Реферат
OBJECTIVE: Pregnant women with gestational diabetes mellitus (GDM) are 50% more likely to develop type II diabetes (T2D) within 6 months to 2 years after giving birth. Therefore, international guidelines recommend it is best practice for women diagnosed with GDM to attend screening for T2D 6-12 weeks postpartum and every 1-3 years thereafter for life. However, uptake of postpartum screening is suboptimal. This study will explore the facilitators of and barriers to attending postpartum screening for T2D that women experience. STUDY DESIGN: This was a prospective qualitative cohort study using thematic analysis. METHODS: A total of 27 in-depth, semistructured interviews were conducted over the telephone with women who had recent GDM. Interviews were recorded and transcribed, and data were analysed using thematic analysis. RESULTS: Facilitators of and barriers to attending postpartum screening were identified at three different levels: personal, intervention, and healthcare systems level. The most common facilitators identified were concern for their own health and having the importance of screening explained to them by a health professional. The most common barriers identified were confusion over the test and COVID-19. CONCLUSION: This study identified several facilitators of and barriers to attending postpartum screening. These findings will help to inform research and interventions for improving rates of attendance at postpartum screening to reduce the subsequent risk of developing T2D.
Реферат
Background: Early data suggested a higher risk of COVID-19 in oncology patients, in particular those with co-morbidities or on systemic anticancer therapy (SACT). Immunisation strategies are likely to be critical in risk-reduction patient management. We examined patients' attitudes towards COVID-19 vaccines, studying factors affecting uptake such as demographics, socioeconomics, cancer diagnoses and treatments, and previous influenza vaccination. Methods: An anonymised questionnaire was distributed among oncology patients attending for SACT from November to December 2020. Statistical analyses were performed using SPSS v23 (IBM, Armonk, NY, USA). Results: In total 115 patients completed the survey. Of these, 30 (26%) were aged > 65, 65 (56%) were female and 54 (47%) were treated for metastatic disease. Overall 68 (59%) were receiving cytotoxic chemotherapy, and 15 (13%) were receiving immunotherapy. The most common cancer was breast (29%), followed by colorectal (18%) and lung (10%). Most patients (72%) had received or were intending to receive the influenza vaccine. Of patients surveyed 19 (17%) had friends or family who had been diagnosed with COVID-19, while only 3 (2.6%) had had COVID-19. The majority (81%) were in favour of receiving a COVID-19 vaccine if it was recommended for them. A small number however (5.2%) were against receiving a vaccine. Similar numbers of patients worried (30%) and did not worry (33%) that a COVID-19 vaccine could be unsafe. Interestingly 42% stated they if a COVID-19 vaccine were to be made available they would prefer to wait rather than to get it immediately. Patients who had received or intended to receive the influenza vaccine were less likely to want to delay receiving a COVID-19 vaccine (p=0.018). Age group, education level and palliative treatment was not associated with a significant difference in vaccine acceptance. Conclusions: The majority of patients surveyed were agreeable to COVID-19 vaccination, particularly those with prior influenza vaccination. An interesting finding was that though 42% of patients would prefer not to be first to receive the vaccine the majority welcomed vaccination. This finding, especially within a cohort regarded as being "highly vulnerable” to COVID, may have implications for the vaccine program in the general population. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Реферат
Background: The COVID pandemic has forced organisations to adapt to restrict spread of the virus while continuing to function. Oncology Clinical Nurse Specialists (CNS) have been forefront in these endeavours, often below the radar, ensuring coordination and administration of complex care. Nursing / Midwifery National Planning & Development Unit funding was awarded for a "task versatile" (tv) CNS in 2019 to focus on non ED direct access to a CNS. The key areas of this analysis were telephone triage and the ability of tvCNS COVID screening pre-chemotherapy visits to maintain a safe environment. Methods: Changes in primary roles of individual oncology CNS posts were recorded for 1/20 to 12/20. Data on the activity of the varied adaptive roles of the CNS were captured from the hospital information systems. All patients attending for chemotherapy were contacted 24 hours prior to their planned visit for chemotherapy to screen for COVID symptoms. Patients on arrival for chemotherapy were screened again prior to being allowed up to the chemotherapy unit. Those with concerning COVID symptoms were referred for COVID testing. Activity numbers were recorded by the tvCNS. Results: Nurse-lead telephone triage (NLTT) was assessed from 1/20 to 12/20. From the outbreak of COVID on 1/3/20 the "tv"CNS moved from the NLTT to that of COVID screening / risk reduction. A new CNS was appointed to continue NLTT. Of the 1837 telephone calls received requesting help from 1/20 to 12/20, 93% were resolved by the triage nurse, with only 121 cases attending the ER. In that time period 1304 individual patients made 11606 attendances to the oncology day unit for treatment. From 3/20 to 12/20 COVID pre-screening was performed for 10,417 patient visits. Screening was performed by phone the day before attendance, and on arrival on the day of planned treatment. 133 patients required COVID swab in view of symptoms. No day unit linked outbreaks of COVID occured. Conclusions: The COVID pandemic has demonstrated that versatility is essential in adjusting to the ever-changing scenarios which arise during peaks and troughs of COVID outbreaks. The broad skill mix within specialist oncology nursing were key to such adaptations, allowing continued availability of essential anti-cancer therapies. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Реферат
Background: The COVID-19 pandemic has impacted significantly on health systems across the globe. It has been reported to have higher incidence and to be associated with worse outcomes in patients with cancer. Beaumont Hospital is a large Dublin-based teaching hospital which was at the centre of the Irish outbreak of COVID-19. Methods: During the period 11th March to 15th May 2020, patients diagnosed with COVID-19 infection who were attending Beaumont Hospital for systemic anti-cancer therapy were included. Data were collected by chart review. Statistical analyses were performed using SPSS. Cancer-related prognosis was estimated using the Palliative Prognostic Score (PAP) with a score ≥11 associated with a 30-day survival of <30%. Results: In total, 717 patients attended oncology services for cancer directed treatment during the study period. 27 of these patients were diagnosed with COVID-19 based on RT-PCR. A further 4 patients were diagnosed clinically due to characteristic symptoms and radiology. The median age was 60 (38-84). 12 (39%) were female. The most common cancer type was lung n=9 (29%). 21 (67%) had metastatic disease;4 (13%) locally advanced disease and 6 (19%) were being treated with curative intent. Of the 31 patients diagnosed with COVID-19, 25 (80%) were hospitalised and none were admitted to intensive care. In total, 12/31 (41%) died, of which 5 (41%) had lung cancer, 10 (83%) had an PS of ≥3 and 3 (25%) had received systemic anti-cancer treatment in the last 30 days of life. The median age was 66 (38-84). 4 (33%) were female. All had incurable, locally advanced or metastatic disease. The mean time from diagnosis to death was 9.5 days. Those with an ECOG performance status (PS) ≥3 were more likely to die than those with PS ≤2 (p<0.001).Compared to those who recovered, patients who died from COVID-19 had higher mean number of organs affected by cancer (3.7 vs. 1.8, p=0.015) and higher mean PAP score (9.6 vs. 1.5, p<0.001). Conclusions: Patients with cancer who contracted COVID-19 and died had more sites of metastatic disease, a poorer performance status, and a higher Palliative Prognostic Score. The presence of multi-organ involvement appears to predict for poorer outcomes in COVID-19 positive cancer patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Реферат
Background: The delivery of systemic anticancer therapy during the COVID-19 pandemic is extremely challenging. Increased hospital visits and active anticancer therapy have been described as risk factors for developing more severe infection. In order to balance the benefits of continuing anticancer therapy with these risks, we undertook a series of system changes in the delivery of cancer care. We examined the rate of COVID-19 infection in patients attending for systemic anticancer treatments and the impact of COVID-19 on therapy delivered at our oncology dayward. Methods: Patients who attended our dayward over a 4 month period were included. Data were obtained from electronic patient records and chemotherapy prescribing records. Patients were screened for symptoms of COVID-19 infection at two separate timepoints: the day prior to their visit via telephone, and using a symptom questionnaire given in a preassessment area on arrival at the hospital. This area was established so that patients didn't have to transit through the main hospital. If patients displayed COVID-19 symptoms, they were isolated and a viral swab was arranged. Results: A total of 456 patients attended from January 1st to April 30th. During this time there were 2369 patient visits to the oncology dayward and 1953 intravenous therapies administered. 416 (18%) visits did not lead to treatments, 114 (27%) of which were scheduled non-treatment visits. 194 (47%) treatments were held due to disease-related illness and 108 (26%) treatments were held due to treatment-related complications. 19 patients were identified as having COVID-19 symptoms via telephone screening. 34 patients were symptomatic on arrival at our pre-assessment area and referred for swabs, of which 4 were positive. Those with a negative swab were rescheduled for chemotherapy the following week. Overall, 53 treatments were held due to the screening process. Conclusions: With the introduction of a new patient screening pathway, there have been few treatment disruptions due to the COVID-19 pandemic. The overall rate of symptomatic COVID-19 infection appears low in those who continue on active treatments with regular hospital visits. With careful systematic changes, it is feasible to continue to safely deliver systemic anticancer therapy during the COVID-19 pandemic. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.