activities, and COVID-related restrictions emerged as principal reasons for declining. Thematic analyses suggested that an organisation’s perception of the value of FirstCPR’s training was a key factor motivating enrolment. Conclusions: Organisational barriers included COVID restrictions, lack of perceived relevance, and staffing limitations. Obtaining adequate enrolment is essential for the generalisability of community intervention trials such as FirstCPR. Further semi-structured interviews with organisation leaders will delve into contextual factors that facilitated or impeded the intervention’s planned delivery;study records and web-analytics will inform intervention’s fidelity and reach.

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