33778 The impact and implications of COVID-19 on using scalp cooling therapy for prevention of chemotherapy-induced alopecia

Background: Scalp cooling therapy (SCT) is currently the most effective method to reduce chemotherapy-induced alopecia. Manual SCT requires a “capper” to change the caps throughout the infusion day whereas machine SCT only requires a 1-time cap fitting prior to infusion, usually performed by the health care staff. Coronavirus disease 2019 (COVID-19) brought restrictions on permitted infusion center visitors, which we hypothesized would include “cappers,” creating an additional barrier to SCT use. Methods: A scripted call was placed during May 2021 by a study author to infusion centers of Commission on Cancer (CoC) accredited hospitals in Michigan, New York City (NYC) and major cities in Texas in order to investigate how COVID-19 impacted SCT at their institution. The University of Michigan’s Institutional Review Board (IRB) deemed this study exempt from IRB approval. Results: Forty-one infusion centers were successfully contacted (40/62, 64.5%). Of the 33 that allow SCT, 41% (14) did not allow “cappers” under COVID-19 restrictions. Of the 13 institutions offering machine SCT, 92% (12/13) allowed patients to continue using the machines during the pandemic as it does not require an outside “capper.” Conclusion: Our study demonstrates the negative impact of COVID-19 on manual SCT use. As COVID-19 is likely here for the foreseeable future, it is critical to find ways to safely use SCT during these times. Hence, hospital adoption of SCT machines is even more critical given the pandemic, particularly for those of lower socioeconomic status and without strong social support

The cost-effectiveness of providing antenatal lifestyle advice for women who are overweight or obese: the LIMIT randomised trial

Background: Overweight and obesity during pregnancy is common, although robust evidence about the economic implications of providing an antenatal dietary and lifestyle intervention for women who are overweight or obese is lacking. We conducted a health economic evaluation in parallel with the LIMIT randomised trial. Women with a singleton pregnancy, between 10+0-20+0weeks, and BMI ≥ 25 kg/m2were randomised to Lifestyle Advice (a comprehensive antenatal dietary and lifestyle intervention) or Standard Care. The economic evaluation took the perspective of the health care system and its patients, and compared costs encountered from the additional use of resources from time of randomisation until six weeks postpartum. Increments in health outcomes for both the woman and infant were considered in the cost-effectiveness analysis. Mean costs and effects in the treatment groups allocated at randomisation were compared, and incremental cost effectiveness ratios (ICERs) and confidence intervals (95%) calculated. Bootstrapping was used to confirm the estimated confidence intervals, and to generate acceptability curves representing the probability of the intervention being cost-effective at alternative monetary equivalent values for the outcomes avoiding high infant birth weight, and respiratory distress syndrome. Analyses utilised intention to treat principles. Results: Overall, the increase in mean costs associated with providing the intervention was offset by savings associated with improved immediate neonatal outcomes, rendering the intervention cost neutral (Lifestyle Advice Group 11261.19±14573.97 versus Standard Care Group 11306.70±14562.02; p=0.094). Using a monetary value of $20,000 as a threshold value for avoiding an additional infant with birth weight above 4 kg, the probability that the antenatal intervention is cost-effective is 0.85, which increases to 0.95 when the threshold monetary value increases to$45,000. Conclusions: Providing an antenatal dietary and lifestyle intervention for pregnant women who are overweight or obese is not associated with increased costs or cost savings, but is associated with a high probability of cost effectiveness. Ongoing participant follow-up into childhood is required to determine the medium to long-term impact of the observed, short-term endpoints, to more accurately estimate the value of the intervention on risk of obesity, and associated costs and health outcomes

Trans-abdominal cervical cerclage revisited

Changes in contemporary obstetric and gynaecological practice in relation to ultrasound cervical screening during pregnancy, the treatment of intra-epithelial cervical neoplasia and laparoscopic surgery have resulted in an increased utilization of trans-abdominal cervico-isthmic cerclage in an attempt to reduce the incidence of mid-trimester and early preterm birth in women with repeated pregnancy loss

Threatened and actual preterm labor including mode of delivery

John M. Svigos, Jodie M. Dodd and Jeffrey S. RobinsonIntroduction, Definition, and Incidence. Maternal Risks. Fetal and Neonatal Risks. Management Options. Acknowledgment. Suggested Readings. References.http://trove.nla.gov.au/work/728280

Threatened and actual preterm labor including mode of delivery

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Prelabour rupture of the membranes

J. Robinson, J. Svigos, R. Vigneswaranhttp://shop.elsevier.com.au/individualtitle.aspx?sa=36&su=632&sf=1&tl=1534

Prelabor rupture of the membranes

John M. Svigos, Jodie M. Dodd and Jeffrey S. RobinsonIntroduction. Definition and Incidence. Risks. Management Options. Future Directions. Acknowledgment. Suggested Readings. References.http://trove.nla.gov.au/work/728280