scholarly journals Clinical and economic strategies in outpatient medical care during the COVID-19 pandemic

2020 ◽  
Vol 45 (8) ◽  
pp. 579-585 ◽  
Author(s):  
David Anthony Provenzano ◽  
B Todd Sitzman ◽  
Samuel Ambrose Florentino ◽  
Glenn A Buterbaugh

The COVID-19 pandemic has resulted in significant clinical and economic consequences for medical practices of all specialties across the nation. Although the clinical implications are of the utmost importance, the economic consequences have also been serious and resulted in substantial damage to the US healthcare system, including pain practices. Outpatient pain practices have had to significantly change their clinical care pathways, including the incorporation of telemedicine. Elective medical and interventional care has been postponed. For the most part, ambulatory surgical centers have had to cease operations. As patient volumes have decreased for non-emergent elective care, the financial indicators have deteriorated. This review article will provide insight into solutions to mitigate the clinical and economic challenges induced by COVID-19. Undoubtedly, the COVID-19 pandemic will have short-term and long-term implications for all medical practices and facilities. In order to survive, medical practices will need dynamic, operational, and creative strategic plans to mitigate the disruption in medical care and pathways for successful reintegration of clinical and surgical practice.

2017 ◽  
Vol 16 (1) ◽  
pp. 51-61 ◽  
Author(s):  
Urszula Polska

AbstractThe aim of this paper is to present a modern model of non-institutional geriatric care which operates in the US, called the Program of All-Inclusive Care for the Elderly (PACE). The economic consequences of an aging population with multiple chronic diseases are creating new solutions in the delivery of medical care. The author of the following article, based on review of PACE literature and her own experience, will focus on the history of the program, its nature, the social and economic advantages, and its efficacy in practice. In addition, the difficulties and limitations of PACE are analyzed, taking into account solutions for increased availability and popularization of the program on an international scale.Author currently works as an ANP at Mercy LIFE (Living Independently For Elders) of Alabama, a PACE organization, delivering primary care. She has identified a need for a model similar to PACE in the context of her own home country of Poland, where cultural and societal norms value caring for a loved one in his or her own household rather than institutional care.The author concludes that the PACE model would be indispensable as a geriatric healthcare model for countries outside the US experiencing a rapid growth in elderly patients resulting from demographic shifts common in the 21st century. Fast response is needed in creation of a similar program to PACE to prevent future economical consequences affecting medical care for the elderly.


2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii3-ii3
Author(s):  
Webster K Cavenee

Abstract A young neurosurgeon has several interesting and important possible career paths: clinical care, clinical/translational research and more fundamental research. Each of these has its own requirements for training, talent and commitment. A closer inspection of each of these, however, reveals that they are basically quite similar. From this, several general conclusions can be gleaned and recommendations for optimizing the chances of long-term career success. In this short talk, I will review the aspects of our training program that has allowed each of our Japanese trainees to have remarkable success both while with us in the US and upon their return to Japan. My goal is to explicitly describe and state these as a roadmap for success, particularly in the rapidly developing field involving the application of molecular and genetic technologies to translational and basic neuro-oncology research—but also as more generally applicable principles.


2020 ◽  
Author(s):  
Julio Ramírez ◽  
Jose Inciarte-Mundo ◽  
Andrea Cuervo ◽  
Raquel Celis ◽  
Virginia Ruiz-Esq ◽  
...  

Abstract Objective To compare long-term clinical and radiographic outcomes among five sets of remission criteria [four clinical and one Ultrasound (US)-based] in a cohort of RA patients in a clinical care setting. Methods RA patients in remission (DAS28-ESR <2.6) were selected. Hand US assessments were performed, and serum levels of inflammation/angiogenesis biomarkers were determined at baseline. Changes in baseline treatment and radiographic progression, defined as the variation in the modified Sharp van der Heijde score (mSHS) at 5 years, were analyzed. To define remission, five different concepts were used, as follows: DAS28-ESR<2.6, SDAI<3.3, CDAI<2.8, Boolean criteria and score Power Doppler (PD)=0.Results Eighty-seven patients with DAS28-ESR<2.6 were included. One third fulfilled SDAI (33.3%), CDAI (31%) and Boolean (35.6%) remission criteria and 25.3% had no PD signal in the US evaluation. 26 patients (29.9%) changed the therapy, ranging from 13.6% (PD remission) to 33.3% (CDAI remission) (p=0.11). Serum levels of ANG (p=0.015) and TNFa (p=0.025) were significantly lower in patients with Boolean remission, whereas IL-18 levels were significantly lower in those with PD remission (p=0.049). Patients without PD in the US assessment had significantly lower mSHS erosion progression (p=0.014) at 5 years. Conclusions Patients with established RA in DAS28-ESR remission had comparable clinical and radiographic outcomes than SDAI, CDAI and Boolean definitions in a clinical care setting. US remission remained as the closest to structural damage abrogation.


Author(s):  
Latika Gupta ◽  
James B Lilleker ◽  
Vikas Agarwal ◽  
Hector Chinoy ◽  
Rohit Aggarwal

Abstract Objective The COVID-19 pandemic and the subsequent effects on healthcare systems is having a significant effect on the management of long-term autoimmune conditions. The aim of this study was to assess the problems faced by patients with idiopathic inflammatory myopathies (IIM). Methods An anonymized eSurvey was carried out with a focus on effects on disease control, continuity of medical care, drug procurance and prevalent fears in the patient population. Results Of the 608 participants (81.1% female, median (s.d.) age 57  (13.9) years), dermatomyositis was the most frequent subtype (247, 40.6%). Patients reported health-related problems attributable to the COVID-19 pandemic (n = 195, 32.1%); specifically 102 (52.3%) required increase in medicines, and 35 (18%) required hospitalization for disease-related complications. Over half (52.7%) of the surveyed patients were receiving glucocorticoids and/or had underlying cardiovascular risk factors (53.8%), placing them at higher risk for severe COVID-19. Almost one in four patients faced hurdles in procuring medicines. Physiotherapy, critical in the management of IIM, was disrupted in 214 (35.2%). One quarter (159, 26.1%) experienced difficulty in contacting their specialist, and 30 (4.9%) were unable to do so. Most (69.6%) were supportive of the increased use of remote consultations to maintain continuity of medical care during the pandemic. Conclusion This large descriptive study suggests that the COVID-19 pandemic has incurred a detrimental effect on continuity of medical care for many patients with IIM. There is concern that delays and omissions in clinical care may potentially translate to poorer outcomes in the future.


2021 ◽  
Vol 12 (3) ◽  
pp. 1
Author(s):  
Vahid Gholampour

This paper studies the medium-term economic consequences of major pandemics since 1870. The paper compares the average path of economic and financial indicators after a pandemic with their long-term path. According to data, inflation is low over the decade that follows the end of a major pandemic. Investments drive the rebound in real GDP. Financial assets provide above-average real returns. Credit markets experience a boom while fiscal and monetary authorities cutback government expenditure and money supply after pandemics.


2018 ◽  
Vol 23 (1) ◽  
pp. 35-44 ◽  
Author(s):  
Mark Whiting

There is a growing population of children with complex health needs and disabilities who are being cared for at home by their parents 24 hours per day, 7 days per week. Community Children’s Nursing Teams are a major source of support to these children. In 2006, the charity WellChild introduced the first WellChild Nurse (WCN) post specifically focused upon this group of children. In order to gain insight into how the WCN model was supporting this group of children throughout the 24-hour day, semi-structured interviews were undertaken with 12 WCNs and 10 parents of children with a range of long-term clinical care needs. Analysis of the interviews from both groups of study participants revealed complex patterns of decision-making by parents when seeking support and advice particularly ‘out of hours’. This related to four key questions: ‘Why call?’, ‘When to call?’, ‘Who to call?’ and ‘How to call?’. Parents identified how, as a result of the support provided by the WCNs, they are able to draw upon a range of decision-making skills and algorithms that enhance their ability to troubleshoot both clinical and non-clinical problems throughout the 24-hour day.


2021 ◽  
Author(s):  
Casey Mayne ◽  
David May ◽  
David Biedenharn

A phased study of the dike fields within the Vicksburg and Memphis Districts of the US Army Corps of Engineers was conducted to document the channel morphology trends since dike construction on the Lower Mississippi River (LMR). This included the development of the hydrographic survey database and methodology utilized to identify changes in channel geometry in response to dike construction. A subsequent report will provide further refinements to the approach and results of the comprehensive assessment. Recent Mississippi River Geomorphology and Potamology program efforts have employed the database developed by Mr. Steve Cobb to assess the geomorphic changes in 21 dike systems along the LMR. Previous studies using this database have indicated that the dike fields have not caused a loss of channel capacity. Furthermore, these efforts suggested that the trends in the dike fields are closely related to the long-term geomorphic trends along the LMR. Previous efforts using the Cobb database provided considerable insight into the dike effects on the LMR, but they were limited spatially and temporally. In this study, a database and protocols were developed to allow for a more robust assessment of dike field impacts and to extend the spatial and temporal extents of the analysis.


Author(s):  
Peter R. Breggin

BACKGROUND: The vaccine/autism controversy has caused vast scientific and public confusion, and it has set back research and education into genuine vaccine-induced neurological disorders. The great strawman of autism has been so emphasized by the vaccine industry that it, and it alone, often appears in authoritative discussions of adverse effects of the MMR and other vaccines. By dismissing the chimerical vaccine/autism controversy, vaccine defenders often dismiss all genuinely neurological aftereffects of the MMR (measles, mumps, and rubella) and other vaccines, including well-documented events, such as relatively rare cases of encephalopathy and encephalitis. OBJECTIVE: This report explains that autism is not a physical or neurological disorder. It is not caused by injury or disease of the brain. It is a developmental disorder that has no physical origins and no physical symptoms. It is extremely unlikely that vaccines are causing autism; but it is extremely likely that they are causing more neurological damage than currently appreciated, some of it resulting in psychosocial disabilities that can be confused with autism and other psychosocial disorders. This confusion between a developmental, psychosocial disorder and a physical neurological disease has played into the hands of interest groups who want to deny that vaccines have any neurological and associated neuropsychiatric effects. METHODS: A review of the scientific literature, textbooks, and related media commentary is integrated with basic clinical knowledge. RESULTS: This report shows how scientific sources have used the vaccine/autism controversy to avoid dealing with genuine neurological risks associated with vaccines and summarizes evidence that vaccines, including the MMR, can cause serious neurological disorders. Manufacturers have been allowed by the US Food and Drug Administration (FDA) to gain vaccine approval without placebo-controlled clinical trials. CONCLUSIONS: The misleading vaccine autism controversy must be set aside in favor of examining actual neurological harms associated with vaccines, including building on existing research that has been ignored. Manufacturers of vaccines must be required to conduct placebo-controlled clinical studies for existing vaccines and for government approval of new vaccines. Many probable or confirmed neurological adverse events occur within a few days or weeks after immunization and could be detected if the trials were sufficiently large. Contrary to current opinion, large, long-term placebo-controlled trials of existing and new vaccines would be relatively easy and safe to conduct.


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