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Amar Kelkar, MD, MPH, FACP Profile picture
@amarkelkar
Mar 19, 2021 • 10 tweets • 11 min read • Read on X
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Excited to share our (@BlakeJodian @kartc @hmaddd28 @BobbieLMcKee @chris_cogle) paper on #COVID19 #VaccineHesitancy in patients with #Cancer & caregivers, & impact of an educational #Webinar in Healthcare (@MDPIOpenAccess)! A #tweetorial... #MedTwitter 1/ mdpi.com/1041036
-Pre-pandemic rising #VaccineHesitency (#PublicHealth threat by @WHO in 2019)
-April 2020, Fisher et al (@AnnalsofIM) reported ~57% of 991 reported the intention to receive a #COVID19Vaccine (⬆️since then)
-Limited data on successful interventions to combat #vaccine hesitancy
2/ Image
-Jan 8, 2021 @UFHealthCancer, @WellFlorida, & CCRAB hosted a Webinar to improve knowledge & vaccine enthusiasm amongst Cancer and caregiver populations in North/Central Florida
-264 participants
-205 completed pre-Webinar Survey
-105 completed post-Webinar Survey
#patientchat 3/ Image
-Attendees ranked sources of information on the #COVID19Vaccine, favoring physicians & clinics, followed by governmental organizations & then news outlets
-#socialmedia was not as highly reported as we had expected, but still a fairly common source.
4/ #misinformation Image
-Pre-webinar: High baseline #vaccine acceptance rate (Intention: 71%, Unsure: 24%, No intention: 5%) - likely affected by self-selection
-Post-webinar: Intention: 80/97 (82.5%), Unsure: 15 (15.5%), No intention: 2 (2.1%)
-The #Webinar seemed to reduce #VaccineHesitancy!
5/
Predictors of vaccine acceptance:
-Enthusiasm to encourage others to vaccinate (may be uniquely high due to immunocompromised cancer population)
-Doctor recommendation!
-Belief in safety & efficacy of #vaccines
6/ #VaccinesWork Image
However, we have some work to do on #patienteducation & data interpretation ... 😣Visual presentation of numbers has a huge impact on perception!
7/ #SciComm Image
tl;dr The words of #HCWs MATTER!

Patients *want* to hear from HCWs about #vaccine safety & efficacy. Our words can increase vaccine enthusiasm! 8/ Image
This was one of my favorite papers to write! I have to thank @chris_cogle for his awesome mentorship and enthusiasm for this project and our patients! This was my first opportunity to participate in #publichealth research and I'm excited to branch out into #healthservices! 9/fin
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More from @amarkelkar

Amar Kelkar, MD, MPH, FACP Profile picture
Dec 5, 2023
🔥Today in @AnnalsofIM: We show Axi-cel & Liso-cel are NOT COST-EFFECTIVE in our decision analysis of second-line CAR-T therapies for Diffuse Large B-Cell Lymphoma, and calculate the economic impact to be >$6.8 billion over 5 years!

🧵👇

acpjournals.org/doi/10.7326/M2…
Image
2/📉Only 20-30% with relapsed/refractory DLBCL achieve durable remissions with standard-of-care second-line salvage chemoimmunotherapy with autologous stem cell transplantation (ASCT). Novel CAR-T therapies improve survival over ASCT but cost >$400k/infusion! #lymsm #TcellRx Image
3/📊We used a microsimulation model to evaluate if axi-cel & liso-cel are cost-effective for DLBCL second-line treatment compared to ASCT. This allowed us to model real-world situations to predict lifetime costs and lifetime effectiveness for 10,000 simulated patients. #TcellRx
Image
Image
Read 16 tweets
Amar Kelkar, MD, MPH, FACP Profile picture
Apr 15, 2021
Some current Hematologic diagnostic & management dilemmas of Adenovirus #JNJ & #AstraZeneca #VITT:
1⃣VITT seems to behave like autoimmune (Type 2) HIT rather than non-immune (Type 1) HIT (more common).
(Greinacher et al, @JTHjournal, 2017)
1/
 #MedTwitter #HemeTwitter #COVID19 Figure 3. Generation of the heparin‐induced thrombocytopen
2⃣High enough doses of heparin or LWMH can outcompete these PF4-polyanion complexes for binding sites & reduce platelet aggregation (similar to HIT).
➡️BUT, we can't yet tell where/if there's a consistent dose breakeven point at which aggregation⬇️
(Schultz et al, @NEJM, 2021)
2/ Note: High-dose/concentration Heparin in these assays is 100
➡️While many cases reported using LMWH (mostly low-dose Dalteparin), lab results were inconsistent on whether this sufficiently reduced/prevented platelet aggregation.

(Greinacher et al, @NEJM, 2021)
3/ Note: There was a discrepancy in LWMH reaction between the 4
Read 18 tweets
Amar Kelkar, MD, MPH, FACP Profile picture
Apr 14, 2021
#JNJ Vaccine Cerebral Venous Sinus Thrombosis Surveillance🧵after @CDCgov #ACIP (for now ...):
1⃣Watch for symptoms like headache, aphasia, paresis, papilledema, seizure, mental status changes
2⃣High-risk groups *seem* to be young women (~20-50), 6-20 days after #JNJ vaccine

1/
3⃣True #CVST event rate is TBD (as is the true background rate)
4⃣PF4 IgG ELISA in all patients for screening (#publichealth reporting) & management (avoiding heparin if positive)
5⃣Consider IV steroids & IVIg for thrombocytopenia
#HemeTwitter
2/
6⃣Report any suspicious events to #VAERS vaers.hhs.gov/reportevent.ht…
7⃣Remember that these are RARE events and the proposed cause of #VITT remains theoretical. This pause is proof that the safety/surveillance system works!

3/
Read 6 tweets
Amar Kelkar, MD, MPH, FACP Profile picture
Apr 14, 2021
The @CDCgov Advisory Committee on Immunization Practices (ACIP) emergency meeting on the #JNJ vaccine is ongoing. Currently, they're reviewing known data on 8 cases of thrombotic thrombocytopenia. Follow this thread for updates. 1/ #COVID19 #MedTwitter ustream.tv/channel/VWBXKB…
This was the initial @US_FDA announcement yesterday describing the #COVID19Vaccine #JNJ hold. In summary, 6 post-market cases of cerebral venous thrombosis reported as of yesterday (in ~6.8 million doses delivered) prior to the hold.
The awesome @acweyand excellently summarized the data known as of yesteday from the similar #AstraZenaca adenovirus vector vaccines and background on #CVST! #hemetwitter 3/
Read 20 tweets
Amar Kelkar, MD, MPH, FACP Profile picture
Apr 12, 2021
Apparently, I was a much keener observer when I was a student ... or at least took more meticulous notes. From those notes comes a #parasitology story told by a professor during my medical school days. His inflection is lost, but the story remains LEGENDARY! #MedStudentTwitter 1/
As a PhD student, I was on a very small stipend and my supervisor said to me, 'I'll give you $400 if you could be a definitive host for some saginata for me.'

I thought, 'Yeah, no problem.'

2/
I mean the actual tapeworm itself causes no pathology whatsoever. There might be a little bit of abdominal discomfort. Minor diarrhea. But essentially they're fine.

So I thought, 'Yeah, I'll do this.'

*laughs uncomfortably*

3/
Read 7 tweets
Amar Kelkar, MD, MPH, FACP Profile picture
Dec 2, 2019
#Hahnemann is a cautionary tale of for-profit companies plundering a #SafetyNetHospital for a land deal. After speaking with several former physician trainees and the Internal Medicine PD @DaveAizenberg. The stories were disheartening. We must do better. #HahnemannStories 1/
#Hahnemann #tweetorial-In all the talk of policy changes and corporate malfeasance, the personal impact cannot be undersold. One story that needs to be shared is that of Erika Correa (permission given to share her experience). #HahnemannStories #medtwitter #MembersMoveMedicine 2/
Dr. Correa was starting #HemeOnc fellowship orientation at #Hahnemann when the closure was announced on June 26. She was suddenly without a program, funding, or health insurance. She had bought a house in Philadelphia, planning to stay at least 3 more years. #medtwitter 3/
Read 19 tweets

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