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Paffenholz P, Platen M, Kostev K, Loosen SH, Bohlken J, Michalowsky B. Medical care services provision and stress experience in urologists during all waves of the COVID-19 pandemic in Germany. Front Med (Lausanne) 2024; 11:1320489. [PMID: 38405189 PMCID: PMC10893761 DOI: 10.3389/fmed.2024.1320489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose Urologists' practices reported decreasing medical care provision and increasing stress experience in the first wave of the COVID-19 pandemic. However, long-term effects of the pandemic are unknown. Methods Medical record data of n = 127 urologists were used to assess changes in healthcare provision, comparing the pandemic with the pre-pandemic period. An online survey among n = 101 urologists was conducted to assess the physicians' perceptions of the identified healthcare provision and organizational changes and experiences of anxiety, stress, and support needs during the pandemic waves. Urologists consultations, specialists' referrals, hospital admissions, documented cancer diagnoses, urologists' perceptions of causes for these changes and experienced stress, anxiety and support needs. Results were demonstrated using descriptive statistics. Results Over the first two years of the pandemic, there was a slight decline in consultations (-0,94%), but more intensive reduction in hospital admissions (-13,6%) and identified cancer diagnoses (-6,2%). Although patients' behavior was seen as the main reason for the changes, 71 and 61% of consultations of high-risk patients or urgent surgeries were canceled. Telemedical approaches were implemented by 58% of urologists, and 88% stated that the reduced cancer detection rate would negatively affect patients' outcomes. Urologists reported higher anxiety, stress, and need for support during all waves of the pandemic than other disciplines, especially females. Conclusion The pandemic tremendously affects urologists' health care provision and stress experience, possibly causing long-term consequences for patients and physicians.
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Affiliation(s)
- Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Moritz Platen
- German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
| | | | - Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jens Bohlken
- Occupational Medicine, and Public Health (ISAP) of the Medical Faculty at the University of LeipzigInstitute for Social Medicine, Leipzig, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald, Germany
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De Lorenzo R, Montagna M, Bossi E, Vitali G, Taino A, Cilla M, Pata G, Lazorova L, Pesenti R, Pomaranzi C, Bussolari C, Martinenghi S, Bordonaro N, Di Napoli D, Rizzardini G, Cogliati C, Morici N, Rovere-Querini P. A Pilot Study of the Efficacy and Economical Sustainability of Acute Coronavirus Disease 2019 Patient Management in an Outpatient Setting. Front Med (Lausanne) 2022; 9:892962. [PMID: 35572976 PMCID: PMC9092828 DOI: 10.3389/fmed.2022.892962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To report a preliminary experience of outpatient management of patients with Coronavirus disease 2019 (COVID-19) through an innovative approach of healthcare delivery. Patients and Methods Patients evaluated at the Mild-to-Moderate COVID-19 Outpatient clinics (MMCOs) of San Raffaele University Hospital and Luigi Sacco University Hospital in Milan, Italy, from 1 October 2020 to 31 October 2021 were included. Patients were referred by general practitioners (GPs), Emergency Department (ED) physicians or hospital specialists (HS) in case of moderate COVID-19. A classification and regression tree (CART) model predicting ED referral by MMCO physicians was developed to aid GPs identify those deserving immediate ED admission. Cost-effectiveness analysis was also performed. Results A total of 660 patients were included. The majority (70%) was referred by GPs, 21% by the ED and 9% by HS. Patients referred by GPs had more severe disease as assessed by peripheral oxygen saturation (SpO2), ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), C-reactive protein (CRP) levels and interstitial involvement at lung ultrasound. Among them, 18% were addressed to the ED following MMCO assessment. CART analysis identified three independent predictors, namely home-measured SpO2, age and body mass index (BMI), that robustly divide patients into risk groups of COVID-19 severity. Home-measured SpO2 < 95% and BMI ≥ 33 Kg/m2 defined the high-risk group. The model yielded an accuracy (95% CI) of 83 (77-88)%. Outpatient management of COVID-19 patients allowed the national healthcare system to spare 1,490,422.05 € when compared with inpatient care. Conclusion Mild-to-moderate COVID-19 outpatient clinics were effective and sustainable in managing COVID-19 patients and allowed to alleviate pressure on EDs and hospital wards, favoring effort redirection toward non-COVID-19 patients.
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Affiliation(s)
- Rebecca De Lorenzo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy
| | - Marco Montagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy
| | - Eleonora Bossi
- Clinical Governance Division, San Raffaele Hospital, Milan, Italy
| | - Giordano Vitali
- Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy
| | - Alba Taino
- Unit of Internal Medicine, Luigi Sacco Hospital, Azienda Socio Sanitaria Territoriale - Fatebenefratelli (ASST-FBF)-Sacco, Milan, Italy
| | - Marta Cilla
- Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy
| | - Giulia Pata
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy
| | - Ludmilla Lazorova
- Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy
| | - Riccardo Pesenti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Pomaranzi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy
| | - Cecilia Bussolari
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy
| | - Sabina Martinenghi
- Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy
| | - Nicoletta Bordonaro
- Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy
| | - Davide Di Napoli
- Clinical Governance Division, San Raffaele Hospital, Milan, Italy
| | - Giuliano Rizzardini
- Unit of Infectious Diseases, Luigi Sacco Hospital, Azienda Socio Sanitaria Territoriale - Fatebenefratelli (ASST-FBF)-Sacco, Milan, Italy
| | - Chiara Cogliati
- Unit of Internal Medicine, Luigi Sacco Hospital, Azienda Socio Sanitaria Territoriale - Fatebenefratelli (ASST-FBF)-Sacco, Milan, Italy
| | - Nuccia Morici
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Patrizia Rovere-Querini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Unit of Hospital-Primary Care Embedding, San Raffaele Hospital, Milan, Italy
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Pereira-Correia JA, Gomes CMPP, Barbosa PHN, Salomão BA, Morais HS, Muller VJF. Safe urodynamic practices in times of COVID-19: What can be accomplished and what can be added? Neurourol Urodyn 2022; 41:1091-1096. [PMID: 35366376 PMCID: PMC9088589 DOI: 10.1002/nau.24907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Accepted: 02/17/2022] [Indexed: 11/12/2022]
Abstract
AIM To present feedback, after applying national and international urodynamic study (UDS) recommendations for safe practice during the COVID-19 pandemic. METHODS We created a checklist to assess the feasibility of performing UDS recommendations for safe practice during the COVID-19 pandemic from the first week of May 2021 to the last week of July 2021. RESULTS One hundred patients were analyzed during the study period. We observed that all preventive recommendations for the steps that precede UDS could be followed in full. However, some guidelines for performing the exam were not feasible in all patients. We have successfully adopted other safety measures for all patients. CONCLUSIONS The COVID-19 pandemic will likely persist for several more years. We believe that continuous improvement, revision, and updating of existing protocols and guidelines for the safe practice of UDS in times of COVID-19, as we propose in this study, should be encouraged.
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Affiliation(s)
- João A Pereira-Correia
- Department of Urology, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos M P P Gomes
- Department of Urology, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo H N Barbosa
- Department of Urology, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno A Salomão
- Department of Urology, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Heitor S Morais
- Department of Urology, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valter J F Muller
- Department of Urology, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
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