Staffing turnover effect of fellowship-trained surgical specialists on oncologic outcomes in community cancer center.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 187-187
Author(s):  
Jan Franko ◽  
Soren Kraemer ◽  
Charles David Goldman ◽  
Daniela Frankova ◽  
Shankar Raman
Keyword(s):  
Regression Model ◽  
Substantial Reduction ◽  
State Level ◽  
Significant Loss ◽  
Oncologic Outcomes ◽  
Cancer Center ◽  
Late Period ◽  
Index Hospital ◽  
Index Cancer ◽  
The Impact

187 Background: Contemporary health care is delivered in highly interdependent team-based environment. Transitions in surgeon complement may be associated with a disturbance of workflow, especially in smaller-sized community cancer centers. Herein we examined the impact of two surgical oncologists turnover in our cancer center. Methods: Survival outcomes of all cases of esophageal, gastric, rectal and pancreatic adenocarcinoma treated in the index cancer center (n = 1,445) were compared to then-contemporary standard derived from Iowa-SEER registry, 2001-2015 (n = 12,617). Period before and after changeover of surgeons was compared using descriptive statistics and regression model. Results: Substantial reduction of annually referred (101.8±9.2 versus 60.5±0.7 case per year, p = 0.026) and operative cases (37.0±4.5 versus 17.5±3.5 cases per year, p = 0.027) was seen during fully-staffed versus on-boarding periods at the index hospital. At the state level, there was no fluctuation of annually referred cases (898.0±19.8 versus 910.5±35.6 cases per year, p = 0.384) and minimal decrease in operated cases (366.2±18.0 versus 335.0±24.1 cases per year, p = 0.020) in early versus late period. New surgical team was able to improve upon survival of resectable esophageal cancer patients in the index hospital and maintain survival of other complex GI malignancies as compared to geographically relevant standard of Iowa-SEER registry. Survival regression model on all 5,795 non-metastatic cases with available data, adjusted for age, stage and primary disease site, demonstrated that being treated in the index hospital did not result is inferior survival comparing early and late period (HR = 1.060, p = 0.237). Conclusions: Loss of surgical cancer specialists was associated with profound & significant loss of referrals to the index cancer center, and likely outmigration of patients from the community seeking advanced care. Quick restoration of surgical services may reinstate overall efficacy of care for resectable cancer cases without negative survival effect.

scholarly journals Effect of Surgical Oncologist Turnover on Hospital Volume and Treatment Outcomes Among Patients With Upper GI Malignancies

2020 ◽  
pp. JOP.19.00761
Author(s):  
Jan Franko ◽  
Daniela Frankova
Keyword(s):  
Care Delivery ◽  
State Level ◽  
Surgical Oncology ◽  
The State ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Control Group ◽  
Index Hospital ◽  
The Impact ◽  
Surgical Oncologist

PURPOSE: Lack of surgical expertise may affect cancer care delivery. Here, we examined the impact of surgical oncologist vacancy and turnover in a community cancer center serving a mixed urban and rural population. METHODS: Survival outcomes of patients with potentially resectable esophageal, gastric, and pancreatic carcinomas treated in the index hospital (n = 519) were compared with those of a then-contemporary control group derived from the state-specific SEER registry (n = 3,340). The onboarding period (ie, the period without a surgical oncologist) and early and late periods with a surgical oncologist were defined. RESULTS: At the state level, there was a steady trend of patients who were annually referred (290.4 ± 34.3 patients per year; P < .001) and underwent operation (158.7 ± 18.7 patients per year; P < .001). We observed the absence of an analogous trend in the index hospital ( P = .141). The index hospital diagnosed 12.2% of state cancers of interest during the years with surgical oncologists but only 6.7% of cancers when surgical oncologists were absent ( P = .031). The survival model adjusted for age, stage, and primary disease site comparing the early and late periods demonstrated that being treated in the index hospital did not result in inferior survival (hazard ratio, 1.067; P = .265). CONCLUSION: Loss of surgical oncologists was associated with referral decline and likely out-migration of patients, whereas prompt restoration of surgical oncology services reinstated volumes and preserved survival outcomes.

scholarly journals Care as Usual: An Acceptable Strategy to Apply During the COVID-19 Pandemic in a French Tertiary Gynecologic Oncology Department

2021 ◽  
Vol 11 ◽  
Author(s):  
Guillaume Blache ◽  
Houssein El Hajj ◽  
Camille Jauffret ◽  
Gilles Houvenaeghel ◽  
Laura Sabiani ◽  
...  
Keyword(s):  
Gynecological Cancer ◽  
Gynecologic Oncology ◽  
Surgical Patients ◽  
Oncologic Outcomes ◽  
Comprehensive Cancer Center ◽  
Surgical Approaches ◽  
Cancer Center ◽  
Complication Rates ◽  
Oncological Treatment ◽  
The Impact

We describe and analyze a “care as usual” strategy of a French Comprehensive Cancer Center during the COVID-19 pandemic to manage surgical patients with gynecological cancer. We conducted a retrospective analysis evaluating the surgical activity in our gynecologic oncology department between January 21 and May 12, 2020. We compared the surgical activity and surgical and oncologic outcomes during the pre-lockdown period and the pandemic period. The main objective was to evaluate the impact of the COVID-19 pandemic on surgical activity. The secondary objectives were to analyze the surgical and the oncologic outcomes. We compared the surgical activity during the 8 weeks after the national lockdown (85 procedures) to the surgical activity in the 8 weeks preceding the lockdown (127 procedures). We observed a 33% decrease in activity between the two periods. The clinical and epidemiologic characteristics were similar between the two periods. There were no differences between the surgical approaches (p = 0.592), the surgical complexity (p = 0.323), the length of stay (p = 0.85), and even for the complex procedure (p = 0.96) and the perioperative (p = 0.791) and postoperative complication rates (p = 0.102). We observed a significant decrease in the time of return to intended oncological treatment (RIOT) during the lockdown period with an average of 31.9 days compared to 46.9 days in the pre-lockdown period (p = 0.003). During the COVID-19 pandemic, “care as usual” represents an acceptable strategy without impairing the oncologic outcome in a Comprehensive Cancer Center with a patient-centered clinical pathway for gynecologic oncologic surgical patients.

Novel Erosion Control Technology for Production Debottlenecking

2018 ◽  
Author(s):  
Prasad Laxman Kane ◽  
Dominic Pliszka
Keyword(s):  
Substantial Reduction ◽  
Erosion Control ◽  
Significant Loss ◽  
Mitigation Measures ◽  
Control Technology ◽  
Product Flow ◽  
Sand Erosion ◽  
Piping Systems ◽  
Global And Local ◽  
The Impact

Erosion of piping systems is a significant issue for many operators of Hydrocarbon infrastructure. Until now mitigation measures have been limited to detection / measurement and reducing production. For many operators this can be a significant loss in revenue and an increase in IMR costs. A novel Erosion Control Technology (ECT) is being developed that can significantly reduce the impact of erosion on piping infrastructure. This technology has the potential of adding immense value when it is used to debottleneck and optimize flow rates. The patented ECT has been designed to control sand erosion in real-time by deflecting and redistributing sand in the product flow stream. Preliminary laboratory testing of the ECT has been very successful. The ECT inserts designed for the ambient test conditions have shown substantial reduction in erosion (both global and local). Computational Fluid Dynamics (CFD) has been the key enabling factor allowing the critical breakthrough in this technology. Experimental results have shown very good correlation with the CFD sand erosion model results. A roadmap in line with industry practices and standards has been developed for project implementation of the ECT solution in the near future.

scholarly journals Examining the impact of socioeconomic variables on COVID-19 death rates at the state level

2021 ◽  
Author(s):  
James L. Doti
Keyword(s):  
Regression Model ◽  
State Level ◽  
Poverty Rate ◽  
The State ◽  
Death Rates ◽  
Explanatory Variables ◽  
Socioeconomic Variables ◽  
The Impact ◽  
Regression Tests

AbstractThis study uses a step-wise regression model to identify the socioeconomic variables most significant in explaining COVID-19 death rates on a state-level basis. The regression tests cover the 1/1/2020 to 12/1/2020 period as well as the first and second halves of 2020. This study also uses the Oxford stringency index to measure more precisely the efficacy of governmental mandates at the state level. The results in this study rigorously showed that while the density variables were the most significant explanatory variables during the first half of the year, their significance fell during the second half. Use of the Oxford stringency index revealed that more stringent mandates led to significant reductions in COVID-19 death rates, especially during the second half of the year. The study’s findings also reveal that a higher poverty rate in a state is significantly associated with higher COVID-19 death rates during all three periods tested.

The impact of COVID-19 pandemic on oncology workload: The experience of an Italian Reference Cancer Center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13520-e13520
Author(s):  
Carla Corvaja ◽  
Giada Targato ◽  
Silvio Ken Garattini ◽  
Cristina Barazzutti ◽  
Alessandra Bin ◽  
...  
Keyword(s):  
Substantial Reduction ◽  
Cancer Center ◽  
Cancer Treatments ◽  
Peak Period ◽  
Accountability System ◽  
New Therapy ◽  
Global Pandemic ◽  
Oncology Care ◽  
The Impact

e13520 Background: Since its outbreak in January 2020, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic dramatically affected health systems worldwide and a prompt realignment of clinical activities had to be thought. International Oncology guidelines recommended that routine oncology care continued to be delivered, ensuring triage procedures to prevent COVID-19 diffusion alongside treatments prioritization. Aim of this study was to assess the variation of activity volumes due to COVID-19 pandemic in the Oncology Department of the Academic Reference Cancer Center of Udine, Italy. Methods: We extracted activity volumes from the electronic “Data Warehouse” accountability system and compared activity in 2020 with historical activity in 2019. We then narrowed the analysis to the peak of COVID-19 pandemic, comparing data of a four-months period (February-May 2020 vs 2019). In accordance with the Italian Association of Medical Oncology guidelines, the activities analyzed included: new patients referrals, first consultations, new therapy assignments, treatment prescriptions and therapy administrations, disease re-assessments, follow-up visits, tele-examinations, unplanned visits and ward discharges. Results: Overall, throughout COVID-19 pandemic a negligible reduction in the number of first consultations (-5%) and new patients referrals to our Oncology Department (-10%) was detected. Of note, a significant reduction in the number of unplanned oncologic visits was observed (-23%). The replacement of follow up visits with telephonic interviews with the interpretation of laboratory and radiologic examinations (tele-examinations) led to a substantial reduction in follow-up visits throughout 2020 (-25%). Conversely, treatment-related activities, including new therapy assignments (+1%), treatment prescriptions and therapy administrations (+2% and +3%, respectively), confirmed the increasing trend of the previous year. Interestingly, similar trends were observed in the four-months peak period with a substantially higher decrease in follow-up visits in 2020 vs 2019 (-51%), whereas treatment-related activities remained stable. Conclusions: In the context of COVID-19 pandemic, our Oncology Department maintained stable performances on critical oncology activities. Strict triage procedures, serial swabs for patients and healthcare professionals and strategic follow-up visits remodulation were crucial. Notwithstanding the significant decrease in cancer treatments observed in several published reports, our experience demonstrates that the reorganization of oncology departments during a global pandemic is feasible and it should be pursued to preserve patients’ safety without compromising the continuum of care.

Ease of Doing Business and Its Impact on Inward FDI

2018 ◽  
Vol 1 (1) ◽  
pp. 52 ◽  
Author(s):  
Mohamed Tareq Hossain ◽  
Zubair Hassan ◽  
Sumaiya Shafiq ◽  
Abdul Basit
Keyword(s):  
Regression Model ◽  
Causal Relationship ◽  
World Bank ◽  
Least Square ◽  
Doing Business ◽  
Least Square Regression ◽  
Foreign Countries ◽  
Ease Of Doing Business ◽  
The Impact ◽  
Starting A Business

This study investigates the impact of Ease of Doing Business on Inward FDI over the period from 2011 to 2015 across the globe. This study measures ease of doing business using starting a business, getting credit, registering property, paying taxes and enforcing contracts. The research used a sample of 177 countries from 190 countries listed in World Bank. Least square regression model via E-views software used to examine causal relationship. The study found that ease of doing business indicators ‘Enforcing Contracts’ was found to have a positive significant impact on Inward FDI. Nevertheless, ‘Getting Credit’ and ‘Registering Property’ were found to have a negative significant impact on Inward FDI. However, ‘Starting a Business’ and ‘Paying Taxes’ have no significant impact on Inward FDI in the studied timeframe of this research. The findings of the study suggested the ease of doing business enables inward FDI through better contract enforcements, getting credit and registering property. The findings of the research will assist international managers and companies to know the importance of ease of doing business when investing in foreign countries through FDI.

Income Diversification and Bank Efficiency in Vietnam

2017 ◽  
pp. 52-67
Author(s):  
Sang Nguyen Minh
Keyword(s):  
Regression Model ◽  
Commercial Banks ◽  
Banking System ◽  
Operational Efficiency ◽  
Commercial Banking ◽  
Tobit Regression ◽  
Income Diversification ◽  
Positive Effects ◽  
Study Results ◽  
The Impact

This study uses the DEA (Data Envelopment Analysis) method to estimate the technical efficiency index of 34 Vietnamese commercial banks in the period 2007-2015, and then it analyzes the impact of income diversification on the operational efficiency of Vietnamese commercial banks through a censored regression model - the Tobit regression model. Research results indicate that income diversification has positive effects on the operational efficiency of Vietnamese commercial banks in the research period. Based on study results, in this research some recommendations forpolicy are given to enhance the operational efficiency of Vietnam’s commercial banking system.

To Study the impact of Gabbar Singh tax or Goods & services tax for Restaurant and Food Services Business in India

2019 ◽  
Vol 118 (12) ◽  
pp. 32-48
Author(s):  
Mr. Arun Gautam ◽  
Dr. Saurabh Sharma ◽  
CA Narendra Kumar Bansal
Keyword(s):  
State Level ◽  
The State ◽  
Assessment Framework ◽  
Food Services ◽  
Goods And Services ◽  
Single Tax ◽  
The Impact

GST that is Goods and Services Tax has been in compel since first July, 2017 and which is, in constrain on numerous countries globally and they all were thinking about it as their business assessment framework. The principle reason for GST is to realize single tax on products at both centre and the state level in the nation.

scholarly journals Work absence and multimorbidity in Portugal: results from the 1st National Health Examination Survey

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Matos ◽  
C Matias Dias ◽  
A Félix
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Chronic Diseases ◽  
National Health ◽  
Logistic Regression Model ◽  
Health Examination ◽  
Work Absence ◽  
Health Examination Survey ◽  
Absence From Work ◽  
The Impact

Abstract Background Studies on the impact of patients with multimorbidity in the absence of work indicate that the number and type of chronic diseases may increase absenteeism and that the risk of absence from work is higher in people with two or more chronic diseases. This study analyzed the association between multimorbidity and greater frequency and duration of work absence in the portuguese population between the ages of 25 and 65 during 2015. Methods This is an epidemiological, observational, cross-sectional study with an analytical component that has its source of information from the 1st National Health Examination Survey. The study analyzed univariate, bivariate and multivariate variables under study. A multivariate logistic regression model was constructed. Results The prevalence of absenteeism was 55,1%. Education showed an association with absence of work (p = 0,0157), as well as professional activity (p = 0,0086). It wasn't possible to verify association between the presence of chronic diseases (p = 0,9358) or the presence of multimorbidity (p = 0,4309) with absence of work. The prevalence of multimorbidity was 31,8%. There was association between age (p &lt; 0,0001), education (p &lt; 0,001) and yield (p = 0,0009) and multimorbidity. There is no increase in the number of days of absence from work due to the increase in the number of chronic diseases. In the optimized logistic regression model the only variables that demonstrated association with the variable labor absence were age (p = 0,0391) and education (0,0089). Conclusions The scientific evidence generated will contribute to the current discussion on the need for the health and social security system to develop policies to patients with multimorbidity. Key messages The prevalence of absenteeism and multimorbidity in Portugal was respectively 55,1% and 31,8%. In the optimized model age and education demonstrated association with the variable labor absence.

scholarly journals Artificial neural network, predictor variables and sensitivity threshold for DNA methylation-based age prediction using blood samples

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhonghui Thong ◽  
Jolena Ying Ying Tan ◽  
Eileen Shuzhen Loo ◽  
Yu Wei Phua ◽  
Xavier Liang Shun Chan ◽  
...  
Keyword(s):  
Neural Network ◽  
Artificial Neural Network ◽  
Regression Model ◽  
Sensitivity Threshold ◽  
Ann Model ◽  
Blood Samples ◽  
Ann Models ◽  
Artificial Neural ◽  
The Impact ◽  
Age Prediction

AbstractRegression models are often used to predict age of an individual based on methylation patterns. Artificial neural network (ANN) however was recently shown to be more accurate for age prediction. Additionally, the impact of ethnicity and sex on our previous regression model have not been studied. Furthermore, there is currently no age prediction study investigating the lower limit of input DNA at the bisulfite treatment stage prior to pyrosequencing. Herein, we evaluated both regression and ANN models, and the impact of ethnicity and sex on age prediction for 333 local blood samples using three loci on the pyrosequencing platform. Subsequently, we trained a one locus-based ANN model to reduce the amount of DNA used. We demonstrated that the ANN model has a higher accuracy of age prediction than the regression model. Additionally, we showed that ethnicity did not affect age prediction among local Chinese, Malays and Indians. Although the predicted age of males were marginally overestimated, sex did not impact the accuracy of age prediction. Lastly, we present a one locus, dual CpG model using 25 ng of input DNA that is sufficient for forensic age prediction. In conclusion, the two ANN models validated would be useful for age prediction to provide forensic intelligence leads.

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