ResearchPad - 2474 https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[ESMO Management and treatment adapted recommendations in the COVID-19 era: Pancreatic Cancer]]> https://www.researchpad.co/article/elastic_article_12541 The COVID-19 pandemic is challenging the capacities of health systems in many countries. National healthcare services have to manage unexpected shortages of healthcare resources that have to be re-allocated according to the principles of fair and ethical prioritisation, in order to maintain the highest levels of care to all patients, ensure the safety of patients and healthcare workers, and save as many lives as possible. Also, cancer care services have to pursue restructuring, following the same evidence-based dispositions. In this article, we propose a guidance to the management of pancreatic cancer during the pandemic, prioritised according to a three-tiered framework, and based on expert clinical judgement and magnitude of benefit expected from specific interventions. Since the availability of resources for diagnostic procedures, surgery and postoperative care, systemic therapy and radiotherapy may differ, the authors have separated the prioritisation analyses. The impact of postponing or abrogating cancer interventions on outcomes according to a high, medium or low priority scale is outlined and discussed. The implementation of healthcare services using telemedicine is explored; it reveals itself as functional and effective for limiting patients’ need to travel to centres and thereby has the potential to reduce diffusion of SARS-CoV-2. Pancreatic cancer demands a considerable amount of medical resources. Therefore, the redefinition of its diagnostic and therapeutic algorithms with a rigorous method is crucial in order to ensure the highest quality of continuum of care in the broader context of the pandemic and the challenged healthcare systems.

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<![CDATA[Tension pneumothorax in a patient with COVID-19]]> https://www.researchpad.co/article/elastic_article_12524 A 36-year-old man was brought to the emergency department with suspected COVID-19, following a 3-week history of cough, fevers and shortness of breath, worsening suddenly in the preceding 4 hours. On presentation he was hypoxaemic, with an SpO2 of 88% on 15 L/min oxygen, tachycardic and had no audible breath sounds on auscultation of the left hemithorax. Local guidelines recommended that the patient should be initiated on continuous positive airway pressure while investigations were awaited, however given the examination findings an emergency portable chest radiograph was performed. The chest radiograph demonstrated a left-sided tension pneumothorax. This was treated with emergency needle decompression, with good effect, followed by chest drain insertion. A repeat chest radiograph demonstrated lung re-expansion, and the patient was admitted to a COVID-19 specific ward for further observation. This case demonstrates tension pneumothorax as a possible complication of suspected COVID-19 and emphasises the importance of thorough history-taking and clinical examination.

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<![CDATA[Not the 2020 we asked for]]> https://www.researchpad.co/article/elastic_article_10324 <![CDATA[A rationale and framework for seeking remote electronic or phone consent approval in endovascular stroke trials – special relevance in the COVID-19 environment and beyond]]> https://www.researchpad.co/article/elastic_article_10274 Enrollment in time-sensitive endovascular stroke trials can be challenging because of an inability to consent a debilitated patient. Often the legally authorized representative is not on site. Remote consent procedures in the US are inconsistent with the majority of sites shunning these approaches. The current pandemic with visitor restrictions highlights the need for enhancing these options.MethodsRemote electronic and phone consent procedures specifically for endovascular stroke trials from two comprehensive stroke centers (CSC) are presented. An overview of the genesis of informed consent procedures in the US is also included.ResultsThe two CSCs identified as Institution-1 and Institution-2 are large tertiary systems. Institution-1 is a non-profit university-affiliated academic medical center in rural geography. Institution-2 is an HCA hospital in an urban environment. Both serve patients through a spoke-and-hub network, have participated in multiple randomized endovascular stroke trials, and have successfully used these remote options for enrollment. A tiered approach is employed at both institutions with an emphasis on obtaining informed consent in person and resorting to alternatives methods when efforts to that are unsuccessful. A rationale for electronic and phone consent is included, followed by step-by-step illustration of the process at each institution.ConclusionTwo examples of remote electronic or phone consent procedures from institutions in different geographic environments and organization structures demonstrate that these options can be successfully used for enrollment in stroke trials. The current pandemic highlights the need to enhance these approaches while maintaining appropriate adherence to ethical and legal frameworks. ]]> <![CDATA[Legal preparedness as part of COVID-19 response: the first 100 days in Taiwan]]> https://www.researchpad.co/article/elastic_article_10273 <![CDATA[Diffuse pneumonitis from coronavirus HKU1 on checkpoint inhibitor therapy]]> https://www.researchpad.co/article/elastic_article_10272 Immune checkpoint inhibitors (ICIs) can produce specific immune-related adverse events including pneumonitis. The impact of ICI therapy on the severity of acute coronavirus infection symptomatology warrants further exploration.Case presentationWe report a 65-year-old man diagnosed with stage IV melanoma who developed pulmonary and brain metastases and was treated with bilateral craniotomies followed by combined nivolumab and ipilimumab immunotherapy. He developed early-onset severe dyspnea associated with acute coronavirus HKU1 (non-COVID-19) infection, with diffuse pneumonitis evidenced by ground glass opacification on CT scan. He was treated with steroids leading to resolution of pneumonitis on repeat imaging, suggesting an exacerbated immune-mediated toxicity.ConclusionWe report the first case of a patient with melanoma with severe and reversible diffuse pneumonitis in association with coronavirus HKU1 following combined nivolumab and ipilimumab immunotherapy. Although we do not have data on the impact of ICI therapy on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptomatology, a possible interaction should be considered when deciding on dosing in patients with possible SARS-CoV-2 exposure or when evaluating patients with presumed ICI-related pneumonitis during the COVID-19 pandemic. ]]> <![CDATA[COVID-19 and lung cancer: risks, mechanisms and treatment interactions]]> https://www.researchpad.co/article/elastic_article_10271 Cases of the 2019 novel coronavirus also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to rise worldwide. To date, there is no effective treatment. Clinical management is largely symptomatic, with organ support in intensive care for critically ill patients. The first phase I trial to test the efficacy of a vaccine has recently begun, but in the meantime there is an urgent need to decrease the morbidity and mortality of severe cases. It is known that patients with cancer are more susceptible to infection than individuals without cancer because of their systemic immunosuppressive state caused by the malignancy and anticancer treatments. Therefore, these patients might be at increased risk of pulmonary complications from COVID-19. The SARS-CoV-2 could in some case induce excessive and aberrant non-effective host immune responses that are associated with potentially fatal severe lung injury and patients can develop acute respiratory distress syndrome (ARDS). Cytokine release syndrome and viral ARDS result from uncontrolled severe acute inflammation. Acute lung injury results from inflammatory monocyte and macrophage activation in the pulmonary luminal epithelium which lead to a release of proinflammatory cytokines including interleukin (IL)-6, IL-1 and tumor necrosis factor-α. These cytokines play a crucial role in immune-related pneumonitis, and could represent a promising target when the infiltration is T cell predominant or there are indirect signs of high IL-6-related inflammation, such as elevated C-reactive protein. A monoclonal anti-IL-6 receptor antibody, tocilizumab has been administered in a number of cases in China and Italy. Positive clinical and radiological outcomes have been reported. These early findings have led to an ongoing randomized controlled clinical trial in China and Italy. While data from those trials are eagerly awaited, patients’ management will continue to rely for the vast majority on local guidelines. Among many other aspects, this crisis has proven that different specialists must join forces to deliver the best possible care to patients.

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<![CDATA[COVID-19 and immune checkpoint inhibitors: initial considerations]]> https://www.researchpad.co/article/elastic_article_10270 COVID-19 infections are characterized by inflammation of the lungs and other organs that ranges from mild and asymptomatic to fulminant and fatal. Patients who are immunocompromised and those with cardiopulmonary comorbidities appear to be particularly afflicted by this illness. During pandemic conditions, many aspects of cancer care have been impacted. One important clinical question is how to manage patients who need anticancer therapy, including immune checkpoint inhibitors (ICIs) during these conditions. Herein, we consider diagnostic and therapeutic implications of using ICI during this unprecedented period of COVID-19 infections. In particular, we consider the impact of ICI on COVID-19 severity, decisions surrounding continuing or interrupting therapy, diagnostic measures in patients with symptoms or manifestations potentially consistent with either COVID-19 or ICI toxicity, and resumption of therapy in infected patients. While more robust data are needed to guide clinicians on management of patients with cancer who may be affected by COVID-19, we hope this commentary provides useful insights for the clinical community.

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<![CDATA[Vitamin D and SARS-CoV-2 virus/COVID-19 disease]]> https://www.researchpad.co/article/elastic_article_10269 <![CDATA[Providing uninterrupted care during COVID-19 pandemic: experience from Beijing Tiantan Hospital]]> https://www.researchpad.co/article/elastic_article_10267 The COVID-19 pandemic has already stressed the healthcare system in the world. Many hospitals have been overwhelmed by the large number of patients with COVID-19. Due to the shortage of equipment and personnel and the highly contagious nature of COVID-19, many other healthcare services are on hold. However, at Beijing Tiantan Hospital, a rapid response system has been in place so that routine care is not interrupted. We, therefore, would like to share our hospital-wide prevention and management policy during this pandemic to help other healthcare systems to function in this crisis.MethodTiantan hospital is one of the leading neuroscience institutions in the world. With 1650 beds, its annual inpatient admission exceeds 30 000 patients. Its COVID-19 rapid response policy was reviewed for its functionality.ResultsThere are nine key components of this policy: an incident management system; a comprehensive infection prevention and control, outpatient triage and flow system; a designated fever clinic; patient screening and administration; optimised surgical operations, enhanced nucleic acid testing; screening of returning employees; and a supervision and feedback system. In addition, a specific protocol was designed for treating patients with acute stroke.ConclusionA comprehensive policy is helpful to protect the employee from infection and to provide quality and uninterrupted care to all who need these, including patients with acute ischaemic stroke. ]]> <![CDATA[Could severe COVID-19 be considered a complementopathy?]]> https://www.researchpad.co/article/elastic_article_10265 <![CDATA[Status and situation of postgraduate medical students in China under the influence of COVID-19]]> https://www.researchpad.co/article/elastic_article_10264 <![CDATA[Is COVID-19 more severe in older men?]]> https://www.researchpad.co/article/elastic_article_10263 <![CDATA[Ten minutes with Dr Gregory R Ciottone, MD, FACEP, FFSEM, President of the World Association for Disaster and Emergency Medicine]]> https://www.researchpad.co/article/elastic_article_10262 <![CDATA[COVID-19 guidance in chronic diseases: a need to reach across the borders of the traditional medical specialities]]> https://www.researchpad.co/article/elastic_article_10261 <![CDATA[Flattening the curve in COVID-19 using personalised protective equipment: lessons from air pollution]]> https://www.researchpad.co/article/elastic_article_10260 <![CDATA[Resuming elective surgical services in times of COVID-19 infection]]> https://www.researchpad.co/article/elastic_article_10259 The consequences of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus have been devastating to the healthcare system.

As the positive effects of social distancing, mandatory masking, and societal lockdown on the spread of the disease and its incidence in the community were documented, societal and financial pressures mounted worldwide, prompting efforts to “re-open” countries, states, communities, businesses, and schools. The same happened with hospital, which had to start developing strategies to resume elective surgery activities. This manuscript describes the pre-requisites as well as the strategies for resuming surgical activity, be it in the outpatient or inpatient setting.

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<![CDATA[The impact of COVID-19 on HIV financing in Nigeria: a call for proactive measures]]> https://www.researchpad.co/article/elastic_article_10258 <![CDATA[GI symptoms as early signs of COVID-19 in hospitalised Italian patients]]> https://www.researchpad.co/article/elastic_article_10257 <![CDATA[‘Your country needs you’: the ethics of allocating staff to high-risk clinical roles in the management of patients with COVID-19]]> https://www.researchpad.co/article/elastic_article_10256 As the COVID-19 pandemic impacts on health service delivery, health providers are modifying care pathways and staffing models in ways that require health professionals to be reallocated to work in critical care settings. Many of the roles that staff are being allocated to in the intensive care unit and emergency department pose additional risks to themselves, and new policies for staff reallocation are causing distress and uncertainty to the professionals concerned. In this paper, we analyse a range of ethical issues associated with changes to staff allocation processes in the face of COVID-19. In line with a dominant view in the medical ethics literature, we claim, first, that no individual health professional has a specific, positive obligation to treat a patient when doing so places that professional at risk of harm, and so there is a clear ethical tension in any reallocation process in this context. Next, we argue that the changing asymmetries of health needs in hospitals means that careful consideration needs to be given to a stepwise process for deallocating staff from their usual duties. We conclude by considering how a justifiable process of reallocating professionals to high-risk clinical roles should be configured once those who are ‘fit for reallocation’ have been identified. We claim that this process needs to attend to three questions that we consider in detail: (1) how the choice to make reallocation decisions is made, (2) what justifiable models for reallocation might look like and (3) what is owed to those who are reallocated.

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