GENDER AND REGIONAL DISPARITIES IN EMERGENCY ARRHYTHMIA PROCEDURES DURING COVID-19 LOCKDOWN

Objectives: Worldwide reduction in emergency procedures has been observed during the current COVID-19 pandemic. The effects of the pandemic and its associated lockdown on arrhythmia related emergency procedures is not known. This study was done to see the effects of the COVID-19 pandemic lockdown on provision of emergency arrhythmia procedures and to identify vulnerable patient groups that may be disproportionately affected during lockdown. Methodology: Data for patients requiring emergency intracardiac devices including temporary and permanent pacemakers was collected from three public sector hospitals of Sindh, Pakistan, for the COVID-19 lockdown period of March to May 2020. This was compared to the data for the same period for 2019. Results: Patients presenting during lockdown decreased by 32.8% (from 250 to 168) compared to the same period without lockdown. The decline was across all emergency procedures considered. There was a more than fivefold reduction in the number of patients in patients from outside the metropolitan area of the hospital (64.3%) compared to those residing within the city (12.5%) (p=0.001). There was a trend showing women to be more effected, with the percentage decline in women being statistically significant in the rural setting (-93.8% vs. -52.9%, p=0.043). All age groups were equally affected (p=0.152). Conclusion: A marked reduction in the number of patients who presented for emergency intra cardiac devices and TPM procedures was seen during COVID-19 lockdown. The patients who presented from outside the city of the hospital and women in rural setting were significantly more effected.

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Features of the complex treatment of ulcerative colitis in clinical practice

Terapevt (General Physician) ◽

10.33920/med-12-2005-01 ◽

2020 ◽

pp. 6-11

Author(s):

Svetlana Svetlana ◽

Mikhail Klimentov ◽

Olga Neganova ◽

Alina Nazmieva ◽

Anastasiya Kochurova

Keyword(s):

Ulcerative Colitis ◽

Clinical Practice ◽

Statistical Study ◽

Age Groups ◽

Length Of Hospital Stay ◽

Unknown Etiology ◽

Number Of Patients ◽

First Republic ◽

Bowel Diseases ◽

Inflammatory Bowel

Nowadays there are certain difficulties in the early diagnosis of ulcerative colitis, proceeding with minimal intestinal symptoms. The etiology of the disease remains unclear to this day; there is no exact information about the prevalence of the disease due to the large number of latent forms and the low number of patients seeking medical help. This article presents the results of a retrospective analysis of the incidence of ulcerative colitis in the coloproctology department of the First Republic Clinical Hospital of Izhevsk. The study was conducted to assess the frequency of occurrence and determine the internal picture of ulcerative colitis. To achieve this goal, we selected 34 patients with ulcerative colitis. A statistical study was conducted on the following criteria: gender composition, age groups, forms of the disease, localization, complications, and main complaints. The length of hospital stay often was not more than 20 days. The literature on this pathology was also studied and presented in the form of a theoretical basis, which consisted of the determination and etiology of inflammatory bowel diseases. Due to the unknown etiology, insufficiently studied pathogenesis, difficult differential diagnosis with other intestinal diseases and insufficiently perfect treatment methods, there are a large number of unresolved problems in the field of ulcerative colitis. That is why, in this article we tried to reveal the problem of the features of the course and complex therapy of that disease in clinical practice.

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COVID-19 Epigenetics and Implications for Public Health

Coronaviruses ◽

10.2174/2666796701999201005212515 ◽

2020 ◽

Vol 01 ◽

Author(s):

Verda Tunalıgil ◽

Gülsen Meral ◽

Ahmet Katı ◽

Dhrubajyoti Chattopadhyay ◽

Amit Kumar Mandal

Keyword(s):

Chronic Conditions ◽

Empirical Investigation ◽

Age Groups ◽

Infectious Agent ◽

Well Being ◽

Epigenetic Mechanisms ◽

Age Group ◽

Epigenetic Changes ◽

Patient Groups ◽

Epigenetic Processes

Abstract:: Epigenetic changes in COVID-19 host, a pandemic-causing infectious agent that globally incapacitated communities in varying complexities and capacities are discussed, proposing an analogy that epigenetic processes contribute to disease severity and elevate the risk for death from infection. Percentages of hospitalization, with and without intensive care, in the presence of diseases with increased ACE2 expression, were compared, based on the best available data. Further analysis compared two different age groups, 19-64 and ≥65 years of age. The COVID-19 disease is observed to be the most severe in the 65-and-higher-age group with preexisting chronic conditions. This observational study is a non-experimental empirical investigation of the outcomes of COVID-19 in different patient groups. Results are promising for conducting clinical trials with intervention groups. To ultimately succeed in disease prevention, researchers and clinicians must integrate epigenetic mechanisms to generate valid prescriptions for global well-being.

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What motivates Chinese physicians to provide online counseling services in Internet hospitals: online reputation or offline reputation? (Preprint)

10.2196/preprints.24498 ◽

2020 ◽

Author(s):

Ronghua Xu ◽

Tingting Zhang ◽

Qingpeng Zhang

Keyword(s):

Regression Models ◽

Counseling Services ◽

Online Counseling ◽

Consulting Services ◽

Online Consultation ◽

Number Of Patients ◽

Professional Titles ◽

Online Reputation ◽

Chinese Physicians ◽

The City

BACKGROUND Internet hospitals, or e-hospitals, as one kind of e-health platforms in China, provided novel channels through which physicians present their medical or health-care knowledge to patients and provide online counseling services. The sustainable development of Internet hospitals and e-health platforms relied on the participation of both the patients and the physicians, especially on the provision of health consultation services by the physicians. OBJECTIVE The objective of our study was to explore the factors motivating Chinese physicians to provide online health counseling services from the perspectives of their online reputation and offline reputation. METHODS We collected the data of 141,030 physicians from 6,173 offline hospitals and 350 cities on WeDoctor, an Internet hospital platform authorized by the China Health and Family Planning Committee. We selected the physicians’ online consultation volume, the total amount of counseling conversations from all channels of the platform, as the investigated dependent variable, reflecting the actual online counseling behaviors of the physicians in the platform. Based on the reputation theories and prior study, we incorporated patients’ feedback as the physicians’ online reputation (i.e. patients’ comments and their satisfaction scores), and incorporated the physicians’ offline professional status as the offline reputation (i.e. professional titles and the rankings of their offline working hospitals). We also delved the moderated effects of the city levels where the physicians lived offline and the number of patients who were watching the physicians online. Eight research hypotheses were proposed. Step-wise linear regression models were used to test our hypotheses. Durbin-Watson test and robustness tests were also conducted to ensure the fitness and reliability of our models. RESULTS As a result of the regression models, we found that, 1) physicians’ online reputation, including the number of comments written by the patients (beta=0.588, P<0.001), the satisfaction scores (beta=0.034, P<0.01), significantly and positively influence physicians’ online counseling behaviors; 2) Physicians’ offline reputation, including their professional titles (beta=-0.084, P<0.001) and the hospital rankings (beta=-0.163, P<0.001), significantly and negatively influence physicians’ online counseling behaviors; 3) the city levels where the physicians lived strengthen the negative effect between their offline hospital rankings and their online consulting services (beta=-0.177, P<0.001), indicating that physicians of higher offline reputation spend less time on online counseling, possibly due to the relative heavier offline workload; 4) the number of watching patients weakens the positive effect between patients’ comments and physicians’ online consulting services (beta=-0.216, P<0.001), indicating that the watching patients may switch the channels from online consultation to offline hospital visits after using the Internet hospitals. CONCLUSIONS This study contributed to the literature on physicians online counseling behaviors in Internet hospitals by verifying the contrasting effects of the online reputation and the offline reputation. It then contributed to the motivation theory by separating the online reputation from the offline reputation when the acting entities have constraints of limited time and effort. This study can also provide practical insights for the hospital managers to better arrange for the online counseling services and for the policy makers to consider the patients’ online feedback into the overall evaluation of the physicians’ reputation.

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Routine clinical care data from thirteen cardiac outpatient clinics: design of the Cardiology Centers of the Netherlands (CCN) database

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02020-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sophie H. Bots ◽

Klaske R. Siegersma ◽

N. Charlotte Onland-Moret ◽

Folkert W. Asselbergs ◽

G. Aernout Somsen ◽

...

Keyword(s):

Risk Factors ◽

General Practitioner ◽

Data Collection ◽

The Netherlands ◽

Strong Base ◽

Daily Care ◽

Cardiac Symptoms ◽

Number Of Patients ◽

Patient Groups

Abstract Background Despite the increasing availability of clinical data due to the digitalisation of healthcare systems, data often remain inaccessible due to the diversity of data collection systems. In the Netherlands, Cardiology Centers of the Netherlands (CCN) introduced “one-stop shop” diagnostic clinics for patients suspected of cardiac disease by their general practitioner. All CCN clinics use the same data collection system and standardised protocol, creating a large regular care database. This database can be used to describe referral practices, evaluate risk factors for cardiovascular disease (CVD) in important patient subgroups, and develop prediction models for use in daily care. Construction and content The current database contains data on all patients who underwent a cardiac workup in one of the 13 CCN clinics between 2007 and February 2018 (n = 109,151, 51.9% women). Data were pseudonymised and contain information on anthropometrics, cardiac symptoms, risk factors, comorbidities, cardiovascular and family history, standard blood laboratory measurements, transthoracic echocardiography, electrocardiography in rest and during exercise, and medication use. Clinical follow-up is based on medical need and consisted of either a repeat visit at CCN (43.8%) or referral for an external procedure in a hospital (16.5%). Passive follow-up via linkage to national mortality registers is available for 95% of the database. Utility and discussion The CCN database provides a strong base for research into historically underrepresented patient groups due to the large number of patients and the lack of in- and exclusion criteria. It also enables the development of artificial intelligence-based decision support tools. Its contemporary nature allows for comparison of daily care with the current guidelines and protocols. Missing data is an inherent limitation, as the cardiologist could deviate from standardised protocols when clinically indicated. Conclusion The CCN database offers the opportunity to conduct research in a unique population referred from the general practitioner to the cardiologist for diagnostic workup. This, in combination with its large size, the representation of historically underrepresented patient groups and contemporary nature makes it a valuable tool for expanding our knowledge of cardiovascular diseases. Trial registration: Not applicable.

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Characteristics of Osteoporosis & Osteoporotic Fractures in Korea Based on Health Insurance Review and Assessment (HIRA) Database: 2009–2017

Healthcare ◽

10.3390/healthcare9030324 ◽

2021 ◽

Vol 9 (3) ◽

pp. 324

Author(s):

Ho-Seok Oh ◽

Sung-Kyu Kim ◽

Hyoung-Yeon Seo

Keyword(s):

Health Insurance ◽

Age Groups ◽

Osteoporotic Fractures ◽

Prescription Data ◽

Diagnostic Codes ◽

Number Of Patients ◽

Upper And Lower Extremities ◽

Fractures Of The Spine ◽

And Gender ◽

Age Range

To investigate the incidence and characteristics of osteoporosis and osteoporotic fractures in Korea, we used the Health Insurance Review and Assessment Service (HIRA) database. Patients over 50 years old, who were diagnosed or treated for osteoporosis and osteoporotic fractures in all hospitals and clinics, were analyzed between 1 January 2009 and 31 December 2017 by using the HIRA database that contains prescription data and diagnostic codes. These data were retrospectively analyzed by decade and age-specific and gender-specific incidents in each year. We also evaluated other characteristics of patients including medication state of osteoporosis, primary used medical institution, regional-specific incidence of osteoporosis, and incidence of site-specific osteoporotic fractures. The number of osteoporosis patients over 50 years old, as diagnosed by a doctor, steadily increased from 2009 to 2017. The number of osteoporosis patients was notably greatest in the 60′s and 70′s age groups in every study period. Patients undergoing treatment for osteoporosis increased significantly (96%) from 2009 to 2017. Among the patients diagnosed with osteoporosis, the proportion who experienced osteoporotic fracture increased gradually (60%) from 2009 to 2017. The number of patients with osteoporotic fractures of the spine and hip was highest in the 70 to 90 age range, and the number of patients with osteoporotic fractures in the upper and lower extremities was highest in the 50 to 70 age range. Understanding the trends of osteoporosis in Korea will contribute to manage the increased number of patients with osteoporosis and osteoporotic fractures.

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Non-medical risk factors associated with postponing elective surgery: a prospective observational study

BMC Medical Ethics ◽

10.1186/s12910-021-00660-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Julia Becker ◽

Gerald Huschak ◽

Hannes-Caspar Petzold ◽

Volker Thieme ◽

Sebastian Stehr ◽

...

Keyword(s):

Elderly Patients ◽

Low Socioeconomic Status ◽

Elective Surgery ◽

Nursing Home Residents ◽

Hospital Staff ◽

Data Management System ◽

Electronic Patient Records ◽

Specific Patient ◽

Emergency Procedures ◽

Patient Groups

Abstract Background Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons. Methods In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR’s patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann–Whitney U test and Fisher's exact test/χ2-test. Results Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer. Conclusions Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery. Trial registration DRKS00015836. Retrospectively registered.

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Letter to the Editor: Microbiota in the Respiratory System—A Possible Explanation to Age and Sex Variability in Susceptibility to SARS-CoV-2

Microbiology Insights ◽

10.1177/1178636120988604 ◽

2021 ◽

Vol 14 ◽

pp. 117863612098860

Author(s):

Vishal Shah

Keyword(s):

Respiratory System ◽

Elderly Population ◽

Age Groups ◽

The Elderly ◽

Elderly Adult ◽

Human Respiratory Tract ◽

System A ◽

Number Of Patients ◽

Children And Young Adults ◽

Age And Sex

The Human respiratory tract is colonized by a variety of microbes and the microbiota change as we age. In this perspective, literature support is presented for the hypothesis that the respiratory system microbiota could explain the differential age and sex breakdown amongst COVID-19 patients. The number of patients in the older and elderly adult group is higher than the other age groups. The perspective presents the possibility that certain genera of bacteria present in the respiratory system microbiota in children and young adults could be directly or through eliciting an immune response from the host, prevent full-fledged infection of SARS-CoV-2. The possibility also exists that the microbiota in older adults and the elderly population have bacteria that make it easier for the virus to cause infection. I call upon the scientific community to investigate the link between human microbiota and SARS-CoV-2 susceptibility to further understand the viral pathogenesis.

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Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084350 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4350

Author(s):

Antoni Sisó-Almirall ◽

Pilar Brito-Zerón ◽

Laura Conangla Ferrín ◽

Belchin Kostov ◽

Anna Moragas Moreno ◽

...

Keyword(s):

Primary Care ◽

Disease Management ◽

Signs And Symptoms ◽

Diagnostic Process ◽

Press Releases ◽

Expert Opinions ◽

Number Of Patients ◽

Patient Groups

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors’ clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.

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Impact of COVID-19 pandemic on non-COVID patient’s management in urology: a public hospital experience in Mumbai

African Journal of Urology ◽

10.1186/s12301-021-00196-0 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Nikhilesh A. Jibhakate ◽

Sujata K. Patwardhan ◽

Ajit S. Sawant ◽

Hemant R. Pathak ◽

Bhushan P. Patil ◽

...

Keyword(s):

Tertiary Care ◽

Stone Disease ◽

Outpatient Clinics ◽

Percentage Decrease ◽

Emergency Procedures ◽

Number Of Patients ◽

Long Term Impact ◽

Tertiary Care Hospitals ◽

The Impact ◽

Near Future

Abstract Background To evaluate the impact of COVID-19 lockdown on non-COVID urological patient’s management in tertiary care urology centres. Methods This is an observational study in which data of patients visiting the urology department of all the MCGM run tertiary care hospitals were recorded for the duration of 1 April 2020 to 31 July 2020 and were compared to data of pre-COVID-19 period of similar duration. Results There was a decrease of 93.86% in indoor admissions of urology patients during the COVID-19 lockdown. Indoor admissions for stone disease, haematuria, malignancy accounted for 53.65%, 15.85%, 9.75%, respectively. Elective surgeries had the highest percentage decrease followed by emergency and semi-emergency procedures. There was a reduction of more than 80% in patients attending outpatient clinics. Stone disease and its consequences were the main reasons for visiting outdoor clinics (39%). A substantial number of patients presented with flank and abdominal pain (14.8%) and benign enlargement of the prostate (10.23%). Malignancy accounted for a very small number of patients visiting outdoor clinics (1.58%). Conclusions COVID-19 pandemic has a profound impact on patient care and education in Urology. There was more than ninety percent reduction in indoor admissions, operative procedures, and outpatient clinics attendance. Once the pandemic is controlled, there will be a large number of patients seeking consultation and management for urological conditions and we should be prepared for it. Surgical training of urology residents needs to be compensated in near future. Long-term impact on urological patient outcome remains to be defined.

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The Use of GIS Technology to Optimize COVID-19 Vaccine Distribution: A Case Study of the City of Warsaw, Poland

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115636 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5636

Author(s):

Sylwia Krzysztofowicz ◽

Katarzyna Osińska-Skotak

Keyword(s):

Herd Immunity ◽

Research Work ◽

Age Groups ◽

Group Living ◽

Population Group ◽

Gis Technology ◽

Vaccination Site ◽

Global Challenge ◽

Vaccine Distribution ◽

The City

The COVID-19 pandemic is a global challenge, and the key to tackling it is vaccinating a specified percentage of the population to acquire herd immunity. The observed problems with the efficiency of the vaccination campaigns in numerous countries around the world, as well as the approach used at the initial stage of the National Immunization Program in Poland, prompted us to analyse the possibility of using GIS technology to optimize the distribution of vaccines to vaccination sites so as to minimize the period needed to vaccinate individual population groups. The research work was carried out on the example of Warsaw, the capital of Poland and the city with the largest population in the country. The analyses were carried out for the 60–70 and 50–60 age groups, in various approaches and for vaccines of different companies (Moderna, BioNTech, AstraZeneca), used to vaccinate people in Poland. The proposed approach to optimize vaccine distribution uses Thiessen’s tessellation to obtain information on the number of people in a given population group living in the area of each vaccination site, and then to estimate the time needed to vaccinate that group. Compared to the originally used vaccination scenario with limited availability of vaccines, the proposed approach allows practitioners to design fast and efficient distribution scenarios. With the developed methodology, we demonstrated ways to achieve uniform vaccination coverage throughout the city. We anticipate that the proposed approach can be easily automated and broadly applied to various urban settings.

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