scholarly journals Changes in Cancer Management due to COVID-19 Illness in Patients with Cancer in Northern California

2020 ◽  
pp. OP.20.00790
Author(s):  
Julie Tsu-Yu Wu ◽  
Daniel H. Kwon ◽  
Michael J. Glover ◽  
Solomon Henry ◽  
Douglas Wood ◽  
...  
Keyword(s):  
San Francisco ◽  
Curative Intent ◽  
Palliative Intent ◽  
Patients With Cancer ◽  
Cancer Management ◽  
Bay Area ◽  
Treatment Intent ◽  
The University ◽  
The Impact ◽  
Active Cancer

PURPOSE: The response to the COVID-19 pandemic has affected the management of patients with cancer. In this pooled retrospective analysis, we describe changes in management patterns for patients with cancer diagnosed with COVID-19 in two academic institutions in the San Francisco Bay Area. MATERIALS AND METHODS: Adult and pediatric patients diagnosed with COVID-19 with a current or historical diagnosis of malignancy were identified from the electronic medical record at the University of California, San Francisco, and Stanford University. The proportion of patients undergoing active cancer management whose care was affected was quantified and analyzed for significant differences with regard to management type, treatment intent, and the time of COVID-19 diagnosis. The duration and characteristics of such changes were compared across subgroups. RESULTS: A total of 131 patients were included, of whom 55 were undergoing active cancer management. Of these, 35 of 55 (64%) had significant changes in management that consisted primarily of delays. An additional three patients not undergoing active cancer management experienced a delay in management after being diagnosed with COVID-19. The decision to change management was correlated with the time of COVID-19 diagnosis, with more delays identified in patients treated with palliative intent earlier in the course of the pandemic (March/April 2020) compared with later (May/June 2020) (OR, 4.2; 95% CI, 1.03 to 17.3; P = .0497). This difference was not seen among patients treated with curative intent during the same timeframe. CONCLUSION: We found significant changes in the management of cancer patients with COVID-19 treated with curative and palliative intent that evolved over time. Future studies are needed to determine the impact of changes in management and treatment on cancer outcomes for patients with cancer and COVID-19.

Measuring alignment with evidence-informed practice in Ontario’s systemic treatment funding model.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 15-15
Author(s):  
Leonard Kaizer ◽  
Vicky Simanovski ◽  
Irene Blais ◽  
Carlin Lalonde ◽  
Huma Tariq ◽  
...  
Keyword(s):  
Systemic Treatment ◽  
Life Time ◽  
Curative Intent ◽  
Palliative Intent ◽  
Treatment Regimens ◽  
Funding Model ◽  
Disease Site ◽  
Episodes Of Care ◽  
Treatment Intent ◽  
The Impact

15 Background: A new systemic treatment funding model (STFM) was implemented in Ontario on April 1, 2014, transitioning from life-time per case funding to reimbursement based on evidence-informed episodes of care. The effectiveness of the model will be evaluated against key indicators including the percent of patients on evidence-informed regimens (PPEIR). Methods: Provincial Disease Site Group (DSG) experts reviewed all chemotherapy regimens administered in Ontario over the two years prior to implementation. Each DSG identified the treatment regimens to be STFM reimbursed, based on evidence of clinical benefit according to treatment intent (curative/adjuvant vs. palliative or both). A year of pre-implementation data will serve as a baseline to assess the impact of transition to the new funding model. Clinical and administrative stakeholders have received their baseline facility-level data and will receive monthly reports, including the PPEIR, to aid in identifying and resolving clinical practice and/or data quality issues post-implementation. Results: Of approximately 1,000 regimens reviewed by the DSGs, ~100 were deemed to be evidence informed for adjuvant/curative intent, ~325 for palliative intent, and ~90 for both intents. Overall, the 2013/14 baseline provincial PPEIR was 91.6% for 16,200 treatment courses given with adjuvant/curative intent while 93.2% of 56,800 patient-months of treatment with palliative intent were aligned with the proposed evidence informed definition. Significant variation in baseline PPEIR was seen for the 29 level 1-3 provincial treatment facilities (range = 71-99%) and for the 10 different disease sites. Conclusions: Knowledge of the PPEIR utilized increases understanding of practice at the system (provincial), regional, facility and disease site level and will provide opportunities for benchmarking and ongoing improvement in quality of care.

Patterns in cancer management changes for patients with COVID-19 in northern California.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1535-1535
Author(s):  
Michael Glover ◽  
Julie Wu ◽  
Daniel H Kwon ◽  
Sylvia Zhang ◽  
Solomon Henry ◽  
...  
Keyword(s):  
Clinical Status ◽  
Northern California ◽  
Curative Intent ◽  
Palliative Intent ◽  
Cancer Management ◽  
Chi Squared ◽  
Oncology Practice ◽  
Management Changes ◽  
Over Time ◽  
Active Cancer

1535 Background: The COVID-19 pandemic affected oncology practice in ways that are still evolving. In particular, COVID-19 has led to changes in cancer treatment for patients (pts) infected with COVID, which may have long-term implications for both COVID and cancer-related outcomes. In this retrospective analysis, we describe changes in cancer management over time for cancer pts diagnosed with COVID-19 at two academic institutions in Northern California. Methods: Adult and pediatric pts diagnosed with COVID-19 receiving active cancer management, defined as therapy/surgery/diagnostics within 3 weeks of COVID diagnosis, were identified through the EMR. Patients whose care was affected by COVID-19 were identified and analyzed for significant intra-group differences with regards to management type, treatment intent, and the time of COVID-19 diagnosis (“early” was defined as March to June 2020 and “late” as July 2020 to January 2021). The duration and characteristics of such changes were compared across subgroups. Chi-squared test was used to compare the incidence of delays between subgroups. Results: Among 134 COVID-positive pts on active cancer management, 83 (62%) had significant changes in management that consisted primarily of treatment delays. More delays were identified in patients treated with curative intent earlier in the course of the pandemic compared to later (OR 4.1, p=0.022). This difference was not seen among pts treated with palliative intent. In addition, pts on oral (PO) therapy were significantly less likely to have treatment changes than those on IV/IM therapy (OR 0.32, p=0.005). This difference was driven by a decrease in management changes for those on PO therapy in the later time period (OR 0.27, p=0.026). Pts diagnosed later were more likely to have delays due to clinical reasons rather than institutional policy (OR 6.2, P<.005). The median delay in both time frames was 21 days. Comparison of subgroups is shown in the table. Conclusions: We found significant changes in management of cancer pts with COVID-19 that evolved over time. Oncologists have become increasingly willing to continue therapy for cancer pts treated with curative intent and pts on oral therapy. Changes in cancer therapy have become more frequently related to patient clinical status, and less so due to institutional policies. It will be important to analyze how these changes in management are ultimately reflected in cancer outcomes in order to equip patients and oncologists to react to the next pandemic.[Table: see text]

scholarly journals High food insecurity in Latinx families and associated COVID-19 infection in the Greater Bay Area, California

BMC Nutrition ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Milagro Escobar ◽  
Andrea DeCastro Mendez ◽  
Maria Romero Encinas ◽  
Sofia Villagomez ◽  
Janet M. Wojcicki
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
San Francisco ◽  
Employment Status ◽  
The United States ◽  
Household Food Security ◽  
Bay Area ◽  
Household Food ◽  
History Of ◽  
The Impact

Abstract Background Food insecurity impacts nearly one-in-four Latinx households in the United States and has been exacerbated by the novel coronavirus or COVID-19 pandemic. Methods We examined the impact of COVID-19 on household and child food security in three preexisting, longitudinal, Latinx urban cohorts in the San Francisco Bay Area (N = 375 households, 1875 individuals). Households were initially recruited during pregnancy and postpartum at Zuckerberg San Francisco General Hospital (ZSFG) and UCSF Benioff prior to the COVID-19 pandemic. For this COVID-19 sub-study, participants responded to a 15-min telephonic interview. Participants answered 18 questions from the US Food Security Food Module (US HFSSM) and questions on types of food consumption, housing and employment status, and history of COVID-19 infection as per community or hospital-based testing. Food security and insecurity levels were compared with prior year metrics. Results We found low levels of household food security in Latinx families (by cohort: 29.2%; 34.2%; 60.0%) and child food security (56.9%, 54.1%, 78.0%) with differences between cohorts explained by self-reported levels of education and employment status. Food security levels were much lower than those reported previously in two cohorts where data had been recorded from prior years. Reported history of COVID-19 infection in households was 4.8% (95% Confidence Interval (CI); 1.5–14.3%); 7.2% (95%CI, 3.6–13.9%) and 3.5% (95%CI, 1.7–7.2%) by cohort and was associated with food insecurity in the two larger cohorts (p = 0.03; p = 0.01 respectively). Conclusions Latinx families in the Bay Area with children are experiencing a sharp rise in food insecurity levels during the COVID-19 epidemic. Food insecurity, similar to other indices of poverty, is associated with increased risk for COVID-19 infection. Comprehensive interventions are needed to address food insecurity in Latinx populations and further studies are needed to better assess independent associations between household food insecurity, poor nutritional health and risk of COVID-19 infection.

A Musical Technography of John Bischoff

2004 ◽  
Vol 14 ◽  
pp. 75-79
Author(s):  
Douglas Kahn
Keyword(s):  
San Francisco ◽  
Early Development ◽  
Computer Music ◽  
Turning Point ◽  
San Francisco Bay Area ◽  
Experimental Music ◽  
Music Technology ◽  
Electronic Components ◽  
Bay Area ◽  
The Impact

John Bischoff has been part of the formation and growth of electronic and computer music in the San Francisco Bay Area for over three decades. In an interview with the author, he describes his early development as a student of experimental music technology, including the impact of hearing and assisting in the work of David Tudor. Bischoff, like Tudor, explored the unpredictable potentials within electronic components, and he brought this curiosity to bear when he began working on one of the first available micro-computers. He was a key individual at the historical turning point when computer music escaped its institutional restric-tions and began becoming widespread.

scholarly journals Commuter Response to Traffic Information on an Incident

1998 ◽  
Vol 1621 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Ronald Koo ◽  
Youngbin Yim
Keyword(s):  
San Francisco ◽  
Travel Behavior ◽  
San Francisco Bay Area ◽  
Traffic Information ◽  
Behavior Changes ◽  
Bay Area ◽  
Telephone System ◽  
Changes Over Time ◽  
The Impact ◽  
Insight Into

How traffic information is obtained and how it affects travel behavior when a major freeway is congested are presented and discussed. Immediately following a major highway incident south of San Francisco that caused congestion, a telephone survey was conducted of commuters who use the affected corridor of the highway. The behavior of commuters before and during their commute at the time of the incident was determined, including obtaining traffic information and how the information influenced changes in route, mode of travel, and departure time. The results of the survey suggest that traveler behavior is largely unaffected by individual incidents of congestion. Furthermore, although a fair proportion of commuters do obtain traffic information, they do not often modify their travel behavior in response. This study is one of several that collectively will provide insight into how travel behavior changes over time and allow the authors to assess the impact of TravInfo Traveler Advisory Telephone System in the San Francisco Bay Area.

Paediatric relapsed acute leukaemia: curative intent chemotherapy improves quality of life

2021 ◽  
pp. bmjspcare-2020-002722
Author(s):  
Carmen Salaverria ◽  
Erin Plenert ◽  
Roberto Vasquez ◽  
Soad Fuentes-Alabi ◽  
George A Tomlinson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Health ◽  
Acute Leukaemia ◽  
Self Report ◽  
Curative Intent ◽  
Palliative Intent ◽  
Paediatric Patients ◽  
Induction Failure ◽  
The Impact

ObjectivesPaediatric patients with leukaemia with relapse or induction failure have poor prognosis. Anticipated quality of life (QoL) is important in treatment decision making. The objective was to determine if curative intent at relapse or induction failure, when compared with palliative intent, was associated with child’s physical health, pain or general fatigue and parents’ QoL over time among patients with paediatric leukaemia in El Salvador.MethodsThis was a prospective observational cohort study. Children 2–18 years with acute leukaemia at first relapse or induction failure were eligible. Assessments occurred every 2 months for up to 2 years using validated proxy report and self-report scales, where guardians were the primary respondents. Initial curative or palliative intent was categorised at enrolment by physicians. The impact of initial intent on QoL was assessed using linear mixed effects models and interaction between QoL and time.ResultsOf the 60 families enrolled, initial treatment intent was curative in 31 (51.7%) and palliative in 29 (48.3%). During the 2-year observation period, 44 children died. Initial curative intent significantly improved child’s physical health (estimate=8.4, 95% CI 5.1 to 11.6), pain (estimate=5.4, 95% CI 1.5 to 9.2) and fatigue (estimate=6.6, 95% CI 3.2 to 9.9) compared with palliative intent, but not parents’ QoL (estimate=1.0, 95% CI −0.8 to 2.8).ConclusionsAmong paediatric patients with acute leukaemia at relapse or induction failure, initial curative intent treatment plan was associated with better physical health, pain and fatigue when compared with palliative intent. A curative approach may be a reasonable option for patients with acute leukaemia even when prognosis is poor.

History of geological investigations of Mount Diablo, Contra Costa County, California

2021 ◽  
Author(s):  
Gregory W. Bartow
Keyword(s):  
San Francisco ◽  
Focal Point ◽  
San Francisco Bay Area ◽  
University Of California ◽  
General Description ◽  
Mountain Building ◽  
Structural Interpretation ◽  
Bay Area ◽  
History Of ◽  
The University

ABSTRACT Over the past 150 years, Mount Diablo has served as a window into the evolving understanding of California geology. In the 1800s, geologists mapped this easily accessible peak located less than 100 km (62 miles) from the rapidly growing city of San Francisco and the geology departments at the University of California at Berkeley and Stanford University. Later, the mountain served as a focal point for investigating San Francisco Bay area tectonics. The structural interpretation of the up-thrusting mechanisms has evolved from a simple compressional system involving a few local faults to a more complex multifault and multiphase mountain-building theory. The stratigraphic interpretation and understanding have been advanced from a general description of the lithologies and fossils to a detailed description using sequence stratigraphy to define paleogeographic settings and depositional regimes.

scholarly journals A mixed-methods evaluation of the impact of a person-centered family planning intervention for community health workers on family planning outcomes in India

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nadia Diamond-Smith ◽  
Claire McDonell ◽  
Ananta Basudev Sahu ◽  
Kali Prasad Roy ◽  
Katie Giessler
Keyword(s):  
Mixed Methods ◽  
Family Planning ◽  
Community Health ◽  
San Francisco ◽  
Health Workers ◽  
Qualitative Interviews ◽  
Centered Care ◽  
The University ◽  
Care Worker ◽  
The Impact

Abstract Background Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs). Methods In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake. Results Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention. Conclusions More research is needed on how to intervene to change behaviors related to person-centered family planning. Trial registration This study received IRB approval from the University of California, San Francisco (IRB # 15–25,950) and was retrospectively registered at clinicaltrials.gov (NCT04206527).

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