scholarly journals The impact of the COVID-19 pandemic on urological care in Poland - Post-COVID resilience scenarios and recommendations for healthcare system: A national population-based modelling study.

2021 ◽  
Author(s):  
Artur Antoniewicz ◽  
Wojciech Niemczyk ◽  
Piotr Regulski ◽  
Marek Niezgodka
Keyword(s):  
Healthcare System ◽  
Healthcare Providers ◽  
Wait Time ◽  
Population Based ◽  
Surgical Capacity ◽  
Access To Treatment ◽  
Number Of Patients ◽  
Urological Procedures ◽  
Time Required ◽  
The Impact

IntroductionOur aim was to assess the time required to recover the hypothetical surgical capacity of urological procedures that were suspended due to lockdowns caused by the SARS-CoV-2 outbreak in 2020 and 2021 in Poland, to indicate the most affected procedures, and to estimate the recovery time after a likely fourth lockdown.Material and methodsThe data aggregates contained the number of patients who underwent specific urological procedures classified in the ICD-9, performed from January 2009 to October 2019, acquired in granulation per month and per single voivodeship, and obtained by healthcare providers such as hospitals, ambulatory units, and primary care facilities. Using the model, we obtained the time required to discharge the excessive load on the healthcare system and the median wait time in the post-lockdown period. We validated the model based on the data aggregates from March to October 2020.ResultsLeaving the capacity of the most affected procedures unaltered, or increasing it by 20%, would not reduce the backlog of patients waiting to receive care after the third lockdown. The consequences of a feasible fourth lockdown would cause the necessity of a post-lockdown increase in capacity by more than 50%.ConclusionsThe availability of the most affected procedures will never achieve the pre-pandemic state without increasing the hypothetical surgical capacity of urological procedures that were suspended due to lockdowns caused by the SARS-CoV-2 outbreak. These procedures require taking special steps to unblock the urological healthcare system and allow patients continuous access to treatment.

scholarly journals Population impact of direct-acting antiviral treatment on new presentations of hepatitis C-related decompensated cirrhosis: a national record-linkage study

Gut ◽  
2020 ◽  
Vol 69 (12) ◽  
pp. 2223-2231 ◽  
Author(s):  
Sharon J Hutchinson ◽  
Heather Valerio ◽  
Scott A McDonald ◽  
Alan Yeung ◽  
Kevin Pollock ◽  
...  
Keyword(s):  
Antiviral Treatment ◽  
Scale Up ◽  
Sustained Viral Response ◽  
Population Based ◽  
Decompensated Cirrhosis ◽  
Direct Acting Antiviral ◽  
Clinical Databases ◽  
Number Of Patients ◽  
Direct Acting ◽  
The Impact

ObjectivePopulation-based studies demonstrating the clinical impact of interferon-free direct-acting antiviral (DAA) therapies are lacking. We examined the impact of the introduction of DAAs on HCV-related decompensated cirrhosis (DC) through analysis of population-based data from Scotland.DesignThrough analysis of national surveillance data (involving linkage of HCV diagnosis and clinical databases to hospital and deaths registers), we determined i) the scale-up in the number of patients treated and achieving a sustained viral response (SVR), and ii) the change in the trend of new presentations with HCV-related DC, with the introduction of DAAs.ResultsApproximately 11 000 patients had been treated in Scotland over the 8-year period 2010/11 to 2017/18. The scale-up in the number of patients achieving SVR between the pre-DAA and DAA eras was 2.3-fold overall and 5.9-fold among those with compensated cirrhosis (the group at immediate risk of developing DC). In the pre-DAA era, the annual number of HCV-related DC presentations increased 4.6-fold between 2000 (30) and 2014 (142). In the DAA era, presentations decreased by 51% to 69 in 2018 (and by 67% among those with chronic infection at presentation), representing a significant change in trend (rate ratio 0.88, 95% CI 0.85 to 0.90). With the introduction of DAAs, an estimated 330 DC cases had been averted during 2015–18.ConclusionsNational scale-up in interferon-free DAA treatment is associated with the rapid downturn in presentations of HCV-related DC at the population-level. Major progress in averting HCV-related DC in the short-term is feasible, and thus other countries should strive to achieve the same.

Using adjuvant radiotherapy to improve cancer-specific survival in patients with highly aggressive prostate cancer: Examining recently released criteria.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 30-30
Author(s):  
Firas Abdollah ◽  
Giorgio Gandaglia ◽  
Alberto Briganti ◽  
Quoc-Dien Trinh ◽  
Paul Linh Nguyen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Score ◽  
Adjuvant Radiotherapy ◽  
Survival Rates ◽  
Population Based ◽  
Number Needed To Treat ◽  
Cancer Specific Survival ◽  
Pathological Characteristics ◽  
Number Of Patients ◽  
The Impact

30 Background: Although adjuvant radiotherapy (aRT) after radical prostatectomy (RP) improves biochemical recurrence (BCR)-free survival rates, its effect on cancer-specific mortality (CSM) in patients with prostate cancer (PCa) is still controversial. The aim of our study was to test the effect of aRT on CSM according to a risk score based on the number and nature of adverse pathological characteristics (Gleason score 8-10; pT3b/4, lymph node invasion [LNI]). Methods: Overall, 7,616 patients with pT3/4 N0/1 PCa treated with RP between 1995 and 2009 within the Surveillance Epidemiology and End Results Medicare-linked database were included in the study. Patients were stratified according to the risk score (less than 2 vs. 2 or more adverse characteristics), and the impact of aRT on CSM was examined in each sub-group. Additionally, to evaluate the effectiveness of aRT, we calculated the number needed to treat (NNT), defined as the average number of patients who must be treated to prevent one detrimental outcome. Subsequently, competing-risks regression models were used to test the effect of aRT on CSM rates in the overall population and after stratifying patients according to their risk score (less than 2 vs. 2 or more). Results: The risk score was associated with increasing 10-year CSM rates (P<0.001). When focusing on patients with a risk score 2 or more, 10-year CSM rates were significantly lower for individuals undergoing aRT compared to their counterpart not receiving aRT (6.9 vs. 16.2%, respectively; P=0.002). The corresponding NNT to prevent one death from PCa was 10. Adjuvant RT was not associated with lower CSM rates overall and in patients with a risk score less than 2. This was confirmed in multivariable analyses, where aRT decreased the risk of CSM only in patients with a risk score 2 or more (P≤0.02). Conclusions: Our findings confirm the validity of the previously reported risk score in selecting the most optimal candidates for aRT after surgery in a large contemporary population-based cohort of patients with pT3/4 N0/1 PCa. Patients with two or more adverse pathological characteristics at RP might benefit the most from aRT in terms of reduced CSM.

scholarly journals Informal caregivers’ views on the quality of healthcare services provided to older patients aged 80 or more in the hospital and 30 days after discharge

2020 ◽  
Author(s):  
Ingvild Lilleheie ◽  
Jonas Debesay ◽  
Asta Bye ◽  
Astrid Bergland
Keyword(s):  
Health Services ◽  
Social Services ◽  
Healthcare System ◽  
Older Patients ◽  
Informal Caregivers ◽  
Healthcare Providers ◽  
The European Union ◽  
Professional Care ◽  
The Impact

Abstract Background: In the European Union (EU), informal caregivers provide 60% of all care. Informal caregiving ranges from assistance with daily activities and provision of direct care to helping care recipients to navigate within complex healthcare and social services systems. While recent caregiver surveys document the impact of informal caregivers, systematic reviews show that they have unmet needs. Because of the political desire to reduce the length of hospital stays, older patients are discharged from the hospital ‘quicker and sicker’ than before. The transition between different levels of the healthcare system and the period after hospital discharge is critical for elderly patients.Caregivers’ perspectives on the quality of older patients’ care journeys between levels of the healthcare system may provide valuable information for healthcare providers and policymakers. This study aims to explore older patient’s informal caregivers’ views on healthcare quality in the hospital and in the first 30 days after hospitalisation. Method: We conducted semi-structured individual interviews with 12 participants to explore and describe informal caregivers’ subjective experiences of providing care to older relatives. The interviews were then transcribed and analysed thematically.Results: The analysis yielded the overarching theme ‘Informal caregivers – a health service alliance – quality contributor’, which was divided into four main themes: ‘Fast in, fast out’, ‘Scant information’, ‘Disclaimer of responsibility’ and ‘A struggle to secure professional care’. The healthcare system seemed to pay little attention to ensuring mutual understandings between those involved in discharge, treatment and coordination. The participants experienced that the healthcare providers’ main focus was on the patients’ diseases, although the health services are supposed to view patients holistically.Conclusion: Based on the information given by informal caregivers, health services must take into account each person’s needs and preferences. To deliver quality healthcare, better coordination between inter-professional care teams and the persons they serve is necessary. Health professionals must strengthen the involvement of caregivers in transitions between care and healthcare. Future work should evaluate targeted strategies for formal caregivers to cooperate, support and empower family members as informal caregivers.

scholarly journals Incidence and Mortality of Emergency Patients Transported by Emergency Medical Service Personnel during the Novel Corona Virus Pandemic in Osaka Prefecture, Japan: A Population-Based Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5662
Author(s):  
Yusuke Katayama ◽  
Kenta Tanaka ◽  
Tetsuhisa Kitamura ◽  
Taro Takeuchi ◽  
Shota Nakao ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Population Based ◽  
Emergency Medical Service Personnel ◽  
Emergency Patients ◽  
Emergency Medical ◽  
Number Of Patients ◽  
Incidence And Mortality ◽  
Osaka Prefecture ◽  
The Impact

Although the COVID-19 pandemic affects the emergency medical service (EMS) system, little is known about the impact of the COVID-19 pandemic on the prognosis of emergency patients. This study aimed to reveal the impact of the COVID-19 pandemic on the EMS system and patient outcomes. We included patients transported by ambulance who were registered in a population-based registry of patients transported by ambulance. The endpoints of this study were the incident number of patients transported by ambulance each month and the number of deaths among these patients admitted to hospital each month. The incidence rate ratio (IRR) and 95% confidence interval (CI) using a Poisson regression model with the year 2019 as the reference were calculated. A total of 500,194 patients were transported in 2019, whereas 443,321 patients were transported in 2020, indicating a significant decrease in the number of emergency patients transported by ambulance (IRR: 0.89, 95% CI: 0.88–0.89). The number of deaths of emergency patients admitted to hospital was 11,931 in 2019 and remained unchanged at 11,963 in 2020 (IRR: 1.00, 95% CI: 0.98–1.03). The incidence of emergency patients transported by ambulance decreased during the COVID-19 pandemic in 2020, but the mortality of emergency patients admitted to hospital did not change in this study.

Direct burden of oncologic disease in a socialized health care system: Using acute myeloid leukemia as an example.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e12040-e12040
Author(s):  
Marta Isabel De Correia Pereira ◽  
Emilia Cortesao ◽  
Ana Espadana ◽  
Gilberto P Marques ◽  
Catarina Geraldes ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Healthcare System ◽  
Myeloid Leukemia ◽  
Direct Costs ◽  
Average Hospital ◽  
Major Complications ◽  
Number Of Patients ◽  
Oncologic Patients ◽  
The Impact ◽  
Acute Myeloid

e12040 Background: Portugal has a socialized national healthcare system (NHS), rated 12th overall by WHO (2000), that exempts oncologic patients from paying the direct costs of treatment. It has a per capita Gross Domestic Product of $22 699 (International Monetary Fund, 2011), less than 50% of the US, and was severely affected by the international Financial Crisis, requiring a bail-out; in this scenario, the state budget for health for 2012 is approximately $9900 million. Adult acute myeloid leukemia (AML) is a relatively rare cancer, with standardized non-surgical inpatient treatment protocols (outside clinical trials) that are subject to little variation between centers and over time, characteristics that make it an ideal example to evaluate the impact of oncologic disease on a socialized healthcare system. Methods: We reviewed all new diagnoses of AML over a five-year period (2006 to 2010) in one of the 7 national centers that treat adult AML, to estimate the yearly expenditure with direct costs. Results: Over the period considered, 192 new adult cases were diagnosed (38.4 cases per year, 47% male), with a median age of 63 years; 43.8% were 65 or over. The 2009 National Directive assumes the daily cost of one hospitalization for uncomplicated adult “acute leukemia” [sic] to be $1250, with an average hospital stay of 12.2 days, amounting to $15 250; minor complications increase this to $2400 and 19.5 days, and major complications to $6 480 times 25 days, or $162 000. An allogeneic HSC transplant (allo-HSC) costs $9 605 daily, over 35.5 days, or $340 800. Assuming induction and one cycle of consolidation in under-65 cases, this Hospital would spend between $700 000 (no complications in either cycle) and $7 million (all cases with major complications in both cycles) on new cases per year. Additional cycles and allo-HSC push the estimate towards $1-10 million. Conclusions: While chronic metabolic, cardiovascular and respiratory diseases consume the bulk of resources, the burden of oncologic disease on a socialized NHS is marked. AML ideally exemplifies how a small number of patients can consume vast resources: as this estimate shows, Portugal could expect to spend $7-70 million of the 2012 health budget on new cases of AML alone.

Survival among colorectal cancer patients with a history of previous cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16146-e16146
Author(s):  
Sandi Pruitt ◽  
David E. Gerber ◽  
Hong Zhu ◽  
Daniel Heitjan ◽  
Bhumika Maddineni ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Cox Regression ◽  
Population Based ◽  
Competing Risk ◽  
Cancer Specific Survival ◽  
Risk Of Death ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

e16146 Background: A growing number of patients with colorectal cancer (CRC) have survived a previous cancer. Although little is known about their prognosis, this population is frequently excluded from clinical trials. We examined the impact of previous cancer on overall and cancer-specific survival in a population-based cohort of patients diagnosed with incident CRC. Methods: We identified patients aged ≥66 years and diagnosed with CRC between 2005-2015 in linked SEER-Medicare data. For patients with and without previous cancer, we estimated overall survival using Cox regression and cause-specific survival using competing risk regression, separately by CRC stage, while adjusting for numerous covariates and competing risk of death from previous cancer, other causes, or the incident CRC. Results: Of 112,769 CRC patients diagnosed with incident CRC, 15,935 (14.1%) had a previous cancer – most commonly prostate (32.9%) or breast (19.4%) cancer, with many 7505 (47.1%) diagnosed ≤5 years of CRC. For all CRC stages except IV in which there was no significant difference in survival, patients with previous cancer had modestly worse overall survival (hazard ratios from fully adjusted models range from 1.11-1.28 across stages; see Table). This survival disadvantage was driven by deaths due to previous cancer and other causes. Notably, most patients with previous cancer had improved CRC-specific survival. Conclusions: CRC patients who have survived a previous cancer have generally worse overall survival but superior CRC-specific survival. This evidence should be considered concurrently with concerns about trial generalizability, low accrual, and heterogeneity of participants when determining exclusion criteria. [Table: see text]

scholarly journals Forecasting Hospital Staff Availability During The COVID-19 Epidemic

2020 ◽  
Author(s):  
Chloe N. Schooling ◽  
Norbert Gyenge ◽  
Visakan Kadirkamanathan ◽  
James J.P. Alix
Keyword(s):  
Infection Rate ◽  
Web Application ◽  
Stress Test ◽  
Healthcare Providers ◽  
Hospital Staff ◽  
Population Based ◽  
Work Patterns ◽  
Number Of Patients ◽  
On Line ◽  
Planning Staff

AbstractThe COVID-19 pandemic poses two challenges to healthcare providers. Firstly, a high number of patients require hospital admission. Second, a high number of healthcare staff are either falling ill with the infection, or self-isolating. This poses significant problems for the staffing of busy hospital departments. We have created a simple model which allows users to stress test their rota. The model provides plots of staff availability over time using either a constant infection rate, or a changing infection rate fitted to population-based infection curves. It allows users to gauge the extent and timing of dips in staff availability. The basic constant infection rate model is available within an on-line web application (https://covid19.shef.ac.uk). As for any model, our work is imperfect. However, it allows a range of infection rates to be simulated quickly across different work patterns. We hope it will be useful to those planning staff deployment and will stimulate debate on the most effective patterns of work during the COVID-19 epidemic.

scholarly journals Informal caregivers’ views on the quality of health care services provided to older patients aged 80 or more in the hospital and 30 days after discharge

2020 ◽  
Author(s):  
Ingvild Lilleheie ◽  
Jonas Debesay ◽  
Asta Bye ◽  
Astrid Bergland
Keyword(s):  
Health Services ◽  
Social Services ◽  
Healthcare System ◽  
Older Patients ◽  
Informal Caregivers ◽  
Healthcare Providers ◽  
The European Union ◽  
Professional Care ◽  
The Impact

Abstract Background In the European Union (EU), informal caregivers provide 60% of all care. Informal caregiving ranges from assistance with daily activities and provision of direct care to helping care recipients to navigate within complex healthcare and social services systems. While recent caregiver surveys document the impact of informal caregivers, systematic reviews show that they have unmet needs. Because of the political desire to reduce the length of hospital stays, older patients are discharged from the hospital ‘quicker and sicker’ than before. The transition between different levels of the healthcare system and the period after hospital discharge is critical for elderly patients. Caregivers’ perspectives on the quality of older patients’ care journeys between levels of the healthcare system may provide valuable information for healthcare providers and policymakers. This study aims to explore older patient’s informal caregivers’ views on healthcare quality in the hospital and in the first 30 days after hospitalisation. Method We conducted semi-structured individual interviews with 12 participants to explore and describe informal caregivers’ subjective experiences of providing care to older relatives. The interviews were then transcribed and analysed thematically. Results The analysis yielded the overarching theme ‘Informal caregivers – a health service alliance – quality contributor’, which was divided into four main themes: ‘Fast in, fast out’, ‘Scant information’, ‘Disclaimer of responsibility’ and ‘A struggle to secure professional care’. The healthcare system seemed to pay little attention to ensuring mutual understandings between those involved in discharge, treatment and coordination. The participants experienced that the healthcare providers’ main focus was on the patients’ diseases, although the health services are supposed to view patients holistically. Conclusion Based on the information given by informal caregivers, health services must take into account each person’s needs and preferences. To deliver quality healthcare, better coordination between inter-professional care teams and the persons they serve is necessary. Health professionals must strengthen the involvement of caregivers in transitions between care and healthcare. Future work should evaluate targeted strategies for formal caregivers to cooperate, support and empower family members as informal caregivers.

scholarly journals Informal caregivers’ views on the quality of health care services provided to older patients aged 80 or more in the hospital and 30 days after discharge

2020 ◽  
Author(s):  
Ingvild Lilleheie ◽  
Jonas Debesay ◽  
Asta Bye ◽  
Astrid Bergland
Keyword(s):  
Health Services ◽  
Social Services ◽  
Healthcare System ◽  
Older Patients ◽  
Informal Caregivers ◽  
Healthcare Providers ◽  
The European Union ◽  
Professional Care ◽  
The Impact

Abstract Background In the European Union (EU), informal caregivers provide 60% of all care. Informal caregiving ranges from assistance with daily activities and provision of direct care to helping care recipients to navigate within complex healthcare and social services systems. While recent caregiver surveys document the impact of informal caregivers, systematic reviews show that they have unmet needs. Because of the political desire to reduce the length of hospital stays, older patients are discharged from the hospital ‘quicker and sicker’ than before. The transition between different levels of the healthcare system and the period after hospital discharge is critical for elderly patients. Caregivers’ perspectives on the quality of older patients’ care journeys between levels of the healthcare system may provide valuable information for healthcare providers and policymakers. This study aims to explore older patient’s informal caregivers’ views on healthcare quality in the hospital and in the first 30 days after hospitalisation. Method We conducted semi-structured individual interviews with 12 participants to explore and describe informal caregivers’ subjective experiences of providing care to older relatives. The interviews were then transcribed and analysed thematically. Results The analysis yielded the overarching theme ‘Informal caregivers – a health service alliance – quality contributor’, which was divided into four main themes: ‘Fast in, fast out’, ‘Scant information’, ‘Disclaimer of responsibility’ and ‘A struggle to secure professional care’. The healthcare system seemed to pay little attention to ensuring mutual understandings between those involved in discharge, treatment and coordination. The participants experienced that the healthcare providers’ main focus was on the patients’ diseases, although the health services are supposed to view patients holistically. Conclusion Based on the information given by informal caregivers, health services must take into account each person’s needs and preferences. To deliver quality healthcare, better coordination between inter-professional care teams and the persons they serve is necessary. Health professionals must strengthen the involvement of caregivers in transitions between care and healthcare. Future work should evaluate targeted strategies for formal caregivers to cooperate, support and empower family members as informal caregivers.

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