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1.
Curr Psychol ; : 1-12, 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: covidwho-2035361

RESUMO

There is an emerging literature on the mental and physical exhaustion due to the COVID-19 related restrictions. Some individuals seem to exercise fewer precautions recently in comparison to the onset of the pandemic in preventing the spread of the COVID-19. This phenomenon is described as pandemic fatigue. Though acknowledged in conceptual articles and news reports, there is a lack of empirical evidence pertaining to pandemic fatigue. We collected data from 516 adult participants to investigate pandemic fatigue and its relations to fear of coronavirus, intolerance of uncertainty, apathy, and self-care. 34.40% of the participants reported that the level of COVID-19-related precautions they take have decreased in comparison to measures they took at the onset of the pandemic. Additionally, our model examining the role of fear of coronavirus, intolerance of uncertainty, and apathy as mediated by self-care predicting pandemic fatigue demonstrated acceptable to excellent goodness-of-fit indices. The fact that one in every three individuals is taking fewer precautions is not only a threat to the individuals' own health but also to the public. Given that individuals are experiencing pandemic fatigue, governments should consider paying more attention to the biopsychosocial nature of humans in ordering restrictions and planning necessary precautions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-02397-w.

2.
Curr Psychol ; : 1-10, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: covidwho-2035352

RESUMO

The COVID-19 pandemic has prompted all countries to adopt restraining measures to mitigate the spread of the disease. Usually, large-scale disasters tend to be accompanied by significant increases of psychological distress, depression and anxiety. Confinement measures imposed during the COVID-19 pandemic are likely to have similar consequences. In the present study we aim to evaluate how COVID-19 affected the overall psychological functioning of Portuguese individuals by providing a comparison of current data with status prior to the COVID-19 pandemic. The study sample was composed of 150 cognitively healthy participants. Results show an overall maintenance of cognitive capacities, although subjective cognitive decline complaints significantly increased during the pandemic. Regarding mental health, restraining measures culminated in an aggravation of depressive and decrease of the perceived quality of life, associated with feelings of loneliness and perceived social isolation. Finally, higher levels of pre-COVID-19 quality of life seem to play a protective role against depression and anxiety and predict less difficulties in emotion regulation, feelings of solitude and cognitive complaints. In sum, confinement due to COVID-19 implied an aggravation of the mental health of the Portuguese population, which appears to have been attenuated in those with higher pre-pandemic levels of perceived quality of life.

3.
Curr Psychol ; : 1-13, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: covidwho-2035349

RESUMO

The coronavirus pandemic has caused unemployment to skyrocket, exposed the longstanding inequalities in health care services and working conditions, and mainly affected the poor in different parts of the world. In the current study, we focus on social identity and social class-related factors that are critical during the pandemic to gain insights into what predicts support for policies favoring economic equality in the post-pandemic period. We argue that to the extent that individuals 1) identify with all humanity during the pandemic, 2) are aware of their socio-economic status-based privilege, 3) do not hold classist attitudes, they would support policies favoring economic equality. In Study 1, survey data from 1212 participants in Turkey were analyzed by means of hierarchical linear regression analysis. The findings showed that stronger identification with all humanity, higher awareness of socio-economic status-based privilege, and less endorsement of classist attitudes predict more support for socio-economic equality policies in the post-pandemic period, after controlling for socio-demographic and socio-political characteristics of participants. Study 2 (N = 212) replicated the findings in a different context, namely the U.S. Our findings extend previous studies by showing the importance of a global identity, such as shared human identity, in the ongoing and potentially in the aftermath of the pandemic. In addition, our findings highlight the joint contributions of socio-economic factors such as classist attitudes and awareness of class-based privilege to the support for socio-economic policies.

4.
Curr Psychol ; : 1-9, 2021 Apr 24.
Artigo em Inglês | MEDLINE | ID: covidwho-2035348

RESUMO

Millions of people are mourning the death of a loved to COVID-19. According to previous studies, the circumstances of coronavirus disease-related deaths may lead to dysfunctional grief. The purpose of this study was to introduce the Polish adaptation of the Pandemic Grief Scale (PGS) as well as to assess the relationship between dysfunctional grief due to a COVID-19 death, resilience and perceived social support. The adaptation was carried out on a general population sample of 286 individuals aged 18-54 years, with the evaluation being performed on a group comprising 214 people aged 18-78 years, who lost a loved one during the pandemic. The Polish version of PGS revealed a single-factor structure with strong internal consistency (α = 0.89). The PGS scores were associated with measures of complicated grief (Inventory of Complicated Grief), depression (Kutcher Adolescent Depression Scale) and lower resilience (Resilience Scale 14), which confirmed the scale's convergent validity. No relation between PGS scores and health behaviors (Inventory of Health Behaviors) was observed, which confirmed the scale's discriminant validity. The results of the bootstrapping technique revealed that resilience mediates the relationship between perceived social support (Multidimensional Scale of Perceived Social Support) and dysfunctional grief (total mediation). The results of this study suggest the need for practitioners to focus on resilience-enhancing interventions and perceived social support in order to improve mental health in people who lost their loved ones during the new coronavirus pandemic.

5.
Curr Psychol ; : 1-9, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: covidwho-2035344

RESUMO

The COVID-19 pandemic has called worldwide for strong governmental measures to contain its spread, associated with considerable psychological distress. This study aimed at screening a convenience sample in Germany during lockdown for perceived vulnerability to disease, knowledge about COVID-19, symptoms of depression and anxiety, and behavioral responses. In an online survey, 1358 participants completed the perceived vulnerability to disease scale (PVD), the Patient Health Questionnaire (PHQ-4), and questionnaires on knowledge about COVID-19 and self-perceived change in behaviors in response to COVID-19. Lower and upper quartiles of the PVD were used to classify individuals into low and high PVD. A confirmatory factor analysis supported three factors representing risk, preventive and adaptive behavior as behavioral responses to COVID-19 lockdown. A structural equation model showed that the score of the knowledge scale significantly predicted the self-reported increase in adaptive and preventive behavior. The score in the PVD-subscale Perceived Infectability predicted a self-reported increase in preventive behavior, whereas the Germ Aversion score predicted a self-reported increase in preventive and a decrease in risk behavior. The score in PHQ-4 predicted a higher score in the perceived infectability and germ aversion subscales, and a self-reported decrease in adaptive behavior. Low-, medium- and high-PVD groups reported distinct patterns of behavior, knowledge, and mental health symptoms. This study shows that perceived vulnerability to disease is closely linked to preventive behaviors and may enhance adaptation to COVID-19 pandemic.

6.
Soc Sci Med ; 309: 115253, 2022 Aug 06.
Artigo em Inglês | MEDLINE | ID: covidwho-2036538

RESUMO

BACKGROUND: There is widespread concern over the impact of COVID-19 and lockdown measures on suicidal behaviour. We assessed their effects on suicide and hospitalization for attempted suicide during the initial phase of the pandemic in Chile. METHODS: We used panel data at the county and month level from January 1, 2016 to December 31, 2020 on suicides and related hospitalizations and a pandemic quarantine dataset. Poisson regression models and a difference-in-difference (DiD) methodology was used to estimate the impact of quarantine on both measures. FINDINGS: Suicide and hospitalizations for attempted suicide decreased (18% and 5.8%, respectively) during the COVID-19 outbreak in Chile (March-December 2020) compared to the same period in 2016-2019. The DiD analysis showed that there was at least a 13.2% reduction in suicides in quarantined counties relative to counties without such restrictions. This reduction was in male suicides and unaffected by age. There was no significant difference between quarantined and non-quarantined counties in terms of hospitalization for suicide attempts. CONCLUSIONS: This study shows a significant quarantine effect on reducing suicide during the initial phase of the COVID-19 pandemic in Chile. Changes in the number of hospitalizations for suicide attempts do not explain the differences between quarantined and non-quarantined counties.

7.
Public Health ; 210: 34-40, 2022 Jun 21.
Artigo em Inglês | MEDLINE | ID: covidwho-2036458

RESUMO

OBJECTIVES: Contact tracing for COVID-19 relies heavily on the cooperation of individuals with authorities to provide information of contact persons. However, few studies have clarified willingness to cooperate and motivation to provide information for contact tracing. This study sought to describe willingness to cooperate and motivation to report contact persons for COVID-19 contact tracing among citizens in Japan, and to assess any associated sociodemographic factors. STUDY DESIGN: Cross-sectional study. METHODS: This was an online-based survey using quota sampling. Participants were asked about their willingness to cooperate in reporting contacts for COVID-19 contact tracing if they tested positive. Participants also responded to questions regarding their reasons for cooperating or not cooperating and provided sociodemographic data. Multiple logistic regression analysis was performed to clarify associations between sociodemographic factors and willingness to cooperate. RESULTS: This study included 2844 participants. The proportion of participants who were not willing to cooperate in reporting contacts was 27.6%, with their main reasons being concerns about causing trouble for the other person and being criticised for revealing their names. Willingness to cooperate was lower among men, young adults and those with an educational level less than a university degree. CONCLUSIONS: To improve the effectiveness of contact tracing, educational campaigns, such as reducing the fear and stigma associated with COVID-19, may be important. Furthermore, it is essential to understand that individuals may have contacts whom they do not wish to disclose to others and to be considerate when handling such situations.

8.
Pers Individ Dif ; 199: 111845, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: covidwho-2036407
9.
J Endod ; 2022 Jul 12.
Artigo em Inglês | MEDLINE | ID: covidwho-2036304

RESUMO

INTRODUCTION: There is lack of data on whether the coronavirus disease 2019 (COVID-19) pandemic was associated with changes in the etiology of pathosis in endodontic patients. The aim of this study was to determine the rate of cracks and other etiologic factors during the period of March 16th to May 31st in 2020 (COVID-19 initial outbreak) and 2021 (COVID-19 ongoing pandemic) compared with figures from the same period in 2019 (pre-COVID era) in 2 endodontists' practices. METHODS: The etiologies of patients' chief complaints were determined from records of 2440 teeth (740 in 2019, 651 in 2020, and 1049 in 2021). Changes in the proportion of etiologic factors among all 3 periods were analyzed. The association between the rate of cracked teeth and patients' age and sex was determined using a logistic regression model. RESULTS: The rates of all etiologies collectively during the studied periods showed a significant change (P < .0001). The rate of cracks significantly increased in 2020 (11.8%) (P = .0001) and 2021 (8%) (P = .0018) compared with 2019 (4.3%). The rate of persistent infections decreased in 2020 (22.3%) (P = .0013) and then increased in 2021 (27.5%) (P = .0153) compared with 2019 (30%). Cracked teeth were associated with the age group of 40-60 years (odds ratio [OR] = 1.882; 95% confidence interval [CI], 1.063-3.330) in 2020 and with age ranges of 40-60 years (OR = 2.051; 95% CI, 1.120-3.759) and >60 years (OR = 2.038; 95% CI, 1.050-3.956) and male sex (OR = 1.599; 95% CI, 1.019-2.510) in 2021. CONCLUSIONS: The rate of cracked teeth increased during the initial outbreak of the COVID-19 pandemic and 1 year later. This study provided evidence on the association between the COVID-19 pandemic and changes in the rate and presentation of endodontic etiologic factors.

10.
J Environ Manage ; 320: 115810, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: covidwho-2036229

RESUMO

Most studies on the novel COVID-19 pandemic have focused mainly on human health, food systems, and employment with limited studies on how farmers implement sustainable agricultural practices (SAPs) in response to the pandemic. This study examines how perceptions of COVID-19 shocks influence the adoption of SAPs among smallholder farmers in Ghana. We find that perceptions of COVID-19 shocks influence the probability and intensity of SAPs adoption. Secondly, households who anticipated COVID-19 shocks recorded heterogeneity effects in the combinations (complementarity and substitutability) of SAPs. Farmers who anticipated an increase in input prices and loss of income due to COVID-19 recorded the highest complementarity association between pesticide and zero tillage while farmers who expected limited market access reported the highest complementarity between mixed cropping and mulching. Farmers who projected a decrease in output prices complements pesticides with mixed cropping. The findings suggest that understanding the heterogeneity effects in the combinations of SAPs due to COVID-19 shocks is critical to effectively design, target and disseminate sustainable intensification programs in a post-pandemic period.

12.
Child Youth Serv Rev ; 142: 106619, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: covidwho-2035846

RESUMO

The COVID-19 pandemic has greatly impacted the lives of many around the world, particularly refugee and immigrant communities. In the United States, millions of children and youth had to quickly shift from in-person to remote learning, encountering new challenges and uncertainties in their overall educational experiences. This study explored some of the impacts of the COVID-19 pandemic on the educational, socialization, and mental and emotional health and wellbeing of Rohingya refugee youth from Myanmar resettled in the United States. Through in-depth qualitative interviews with 15 Rohingya refugees ages 12-17, we found that Rohingya youth's experiences with COVID-19 pandemic presented both challenges and opportunities. The challenges included unavailability of personal space to conduct school work, difficulties adjusting to online school due to computer literacy levels, and familial responsibilities that often conflicted with their schooling, as well as feelings of boredom and sadness that consequently impacted their emotional and mental health state. Youth also noted opportunities such as spending more time with their parents who were unable to work due to the pandemic as well as feeling helpful in acting as caregivers to their siblings and in working alongside their parents. Implications for policymakers and educators are also discussed.

13.
Clin Epidemiol Glob Health ; 16: 101109, 2022.
Artigo em Inglês | MEDLINE | ID: covidwho-2035821

RESUMO

Background: This pandemic has resulted in physical and emotional exhaustion among everyone, especially among community healthcare workers (CHWs), resulting in increased burnout and poor sleep quality. This pandemic has increased responsibilities for Accredited Social Health Activist (ASHA) workers and Auxiliary Nurse Midwife (ANM) at the grassroots. Previous studies have shown that infectious diseases like SARS and MERS directly affect sleep. With the COVID-19 pandemic, burnout and poor sleep among healthcare workers are expected to increase. Aim: To determine the prevalence of burnout and sleep quality among community health workers. Settings: and Design: This Cross-sectional study was conducted from February to April 2020 in Urban Primary Health care centres of Guntur city, Andhra Pradesh. Methods and material: Copenhagen Burnout Inventory scale (CBI) with a 5-point Likert scale and Pittsburgh Sleep Quality Index (PSQI) Questionnaire were used among four hundred and ten study participants. Descriptive statistics and the Chi-square test were used; a p-value of ≤0.05 is considered significant. Results: The prevalence of personal burnout was 16.8%, while work-related and pandemic-related burnouts were 10.5% and 25.4%, respectively. The prevalence of poor sleep quality was 35.09%. Fear of contracting the virus was present among 38.3%. Fear of infecting the family members because of their exposure was reported by 36.6% of the respondents; 71.7% and 79.3% reported receiving support from the organisation and colleagues, respectively. Conclusions: The provision of necessary equipment, regular check-ups and timely interventions will minimise the risk of stress and burnout.

14.
Am J Infect Control ; 2022 Aug 07.
Artigo em Inglês | MEDLINE | ID: covidwho-2035672

RESUMO

In the midst of the COVID - 19 pandemic, a multidisciplinary team implemented evidence-based strategies to eliminate catheter associated urinary tract infections (CAUTI), as defined by the National Healthcare Safety Network (NHSN) surveillance definition for those units included in the NHSN standardized infection ratio (SIR). The team evaluated indwelling urinary catheters daily for indication, implemented a urinary catheter order set, established a urinary catheter insertion checklist, and promoted use of external urinary diversion devices. The facility NHSN SIR for CAUTI was 0.37 in 2019, 0.23 in 2020, and 0.00 in 2021. A collaborative approach decreasing hospital acquired infections may be effective even in a climate of increased acuity, increased length of stay, and staffing challenges.

15.
Matern Child Health J ; 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: covidwho-2035168

RESUMO

OBJECTIVES: Despite evidence for heightened psychiatric risk and unique parenting challenges during the COVID-19 pandemic, no research exists on the specific needs of parents of infants and responsiveness of pediatric care to their needs. We aimed to describe the support needs of new parents and explore their experiences with pediatric care. METHODS: In late 2020 we conducted semi-structured interviews with 30 mothers of babies born or due that year. Interviews addressed perinatal experiences during the pandemic, with an emphasis on experiences related to social support. In an iterative, inductive process, thematic analysis was used to analyze the data. RESULTS: This study identifies a set of support needs specific to the context of parenting an infant during the COVID-19 crisis: coping with the compound psychological impacts of the postpartum period and a pandemic; parenting in the absence of expected social support; risk assessment to keep infant and family safe. This study finds that policies implemented by health care providers to reduce risk of COVID-19 transmission came at a cost to new parents and parent-provider relationships. Participants reported mixed experiences with in-person and telehealth pediatric care, including inadequate and/or uncomfortable postpartum mental health screening and breastfeeding support, and identified specific features that constituted responsive care during the pandemic. CONCLUSIONS: Normative changes associated with the postpartum period combined with complex adaptations necessitated by the COVID-19 pandemic presented substantial challenges for families with infants, even relatively privileged families. Providers can incorporate these findings to enhance support for families and promote maternal and child health.

16.
Eur J Clin Pharmacol ; 2022 Aug 09.
Artigo em Inglês | MEDLINE | ID: covidwho-2035031

RESUMO

PURPOSE: The absence of specific treatments for COVID-19 leads to an intense global effort in the search for new therapeutic interventions and better clinical outcomes for patients. This review aimed to present a selection of accepted studies that reported the activity of antidepressant drugs belonging to the selective serotonin receptor inhibitor (SSRI) class for treating the novel coronavirus. METHODS: A search was performed in PubMed and SciELO databases using the following search strategies: [(coronavirus) OR (COVID) OR (SARS-CoV-2) AND (antidepressant) OR (serotonin) OR (selective serotonin receptor inhibitors)]. In the end, eleven articles were included. We also covered information obtained from ClinicalTrials.gov in our research. RESULTS: Although several clinical trials are ongoing, only a few drugs have been officially approved to treat the infection. Remdesivir, an antiviral drug, despite favorable preliminary results, has restricted the use due to the risk of toxicity and methodological flaws. Antidepressant drugs were able to reduce the risk of intubation or death related to COVID-19, decrease the need for intensive medical care, and severely inhibit viral titers by up to 99%. Among the SSRIs studied so far, fluoxetine and fluvoxamine have shown to be the most promising against SARS-CoV-2. CONCLUSION: If successful, these drugs can substantially reduce hospitalization and mortality rates, as well as allow for fully outpatient treatment for mild-to-moderate infections. Thus, repositioning SSRIs can provide benefits when faced with a rapidly evolving pandemic such as COVID-19.

17.
International Journal of Radiation Oncology, Biology, Physics ; 114(3):e474-e474, 2022.
Artigo em Inglês | Academic Search Complete | ID: covidwho-2036123

RESUMO

Although chart rounds is an established quality assurance process, there remains minimal evidence on various forms of peer review, and some studies report relatively low error-detection rates. One question faced by both academic and community practices is whether to structure chart rounds as practice-site specific (PS) or disease-specific (DS). The global COVID pandemic may also offer new opportunities for structuring peer-review by enhancing virtual connectivity of people and practices. The purpose of this study was to determine if changes to treatment plans were recommended more often and assess perceptions following the transition to DS chart rounds. Data was prospectively collected for 6 months before and 6 months after transition to DS chart rounds at a multi-practice institution. Observed data included frequency of questions asked, educational remarks, and recommended changes to the presented plan or future patients. Time spent per case was recorded. Participants were not aware of data collection. Following 10 months of practicing DS chart rounds, a survey was distributed to faculty, dosimetrists, and trainees to assess perceptions of DS chart rounds. Two-tailed t-testing and chi-square testing were used to analyze the data. Criteria for statistical significance was p<0.05. The study was IRB-approved. Over 1 year, 1460 patients were peer reviewed;781 were reviewed by PS chart rounds and 679 by DS chart rounds. A question was asked more often in DS (49.3%) than PS (31.9%) chart rounds (p<0.001). A change to a presented plan was recommended more often in DS (4.9%) than PS (1.4%) chart rounds (p<0.001). A change was recommended for future patients more often in DS (4.4%) than PS (0.9%) chart rounds (p<0.001). An educational point was raised more often in DS (12.5%) than PS (9.3%) chart rounds (p=0.05). Time spent per case was more for DS (2.7 min) than PS (1.6 min) chart rounds (p<0.001). Overall, there were 35 survey respondents (54% response rate). Among attendings, the response rate was 74%. Of all respondents, 89% agreed DS chart rounds improve the quality of patient plans, 83% agreed DS chart rounds improve patient safety, 86% agreed DS chart rounds encourage more discussion, and 77% agreed DS chart rounds are more educational. Only 37% of respondents agreed DS chart rounds are more time efficient;however, 95% of attendings and 89% of all respondents favored continuing DS chart rounds;no respondents disagreed. Time efficiency was not associated with preference for continuing DS chart rounds (p=0.10). Favoring continuing DS chart rounds was associated with the belief that DS chart rounds improve patient safety (p<0.001), quality of patient plans (p<0.001), and education (p<0.001). DS chart rounds were associated with more discussion and recommended changes to treatment plans than PS chart rounds. Most respondents favored continuing DS chart rounds and reported that this format improved the quality of patient treatment plans and safety. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

18.
International Journal of Radiation Oncology, Biology, Physics ; 114(3):e346-e346, 2022.
Artigo em Inglês | Academic Search Complete | ID: covidwho-2036107

RESUMO

In 2003, an article in the Harvard Business Review by Reichheld, et al, identified a simple single investigative question – "How likely is it that you would recommend [company X] to a friend or colleague?" – that best represented customer loyalty and would predict company growth. With a renewed interest in patient satisfaction, this survey has been adapted in the healthcare community, but there are no known publications describing its use in a radiation oncology clinic. From April of 2019 through February of 2022, hard-copy forms were given to patients after CT simulation and at completion of therapy in a private room onsite. The question read, "How likely are you to refer patients who are friends or family to [Institution] Radiation Oncology?" If he or she agreed to answer the survey, the respondent used a Likert scale from 0 to 10 (least to most likely) and added comments in a free-text section. Responses with a 0 to 10 score were logged with no identifying information and were classified as "promoters" (9 to 10) or "detractors" (0 to 6);a monthly Net Promoter Score was calculated by dividing the number of "promoters" by the sum of "promoters" and "detractors." Comments, if available, were additionally transcribed. The scores and comments were shared with the department once weekly in morning huddle. Patients filled out 1318 forms (62%). Monthly Net Promoter scores ranged from 94.44 to 100. The average response was 9.74 with marks of 9.76, 9.74, 9.75, and 10.00 for 2019, 2020, 2021, and 2022, respectively. In 2019 and 2020, replies were separated by timepoints of CT simulation (9.73 and 9.71) and after radiotherapy (9.75 and 9.78). During this timeframe, comments were further analyzed by qualitative analysis and were classified into "staff appreciation," "patient feelings/treatment," "wait times," "respect," and "communication." The Net Promotor Score is an available tool to get immediate feedback from patients, allowing rapid service recovery, if needed. In our department, scores were consistently favorable with little difference through the COVID-19 pandemic, and patients noted that they were appreciated, felt respected, and experienced short wait times. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

19.
International Journal of Radiation Oncology, Biology, Physics ; 114(3):e344-e344, 2022.
Artigo em Inglês | Academic Search Complete | ID: covidwho-2036105

RESUMO

Telemedicine enthusiasm and uptake in radiation oncology rapidly increased during the COVID-19 pandemic, but it is unclear if and how telemedicine should be utilized after the COVID-19 public health emergency (PHE) ends. Despite ongoing COVID-19 risks and public payer support for telemedicine, several private payers have stopped reimbursing telemedicine weekly see video visits. We performed a large single-institution assessment of provider perspectives on telemedicine after we had achieved a more mature level of adoption to better understand factors considered when determining to use telemedicine and to estimate the percent of visits that could be safely performed with telemedicine. We distributed a survey to all radiation oncology attendings at our large academic institution in October 2021 to assess satisfaction, facilitators, and barriers to telemedicine implementation. We performed quantitative and qualitative analyses to characterize satisfaction and to identify factors influencing whether telemedicine is employed. For the qualitative analysis, two authors independently coded open-ended survey responses and identified categories and themes following established content analysis methodology. We calculated the average proportion of visits that providers expected could be appropriately performed with telemedicine without a clinically significant decline in the quality of care for each disease site and visit type. 60 of 82 eligible radiation oncologists (73%) responded to the survey. 78% of respondents were satisfied with telemedicine in the radiation oncology department, and 83% wished to continue offering video visits after the COVID-19 PHE ends. Common reasons providers endorsed for wanting to integrate telemedicine into practice included: patient and provider preference, increased access to care and clinical trials, allowing for greater relationship with the care team, and improved clinical safety, efficiency, and quality. Patient factors influencing whether physicians offer telemedicine included the patient's travel burden, patient preferences, and whether a physical exam is required. About 20% of new consultations and 50% of weekly management visits were estimated to be clinically appropriate for telemedicine. Central Nervous System/Pediatrics and Thoracic faculty considered telemedicine appropriate for the greatest proportion (50%) of new consultations. 93% of respondents felt comfortable determining whether telemedicine was appropriate. Surveyed radiation oncologists were satisfied with telemedicine in their practice and wished to continue offering video visits in the future. Although provider perceptions of clinical appropriateness of telemedicine varied widely based on disease site and visit type, providers felt comfortable determining when telemedicine would be appropriate for patients. Our data suggest payers should continue to support this patient-centered technology. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

20.
International Journal of Radiation Oncology, Biology, Physics ; 114(3):e14-e14, 2022.
Artigo em Inglês | Academic Search Complete | ID: covidwho-2036090

RESUMO

Two landmark randomized controlled trials (RCT) of external beam accelerated partial breast irradiation (EB-APBI) using 38.5 Gy/10 fractions (F) BID demonstrated excellent cancer control outcomes in appropriately selected patients but conflicting results regarding cosmesis. A recent RCT reported high rates of acceptable cosmesis using 30 Gy/5F QOD, making the most appropriate schedule for EB-APBI unclear. We utilized the BID regimen largely until the COVID-19 pandemic with strict contouring, dosimetric, and planning guidelines for gross/clinical/planning target volumes (GTV/CTV/PTV) and organs-at-risk (OAR). We report our experience with BID and QOD EB-APBI with a hypothesis that our treatment planning approach would result in acceptable acute toxicity and cosmesis. We identified patients that received EB-APBI from 4/2017 through 12/2021. Clinical, pathologic, acute toxicity, cosmesis and dosimetric data for the lumpectomy (Lump) GTV/CTV/PTV and key OARs (ipsilateral breast [IB V50%, V80% and V100% of the Rx dose] heart (mean dose, V5% Rx dose;V3 Gy], ipsilateral lung [IL V30% Rx dose] and mean total lung dose [TLD]) were collected. Cosmesis was physician-reported using the 4-point NRG Oncology/RTOG Global Cosmetic Score (GCS): Excellent (E)/Good (G)/Fair (F)/Poor (P). We report descriptive statistics to summarize our results. 245 patients were included with median follow-up 19 months (IQR, 9-30 months): median age, 66 y (IQR, 59-71 y);51% left-sided;82% invasive;100% invasive tumors HR+/HER2-;95% of DCIS HR+;median invasive tumor size 9.5 mm (IQR, 6-13 mm) and DCIS size 8mm (IQR, 4-12 mm);96% nodal surgery in invasive disease. Fractionation was BID in 55%, QOD in 45%. 3DCRT was used in 88% with median 6 fields (IQR, 5-7) and 96% were treated prone. Median Lump PTV eval volume was 176 mL and median breast volume 1335 mL resulting in median breast V50%Rx Dose=40.3% (IQR, 34.5-45.8%) and median breast V100=15.6% (IQR, 10.2-18.6%). Lump PTV coverage was high (median V95=100%). The mean heart dose was 35 cGy (IQR, 15-59 cGy), heart V5%=1.1% (IQR, 0-8.1%), and median heart V3Gy=0% (0-0.5%). The IL V30% (median 0%, IQR 0-0.4%) and TLD (median 49 cGy, IQR 26-93.1 cGy) were also low. The majority of patient had no acute toxicity (55% grade 0 dermatitis;57% grade 0 fatigue;97% grade 0 pruritis). The rate of E/G cosmesis was 97.1% (N=238) and F/P 2.9% (N=7). In patients with at least 2 years follow-up, rates were 96% E/G (N=95) and 4% F/P (N=4). The IB V100 was marginally associated with increased odds of F/P cosmesis (OR=1.18, 95% CI 0.99-1.42, p=0.07). With multiple-field 3DCRT in the prone position, EB-APBI can be delivered with low toxicity and great cosmetic results with BID or QOD treatment. Given the low rate of F/P cosmesis, longer follow-up is needed to confirm stability of these results and to help identify optimal dose-volume parameters to minimize the rate of F/P cosmesis. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

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