Changes in Orthopedic Services in Two Indonesian Tertiary-referral Hospitals during the Coronavirus-19 Pandemic

BACKGROUND: Many countries report decreasing on the number of hospital visit even on the emergency cases. AIM: This study aims to reveal the important data on how big the impact of coronavirus-19 pandemic on orthopedic services in two Government’s tertiary-referral hospitals. METHODS: This research is a comparison study to measure the trend of orthopedic services, the monthly orthopedic surgical load and outpatient visit were examined during the period of March to May 2020 (the early pandemic period) then compared to the same period in the 2019. RESULTS: The lowest number of outpatient visits occurred during May 2020 with 715 total number of outpatient visit. The lowest number of orthopedic surgery occurred during May 2020 with 167 total number of orthopedic surgery. Significant decrease of outpatient visits is recorded in 3 months of early pandemic period compared to the same period in 2019 (p < 0.005). Regarding the orthopedic surgical loads, the data show significant decrease in number of orthopedic surgeries in early pandemic period compared to those months in 2019 (p < 0.005). The largest declines were in visits for post-operative control patient (–179), spinal problem (–127,33), and osteoarthritis (–91,33). CONCLUSION: There was a significant difference in outpatient visit and orthopedic surgery number in the early pandemic period compared to the period before the pandemic occur. The largest drops in outpatient visit were in visits for post–operative control patient and spinal problem.

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The impact of Allergan implant-related issues on patients with breast implants for reconstruction

Archives of Aesthetic Plastic Surgery ◽

10.14730/aaps.2021.00122 ◽

2021 ◽

Vol 27 (4) ◽

pp. 132-138

Author(s):

Ji Min Kim ◽

Woo Jin Song ◽

Hyun Gyo Jeong ◽

Sang Gue Kang

Keyword(s):

Case Report ◽

Breast Implant ◽

Breast Implants ◽

Text Messages ◽

University Hospital ◽

Prophylactic Surgery ◽

Outpatient Visits ◽

First Case ◽

Significant Difference ◽

The Impact

Background In August 2019, the Ministry of Food and Drug Safety and the Korean Society of Plastic and Reconstructive Surgeons confirmed the first case report of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in Korea and provided recommendations. This study was conducted to evaluate the impact of the first case report of BIA-ALCL on patients and whether the impact could be mitigated through expert recommendations.Methods A retrospective chart review was performed of patients who underwent implant-based breast reconstruction using Biocell textured breast implants at Soonchunhyang University Hospital. After the first case report of BIA-ALCL and informing the patients via text messages, the pattern of outpatient visits and the proportion and indications of outpatient office visitors who received reoperations were analyzed.Results After the first BIA-ALCL case report in Korea, 12 patients underwent reoperations due to other complications identified incidentally, while only three patients underwent prophylactic surgery. Among the patients who underwent reoperation after the Allergan issues, 76.7% received implant exchange. There was no significant difference in the proportion of reoperation types before and after the Allergan issues and the transmission of text messages (P=0.700).Conclusions Despite the major issues, outpatients were managed successfully according to our recommendations. The study found a low rate of regular outpatient visits; however, our efforts increased this rate. Therefore, methods for appropriate information delivery are needed for outpatient visits, as well as a system for regular monitoring. As experts, plastic surgeons should provide responsible leadership in this situation to relieve patients’ concerns.

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538 Impact of prior statin use on clinical outcomes in COVID-19 patients: data from tertiary referral hospital during COVID-19 pandemic in Italy

European Heart Journal Supplements ◽

10.1093/eurheartj/suab135.032 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Gianfranco Mitacchione ◽

Marco Schiavone ◽

Antonio Curnis ◽

Marcello Arca ◽

Spinello Antinori ◽

...

Keyword(s):

Hospital Mortality ◽

Statin Therapy ◽

Severe Disease ◽

Early Warning Score ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Multi Centre Study ◽

Referral Hospitals ◽

The Impact ◽

Statin Use

Abstract Aims Epidemiological evidence suggests that anti-inflammatory and immuno-modulatory properties of statins may reduce the risk of infections and infection-related complications. In this observational multi-centre study, we aimed to assess the impact of prior statin use on coronavirus disease (COVID-19) severity and mortality. Methods and results Consecutive patients hospitalized for COVID-19 were considered and enrolled in four tertiary referral hospitals (Luigi Sacco Hospital, Milan; Policlinico Umberto I Hospital, Rome; Spedali Civili Hospital, Brescia; Humanitas Gavazzeni Hospital; Bergamo) From 23 February 2020 to 31 March 2020, in-hospital mortality and severity of COVID-19 assessed with National Early Warning Score (NEWS) were deemed primary and secondary outcomes, respectively. Among 842 patients enrolled, 179 (21%) were treated with statins before admission. Statin patients showed more comorbidities and more severe COVID-19 [NEWS 4 (IQR: 2–6) vs. 3 (IQR: 2–5), P < 0.001]. Despite having similar rates of intensive care unit admission, noninvasive ventilation, and mechanical ventilation, statin users appeared to show higher mortality rates. After balancing pre-existing relevant clinical conditions that could affect COVID-19 prognosis with propensity score matching, statin therapy confirmed its association with a more severe disease (NEWS ≥ 5; 61% vs. 48%, P = 0.025) but not with in-hospital mortality (26% vs. 28%, P = 0.185). At univariate logistic regression analysis, statin use was confirmed not to be associated with mortality (OR: 0.901; 95% CI: 0.537–1.51; P = 0.692) and to be associated with a more severe disease (NEWS ≥ 5 OR: 1.7; 95% CI: 1.067–2.71; P = 0.026). Conclusions Our results did not confirm the supposed favourable effects of statin therapy on COVID-19 outcomes. Conversely, they suggest that statin use should be considered as a proxy of underlying comorbidities, which indeed expose to increased risks of more severe COVID-19.

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Health services utilization and out-of-pocket (OOP) expenditures in public and private facilities in Pakistan: An empirical analysis of 2013-14 OOP Health Expenditure Survey

10.21203/rs.3.rs-30500/v1 ◽

2020 ◽

Author(s):

Faraz Khalid ◽

Wajeeha Raza ◽

David R. Hotchkiss ◽

Rieza H. Soelaeman

Keyword(s):

Health Services ◽

Private Sector ◽

Health Services Utilization ◽

Public And Private ◽

Services Utilization ◽

Factors Associated ◽

Outpatient Visits ◽

Expenditure Survey ◽

Significant Difference ◽

The Impact

Abstract Background As low- and middle-income countries (LMICs) progress towards achieving Universal Health Coverage (UHC), there is an increasing focus on measuring both out-of-pocket (OOP) expenditure and health services utilization within countries. While there have been several reforms to improve health services coverage and financial protection in Pakistan, there is limited empirical research comparing OOP expenditure and health services utilization between public and private facilities and exploring their determinants. In this paper, we have addressed this gap by using the 2013-2014 OOP Expenditure Survey Methods Our study is based on data from nationally representative household survey that includes 7,969 encounters from 4,293 households. In our analysis, we examined factors associated with two outcome variables; the sector where care was sought (public or private) and OOP expenditures. To investigate factors associated with the sector where care was sought, we fitted multivariate models stratified by type of care (i.e., inpatient and outpatient). Next, we fitted multivariate linear regression models to identify determinants of OOP expenditures stratified by type of care.Results  Our bivariate analysis shows that most encounters (82.5%) were in the private sector, and 85% of encounters were for outpatient visits. Expenditures on medicines and vaccines account for the largest proportion of OOP expenditures, followed by diagnostic tests and transportation. We found that the probability of seeking outpatient care in the private sector was higher for men, richer individuals, residents of Punjab and Sindh provinces, and households of smaller sizes. For inpatient care, we found that rural households and females with reproductive health concerns were more likely to seek private sector care. Importantly, our study found no significant difference in OOP expenditures between public and private facilities for both inpatient and outpatient visits. However, there were differences in OOP expenditures by sociodemographic factors. Conclusions This is the first study that has comprehensively investigated how healthcare utilization and OOP expenditures vary by sector, type of care, and socio-economic characteristics in Pakistan. Its findings will be useful for federal and provincial health ministries in planning and monitoring the impact of the next phase of their social health protection programs and supply side reforms.

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How COVID-19 pandemic is changing the practice of prenatal screening and diagnosis?

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0343 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Hakan Golbasi ◽

Ibrahim Omeroglu ◽

Burak Bayraktar ◽

Ceren Golbasi ◽

Duygu Adıyaman ◽

...

Keyword(s):

Diagnostic Tests ◽

Prenatal Screening ◽

Screening Tests ◽

Tertiary Referral ◽

Tertiary Referral Center ◽

Outpatient Visits ◽

Prenatal Diagnostic ◽

The Impact ◽

Fetal Screening ◽

Screening And Diagnosis

Abstract Objectives To evaluate the impact of the COVID-19 pandemic on prenatal screening and diagnostic tests. Methods We conducted a retrospective study with pregnant women attending to the perinatology department of a tertiary referral center. The pre-COVID-19 period between 11 March 2019 and 10 March 2020 and COVID-19 period between 11 March 2020 and 10 March 2021 were evaluated. Both periods were compared in terms of outpatient visits, ultrasound examinations, prenatal screening and diagnostic tests. The correlation of deaths related to COVID-19 pandemic on these parameters was also assessed. Results A total of 38,918 patients were examined and 28,452 ultrasound examinations, 26,672 prenatal screening tests and 1,471 prenatal diagnostic tests were performed over two years. During COVID-19 pandemic, number of outpatient visits decreased by 25.2%, ultrasound examinations decreased by 44.2%, prenatal screening tests decreased by 36.2% and prenatal diagnostic tests decreased by 30.7%. Statistically significant correlation was not observed between deaths related to COVID-19 and outpatient visits (p=0.210), ultrasound examinations (p=0.265), prenatal screening (p=0.781) and diagnostic tests (p=0.158). Among indications of prenatal diagnostic tests, maternal anxiety was significantly higher in COVID-19 period (p=0.023). There was significant decrease in the detection of fetuses with trisomy 21 (p=0.047) and a significant increase in the detection of fetuses with Turner syndrome (p=0.017) during COVID-19 period. Conclusions The COVID-19 pandemic has severely impacted antenatal care. Prenatal fetal screening and diagnosis was adversely affected by the pandemic in terms of detecting genetic and structural anomalies.

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Impact of traumatic perinatal events on burnout rates among midwives

Occupational Medicine ◽

10.1093/occmed/kqaa156 ◽

2020 ◽

Vol 70 (8) ◽

pp. 602-605

Author(s):

Z Amir ◽

A J Reid

Keyword(s):

Response Rate ◽

Traumatic Event ◽

Maternity Hospital ◽

Cross Sectional Study ◽

Tertiary Referral ◽

Cross Sectional ◽

Work Related ◽

Significant Difference ◽

The Impact ◽

Negative Linear Relationship

Abstract Background Little is known about the prevalence of burnout among Irish midwives and how traumatic perinatal events in work contributes to this. Aims To establish the prevalence of burnout among midwives in Ireland and whether exposure to traumatic perinatal events in work contributes to this. Methods A cross-sectional study utilizing a designed questionnaire was carried out in a tertiary-referral maternity hospital involving all clinical midwives (n = 248). Demographic details and frequency of perinatal events deemed traumatic were recorded. The extent of distress was documented on two visual analogues read in combination to reflect the impact of the distressing events. Burnout severity was assessed using the Copenhagen Burnout Inventory. Results The response rate was 55% (n = 137). Mean scores for personal, work-related and patient-related burnout were 56.0, 55.9 and 34.3, respectively. Over 90% of respondents experienced exposure to a traumatic event in work in the previous year, with 58% reporting a frequency of monthly or greater. No significant relationship was demonstrated between frequency of trauma and burnout; however, the extent of distress experienced was positively related to burnout in each domain (R2 = 0.18, 0.15 and 0.09, respectively, P < 0.01). A modest negative linear relationship exists between personal and work-related burnout and increasing age (ρ = −0.25 and −0.27, P < 0.01). A significant difference in work-related burnout score was evident between midwives with less experience and more experienced colleagues (P < 0.01). Conclusions Burnout is common among midwives. Exposure to discrete traumatic perinatal events experienced by women under their care contributes to this.

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Impact of COVID-19 outbreak on ischemic stroke admissions and in-hospital mortality in North-West Spain

International Journal of Stroke ◽

10.1177/1747493020938301 ◽

2020 ◽

Vol 15 (7) ◽

pp. 755-762 ◽

Cited By ~ 5

Author(s):

Herbert Tejada Meza ◽

Álvaro Lambea Gil ◽

Agustín Sancho Saldaña ◽

Maite Martínez-Zabaleta ◽

Patricia de la Riva Juez ◽

...

Keyword(s):

Ischemic Stroke ◽

Observational Study ◽

Hospital Mortality ◽

Stroke Patients ◽

Tertiary Referral ◽

North West ◽

Number Of Patients ◽

Referral Hospitals ◽

Tertiary Hospitals ◽

The Impact

Background and purpose Spain has been one of the countries heavily stricken by COVID-19. But this epidemic has not affected all regions equally. We analyzed the impact of the COVID-19 pandemic on hospital stroke admissions and in-hospital mortality in tertiary referral hospitals from North-West Spain. Methods Spanish multicenter retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. We recorded the number of patients admitted for ischemic stroke between 30 December 2019 and 3 May 2020, the number of IVT and EVT procedures, and in-hospital mortality. Results In the study period, 2737 patients were admitted with ischemic stroke. There was a decrease in the weekly mean admitted patients during the pandemic (124 vs. 173, p<0.001). In-hospital mortality of stroke patients increased significantly (9.9% vs. 6.5%, p = 0.003), but there were no differences in the proportion of IVT (17.3% vs. 16.1%, p = 0.405) or EVT (22% vs. 23%, p = 0.504). Conclusion We found a decrease in the number of ischemic stroke admissions and an increase in in-hospital mortality during the COVID-19 epidemic in this large study from North-West Spain. There were regional changes within the network, not fully explained by the severity of the pandemic in different regions.

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A One-year COVID-19 Pandemic Effect on the Orthopaedic Field in Indonesia: A Cross-sectional Multi-center Study

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6927 ◽

2021 ◽

Vol 9 (E) ◽

pp. 805-811

Author(s):

Pamudji Utomo ◽

Abdurrahman Afa Haridhi ◽

Mochammadsyah Beizar Yudistira

Keyword(s):

Outpatient Clinic ◽

World Health ◽

Tertiary Referral ◽

Cross Sectional ◽

First Case ◽

Number Of Patients ◽

Referral Hospitals ◽

Multi Center Study ◽

The Impact ◽

Center Study

BACKGROUND: The World Health Organization announced the COVID-19 outbreak as a global pandemic on March 11, 2020. Despite the fact that orthopedists are not considered front-line staff in the fight against the pandemic, the pandemic has had an enormous impact on orthopedics daily practice. A few studies have looked at the pandemic effect on the orthopedics field, but none have looked at the impact of a 1-year pandemic, especially in Indonesia. MATERIALS AND METHODS: This cross-sectional multi-center study was conducted at seven tertiary referral hospitals in Indonesia. Through hospital medical records, data were collected for a year, starting from the month the Indonesian government announced the first case of COVID-19 (March 2020–February 2021) and compared to data from the year before COVID-19 as a control (March 2019–February 2020). In addition, the researchers analyzed the number of patients in the emergency room (ER), outpatient clinic, inpatient, and operating room. RESULTS: Overall, the number of orthopedic patients in the ER declined by 44% from 11.053 to 6.139 patients during the 1st year of the pandemic, with 28 patients reported as getting COVID-19. The outpatient clinic decreased by 34%, from 10.9780 to 72.200 patients, with two confirmed cases. Furthermore, the inpatient unit decreased from 15.365 to 9.526 patients, a 38% decrease, with the highest recorded case confirmed at 78 patients. The last, with 73 confirmed, showed a 27% reduction in OR from 12.954 to 9.431 patients. CONCLUSION: In this study, analysis on the effect of the COVID-19 pandemic on the field of orthopedics in seven tertiary referral hospitals in Indonesia shows a significant decrease almost in all units. LEVEL EVIDENCE: III, Cross-sectional multi-center study.

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P373 Telemedicine and inflammatory bowel disease: Results of the IBD assistant pilot project

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.502 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S352-S353

Author(s):

K Malickova ◽

V Pesinova ◽

M Bortlik ◽

D Duricova ◽

N Machkova ◽

...

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Health Care Cost ◽

Controlled Study ◽

Ctrl Group ◽

Outpatient Visits ◽

Significant Difference ◽

Inflammatory Bowel ◽

The Impact

Abstract Background Telemedicine enables proper and immediate monitoring of the patient’s current health state, followed by well-timed and customised treatment. The aim of our study was to assess feasibility and safety of telemonitoring in Czech patients with inflammatory bowel disease (IBD). Furthermore, we wanted to evaluate the impact of telemonitoring on the number of outpatient′s visits and direct health-care cost. Methods We performed randomised controlled study including patients with IBD in stable remission on conventional therapy who were randomised either to telemonitoring (IBDA) or control (CTRL) group and were followed-up for 12 months. All IBDA patients had access to a specific web application which contained a set of questioners assessing disease activity and complications which were filled-in at least every 3 months. Evaluation of clinical activity was accompanied by measurement of faecal calprotectin (FC) at home using CalproSmart test. Individuals in the CTRL group were followed under the standard conditions as other outpatients. Results A total of 131 were included (42% males; 47% with Crohn′s disease) and randomised to IBDA (n = 94) or control group (n = 37). HBI/pMayo activity indexes were not significantly different at baseline (p = 0.636 and p = 0.853) and end of study (p = 0.517 and p = 0.890) in the two groups. Similarly, no significant difference in inflammatory markers (C-reactive protein, FC) was observed in either group (p>0.05). The occurrence of intercurrent infections (0.93 vs. 0.81 cases of infection/patient-year, p = 0.87) or the need for hospitalisations (1 vs. 0) was similar between the groups. The number of outpatient visits was significantly lower in the IBDA than in the CTRL group (median number in IBDA group 0, in the CTRL group 4.2 visits, respectively, p < 0.0001). Telemedicine led to a reduction in the direct annual health-care cost of patient follow-up by ~25% compared with the standard care. Conclusion Results of the first Czech IBD telemedicine study confirm the effectiveness and safety of the telemedicine approach, which led to a reduction in outpatient visits and savings in health-care costs while maintaining a high standard of health care. Acknowledgements: Supported by the IBD-Comfort Endowment Fund.

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Impact of the COVID-19 pandemic on acute otolaryngology inpatient activity at a tertiary referral centre: a retrospective analysis.

10.22541/au.163250559.92665020/v1 ◽

2021 ◽

Author(s):

Praveena Deekonda ◽

Adal Mirza ◽

Huw Jones

Keyword(s):

Age Groups ◽

Neck Surgery ◽

Referral Centre ◽

Tertiary Referral ◽

Tertiary Referral Centre ◽

Admission Rates ◽

Significant Difference ◽

Surgery Department ◽

The Impact ◽

Overall Mortality

Objective To determine the impact of the COVID-19 pandemic on acute admissions and inpatient activity at a tertiary referral centre. Design Retrospective review of coding-based inpatient electronic records. Setting An otolaryngology and head and neck surgery department at a UK major trauma and tertiary referral centre. Participants Otolaryngology patients admitted as an emergency over a period of 12 months pre-COVID19 (01/04/2019-31/03/2020) and 10 months post-COVID19 (01/04/2020-23/01/2021). Main outcome measures Baseline characteristics, admission rates, length of stay (LoS), overall mortality and 30-day mortality. Results 1844 records were reviewed; (1293 pre-COVID19, 551 post-COVID19). Admissions across all age groups were reduced, with an increase in mean age from 40.4 to 47.4 years (p=0.001). LoS remained unchanged (3.74 vs 3.82 days, p=0.251). Epistaxis remained the most common presentation, with an increased LoS compared to the pre-COVID19 cohort. GP referrals reduced from 18.0% to 4.2% (n=233 vs n=23, p<0.001) and ED referrals proportionally increased from 60.9% to 75.3%, n=787 vs n=417, p<0.001). Critical care admissions were higher in the post-COVID19 cohort (OR 1.82 (1.11-2.99) [95% CI], p=0.017). There was no significant difference in overall mortality between groups (n=74, 5.7% vs. n=33, 6.0%; p=0.844). Thirty-day mortality increased from 0.9% (n=12) pre-COVID19 to 2.3% (n=13) post-COVID19 (p=0.03). Conclusions This study demonstrates significant changes and a reduction in acute otolaryngology presentations. Our findings suggest that sicker, frailer patients were admitted during the pandemic. This study highlights important considerations for acute otolaryngology care moving forward after the pandemic.

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Measuring Impact of Stress in Sandwich Generation Caring for Demented Parents

GeroPsych ◽

10.1024/1662-9647/a000114 ◽

2014 ◽

Vol 27 (4) ◽

pp. 171-179 ◽

Cited By ~ 6

Author(s):

Laurence M. Solberg ◽

Lauren B. Solberg ◽

Emily N. Peterson

Keyword(s):

Factor Analysis ◽

Exploratory Factor Analysis ◽

Social Worker ◽

Resource Availability ◽

Well Being ◽

Sandwich Generation ◽

Item Questionnaire ◽

Significant Difference ◽

Adult Caregivers ◽

The Impact

Stress in caregivers may affect the healthcare recipients receive. We examined the impact of stress experienced by 45 adult caregivers of their elderly demented parents. The participants completed a 32-item questionnaire about the impact of experienced stress. The questionnaire also asked about interventions that might help to reduce the impact of stress. After exploratory factor analysis, we reduced the 32-item questionnaire to 13 items. Results indicated that caregivers experienced stress, anxiety, and sadness. Also, emotional, but not financial or professional, well-being was significantly impacted. There was no significant difference between the impact of caregiver stress on members from the sandwich generation and those from the nonsandwich generation. Meeting with a social worker for resource availability was identified most frequently as a potentially helpful intervention for coping with the impact of stress.

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