Toxicity results after treatment with Electronic Brachytherapy in patients with endometrial cancer

Poster Session [EP-2226] Purpose or Objective To analyse the toxicity outcomes after treatment with Electronic Brachytherapy (XB) in postsurgical endometrial cancer patients treated at our medical centre. Material and Methods Prospective study in which we selected 94 patients, between September/2015 and September/2017, that received treatment with XB administered twice a week after endometrial cancer surgery, with IMRT planificati on. The patients were divided in two groups: Group 1 (57/94) considered high risk received external beam radiotherapy (46Gy) followed by XB (15Gy in 5Gy fractions) and group 2 (37/94) considered intermediate risk received exclusive XB (25Gy in 5Gy fraction s). We analysed the median dose in bladder, rectum and sigmoid D2cc, V50, V35 with XB comparing the doses with Ir192. The vaginal mucosa, gastrointestinal (GI) and genitourinary (GU) toxicities were analysed with the Common Terminology Criteria for Adverse Events (CTCAE 4.0) scale. Results The median dose in bladder with XB vs. Ir192 was: 2cc 62.9 vs. 69.9%, V50 7.1 vs. 12.6Gy, V35 15 vs. 28.1. In rectum XB vs. Ir192 was: D 2cc 64.01% vs. 67.7%, V50 7.8 vs. 10.9Gy, V35 16.5 vs. 31.8Gy. In sigmoid XB vs. Ir 192 was: D 50.37%vs. 58.0%, V50 8.8 vs. 16.2Gy, V35 21.2 vs. 37.5Gy. The median follow- up was 11 months (range 1 - 23, 9 months). In group 1, acute vaginal mucositis (G1) was observed in 35.08% of the patients, GI toxicity (G1) in 5.26% and GU toxicity (G1) in 10.52%. In group 2, we observed acute vaginal mucositis G1 in 45% of the patients and G2 in 10.81%, GI toxicity (G1) occurred in 2.7% and GU toxicity (G1) was present in 16.21%. There was no grade 3 or greater toxicity in any of the groups. Late toxici ty was observed in only 4 patients: Mucositis (G1) in 3 patients and GU toxicity (G1) in 1 patient. Conclusion The dose received by the organs at risk with the XB is less compared to Ir192, with a good coverage of the PTV. The greater toxicity was observe d immediately after the treatment was finished with an important reduction of the symptoms after 6 months. This technique shows excellent results as for toxicity

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Background and purpose: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality.

BACKGROUND AND PURPOSE: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. METHODS: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). RESULTS: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. CONCLUSIONS: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

EP-2226: Toxicity results after treatment with Electronic Brachytherapy in patients with endometrial cancer

Poster Session [EP-2226] Purpose or Objective To analyse the toxicity outcomes after treatment with Electronic Brachytherapy (XB) in postsurgical endometrial cancer patients treated at our medical centre. Material and Methods Prospective study in which we selected 94 patients, between September/2015 and September/2017, that received treatment with XB administered twice a week after endometrial cancer surgery, with IMRT planificati on. The patients were divided in two groups: Group 1 (57/94) considered high risk received external beam radiotherapy (46Gy) followed by XB (15Gy in 5Gy fractions) and group 2 (37/94) considered intermediate risk received exclusive XB (25Gy in 5Gy fraction s). We analysed the median dose in bladder, rectum and sigmoid D2cc, V50, V35 with XB comparing the doses with Ir192. The vaginal mucosa, gastrointestinal (GI) and genitourinary (GU) toxicities were analysed with the Common Terminology Criteria for Adverse Events (CTCAE 4.0) scale. Results The median dose in bladder with XB vs. Ir192 was: 2cc 62.9 vs. 69.9%, V50 7.1 vs. 12.6Gy, V35 15 vs. 28.1. In rectum XB vs. Ir192 was: D 2cc 64.01% vs. 67.7%, V50 7.8 vs. 10.9Gy, V35 16.5 vs. 31.8Gy. In sigmoid XB vs. Ir 192 was: D 50.37%vs. 58.0%, V50 8.8 vs. 16.2Gy, V35 21.2 vs. 37.5Gy. The median follow- up was 11 months (range 1 - 23, 9 months). In group 1, acute vaginal mucositis (G1) was observed in 35.08% of the patients, GI toxicity (G1) in 5.26% and GU toxicity (G1) in 10.52%. In group 2, we observed acute vaginal mucositis G1 in 45% of the patients and G2 in 10.81%, GI toxicity (G1) occurred in 2.7% and GU toxicity (G1) was present in 16.21%. There was no grade 3 or greater toxicity in any of the groups. Late toxici ty was observed in only 4 patients: Mucositis (G1) in 3 patients and GU toxicity (G1) in 1 patient. Conclusion The dose received by the organs at risk with the XB is less compared to Ir192, with a good coverage of the PTV. The greater toxicity was observe d immediately after the treatment was finished with an important reduction of the symptoms after 6 months. This technique shows excellent results as for toxicity

Speaking up about bullying and harassment in healthcare: reflections following the introduction of an innovative “speak up” role in NHS England

Healthcare organisations reap significant benefits when workers’ concerns are adequately listened and responded to, including improved patient safety, reduced costs and improved staff experience. Although many concerns are dealt with satisfactorily, compelling evidence suggests that problems of silence (where employees do not speak up) and deafness (where organisations do not hear concerns or act) remain pervasive worldwide. In the English National Health Service (NHS) the response to these problems includes numerous policy initiatives and the introduction in 2016 of the “Freedom to Speak Up Guardian” (FTSUG) role. This globally unique role is described as potentially leading to huge improvements in the way staff concerns are handled and responded to leading to improvements in organisational learning and patient safety. Following their introduction thousands of NHS staff have already spoken up via FTSUGs. The majority of FTSUGs time is spent on bullying and harassment concerns, rather than direct patient safety concerns, which appears to have confounded FTSUGs’ and others’ expectations. This chapter opens by describing the background to the development of the FTSUG role. We then outline the literature on bullying and harassment; its shocking prevalence within healthcare workplaces and the damaging consequences of bullying borne by organisations and individual staff and patients. We also discuss our analysis of semi-structured interviews (n = 87) undertaken with FTSUGs, which illustrates the realities of dealing with colleagues’ concerns about bullying and harassment and how these realities are often overlooked in national, regional and local workplace guidance and training materials currently available to support the implementation of the role

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

BACKGROUND AND PURPOSE: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. METHODS: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). RESULTS: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P CONCLUSIONS: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up

Background: Prior studies indicated a decrease in the incidences of aneurysmal subarachnoid haemorrhage (aSAH) during the early stages of the COVID-19 pandemic. We evaluated differences in the incidence, severity of aSAH presentation, and ruptured aneurysm treatment modality during the first year of the COVID-19 pandemic compared with the preceding year. Methods: We conducted a cross-sectional study including 49 countries and 187 centres. We recorded volumes for COVID-19 hospitalisations, aSAH hospitalisations, Hunt-Hess grade, coiling, clipping and aSAH in-hospital mortality. Diagnoses were identified by International Classification of Diseases, 10th Revision, codes or stroke databases from January 2019 to May 2021. Results: Over the study period, there were 16 247 aSAH admissions, 344 491 COVID-19 admissions, 8300 ruptured aneurysm coiling and 4240 ruptured aneurysm clipping procedures. Declines were observed in aSAH admissions (-6.4% (95% CI -7.0% to -5.8%), p=0.0001) during the first year of the pandemic compared with the prior year, most pronounced in high-volume SAH and high-volume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentations of subarachnoid haemorrhage (SAH) (mild: -5% (95% CI -5.9% to -4.3%), p=0.06; moderate: -8.3% (95% CI -10.2% to -6.7%), p=0.06) but no difference in higher SAH severity. The ruptured aneurysm clipping rate remained unchanged (30.7% vs 31.2%, p=0.58), whereas ruptured aneurysm coiling increased (53.97% vs 56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%, p=0.12). Conclusion: During the first year of the pandemic, there was a decrease in aSAH admissions volume, driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the ruptured aneurysm coiling rate but neither change in the ruptured aneurysm clipping rate nor change in aSAH in-hospital mortality