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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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Hutton D, Mohamed B, Mehmood K, Magro J, Shekhar H, Solth A, Pulhorn H, Bennett D, Okasha M. COVID-19 and Spontaneous Resolution of Lumbar Disk Prolapse: A Retrospective Cohort Study of Patients Awaiting Microdiscectomy. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 37940114 DOI: 10.1055/a-2206-2718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Between individual patients with lumbar disk prolapse (LDP), the natural course of disease is significantly variable. Spontaneous resolution is reported to occur in up to 70% of cases. However, we currently cannot predict for whom and when this will occur. Neurosurgical intervention is indicated for LDP patients with nontolerable pain after at least 8 to 12 weeks of conservative management, or significant neurologic deficit. Channeling essential resources in the National Health Service (NHS) to fight the COVID-19 pandemic led to the postponement of most elective operations, including microdiskectomy. This left many LDP patients previously considered to be surgical candidates with conservative-only options in the interim. To our knowledge, we are the first center to report the specific impact of the peri- and postpandemic period on waiting list times, delayed elective microdiskectomy, and the incidence of spontaneous LDP resolution. METHODS Retrospective case series of a prospectively collected electronic departmental database identified LDP patients who would have been impacted by the COVID-19 pandemic at some point in their care pathway (March 2020-February 2022). Further information was obtained from electronic patient records. RESULTS In total, 139 LDP patients were listed for elective microdiskectomy at the time of postponement of elective surgery. Over a third of LDP patients (n = 47, 33.8%), in shared decision with the responsible neurosurgeon, had their rescheduled microdiskectomy canceled due to clinical improvement (14.1%), radiologic regression (6.5%), or both (12.2%). CONCLUSION Our single-center retrospective analysis revealed that for over a third of LDP patients, the prolonged postpandemic waiting list times for elective microdiskectomy resulted in their surgery not taking place either due to spontaneous clinical improvement or proven radiologic regression. Considering this, a prolonged conservative approach to LDP may be appropriate in some patients, allowing time for natural resolution, while avoiding perioperative risks.
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Affiliation(s)
- Dana Hutton
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
- Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Belal Mohamed
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Khalid Mehmood
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - James Magro
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Himanshu Shekhar
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Anna Solth
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Heinke Pulhorn
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - David Bennett
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Mohamed Okasha
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
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Bohlken J, Riedel-Heller SG, Kostev K, Michalowsky B. [Comparison of the Documented Dementia Diagnoses in German Primary Care with the Prevalence Estimate for 2021]. PSYCHIATRISCHE PRAXIS 2024; 51:45-48. [PMID: 37813361 DOI: 10.1055/a-2160-2864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND A current prevalence estimate predicted the number of people with dementia (PwD) with 1.8 million in 2021. This estimation is based on data from different sources especially from field studies and does not reflect the recognized and documented cases in primary care. We, therefore, aim to compare the prevalence of diagnosed PwD in general practitioner (GP) practices with these estimates of the general population. METHODS The number of diagnosed PwD in 946 GP practices with 2.8 million patients in 2021 was compared with the prevalence estimate of the German Alzheimer Society for 83 million inhabitants in Germany. RESULTS Dementia diagnoses were documented less frequently in GP practices compared to the prevalence estimate (1.88% vs 2.16%), especially the age groups 80+years were less likely present in GP practices prevalence. DISCUSSION There is still potential for optimizing dementia diagnostics in primary care, especially in patients 80 or older.
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Affiliation(s)
- Jens Bohlken
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig Medizinische Fakultät, Leipzig
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig Medizinische Fakultät, Leipzig
| | | | - Bernhard Michalowsky
- Deutsches Zentrum fur Neurodegenerative Erkrankungen, German Center for Neurodegenerative Diseases Site Rostock/Greifswald, Greifswald
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Watnick S. Pandemic Preparedness: Let's Be Ready for the Patient and Their Caregiver. Am J Kidney Dis 2023; 82:384-385. [PMID: 37578413 DOI: 10.1053/j.ajkd.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/03/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Suzanne Watnick
- Northwest Kidney Centers, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, Washington.
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Bohlken J, Michalowsky B, Kostev K. [Dementia Screening and Test Psychology in German General and Specialist Practices under Conditions of the Corona Pandemic]. PSYCHIATRISCHE PRAXIS 2023; 50:321-325. [PMID: 37160156 DOI: 10.1055/a-2043-9939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To analyse changes in frequencies of test psychology examinations (TPE) relevant to detect change in dementia diagnosis in general (GP) and neuropsychiatric (NP) practices during the Covid 19 pandemic. METHODS Cross-sectional study analysis comparing the number of patients aged ≥ 70 with at least one TPE in 908 GP and 107 NP-practices in 2018-2019 (prepandemic) and 2020-2021 (pandemic) using descriptive statisics and correlations. RESULTS While there was a large decrease in TPE between 2018-2019 and 2020-2021 (- 18.4%) conducted in NP-practices, it remained stable in GP-practices (+ 2.6%). In both GP and NP, there was a strong correlation between the number of patients tested and newly diagnosed with dementia. CONCLUSION TPE in performing in GP practices appears less susceptible to a pandemic-related decline in the provision compared to NP practices. Further research is needed to reveal the reasons for these differences.
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Affiliation(s)
- Jens Bohlken
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinischen Fakultät der Universität Leipzig
| | - Bernhard Michalowsky
- Deutsches Zentrum fur Neurodegenerative Erkrankungen (DZNE), Standort Rostock/ Greifswald, Greifswald
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Han X, Yang NN, Nogueira L, Jiang C, Wagle NS, Zhao J, Shi KS, Fan Q, Schafer E, Yabroff KR, Jemal A. Changes in cancer diagnoses and stage distribution during the first year of the COVID-19 pandemic in the USA: a cross-sectional nationwide assessment. Lancet Oncol 2023; 24:855-867. [PMID: 37541271 DOI: 10.1016/s1470-2045(23)00293-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The emergence of COVID-19 disrupted health care, with consequences for cancer diagnoses and outcomes, especially for early stage diagnoses, which generally have favourable prognoses. We aimed to examine nationwide changes in adult cancer diagnoses and stage distribution during the first year of the COVID-19 pandemic by cancer type and key sociodemographic factors in the USA. METHODS In this cross-sectional study, adults (aged ≥18 years) newly diagnosed with a first primary malignant cancer between Jan 1, 2018, and Dec 31, 2020, were identified from the US National Cancer Database. We included individuals across 50 US states and the District of Columbia who were treated in hospitals that were Commission on Cancer-accredited during the study period. Individuals whose cancer stage was 0 (except for bladder cancer), occult, or without an applicable American Joint Committee on Cancer staging scheme were excluded. Our primary outcomes were the change in the number and the change in the stage distribution of new cancer diagnoses between 2019 (Jan 1 to Dec 31) and 2020 (Jan 1 to Dec 31). Monthly counts and stage distributions were calculated for all cancers combined and for major cancer types. We also calculated annual change in stage distribution from 2019 to 2020 and adjusted odds ratios (aORs) using multivariable logistic regression, adjusted for age group, sex, race and ethnicity, health insurance status, comorbidity score, US state, zip code-level social deprivation index, and county-level age-adjusted COVID-19 mortality in 2020. Separate models were stratified by sociodemographic and clinical factors. FINDINGS We identified 2 404 050 adults who were newly diagnosed with cancer during the study period (830 528 in 2018, 849 290 in 2019, and 724 232 in 2020). Mean age was 63·5 years (SD 13·5) and 1 287 049 (53·5%) individuals were women, 1 117 001 (46·5%) were men, and 1 814 082 (75·5%) were non-Hispanic White. The monthly number of new cancer diagnoses (all stages) decreased substantially after the start of the COVID-19 pandemic in March, 2020, although monthly counts returned to near pre-pandemic levels by the end of 2020. The decrease in diagnoses was largest for stage I disease, leading to lower odds of being diagnosed with stage I disease in 2020 than in 2019 (aOR 0·946 [95% CI 0·939-0·952] for stage I vs stage II-IV); whereas, the odds of being diagnosed with stage IV disease were higher in 2020 than in 2019 (1·074 [1·066-1·083] for stage IV vs stage I-III). This pattern was observed in most cancer types and sociodemographic groups, although was most prominent among Hispanic individuals (0·922 [0·899-0·946] for stage I; 1·110 [1·077-1·144] for stage IV), Asian American and Pacific Islander individuals (0·924 [0·892-0·956] for stage I; 1·096 [1·052-1·142] for stage IV), uninsured individuals (0·917 [0·875-0·961] for stage I; 1·102 [1·055-1·152] for stage IV), Medicare-insured adults younger than 65 years (0·909 [0·882-0·937] for stage I; 1·105 [1·068-1·144] for stage IV), and individuals living in the most socioeconomically deprived areas (0·931 [0·917-0·946] for stage I; 1·106 [1·087-1·125] for stage IV). INTERPRETATION Substantial cancer underdiagnosis and decreases in the proportion of early stage diagnoses occurred during 2020 in the USA, particularly among medically underserved individuals. Monitoring the long-term effects of the pandemic on morbidity, survival, and mortality is warranted. FUNDING None.
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Affiliation(s)
- Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA.
| | - Nuo Nova Yang
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Changchuan Jiang
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nikita Sandeep Wagle
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Kewei Sylvia Shi
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Qinjin Fan
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Elizabeth Schafer
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
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Gollop C, Zingel R, Jacob L, Smith L, Koyanagi A, Kostev K. Incidence of Newly-Diagnosed Dementia After COVID-19 Infection versus Acute Upper Respiratory Infection: A Retrospective Cohort Study. J Alzheimers Dis 2023:JAD221271. [PMID: 37212106 DOI: 10.3233/jad-221271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND There is emerging evidence that coronavirus disease 2019 (COVID-19) is giving rise to seemingly unrelated clinical conditions long after the infection has resolved. OBJECTIVE The aim of this study is to examine whether COVID-19 is associated with an increased risk of dementia including Alzheimer's disease. METHODS This retrospective cohort study is based on longitudinal data from the IQVIATM Disease Analyzer database and included patients aged≥65 with an initial diagnosis of COVID-19 or acute upper respiratory infection (AURI) from 1,293 general practitioner practices between January 2020 and November 2021. AURI patients were matched 1 : 1 with COVID-19 patients using propensity scores based on sex, age, index quarter, health insurance type, the number of doctor visits, and comorbidities associated with dementia risk. Incidence rates of newly-diagnosed dementia were calculated using the person-years method. Poisson regression models were used to compute the incidence rate ratios (IRR). RESULTS The present study included 8,129 matched pairs (mean age 75.1 years, 58.9% females). After 12 months of follow-up, 1.84% of the COVID-19 patients and 1.78% of the AURI patients had been diagnosed with dementia. The Poisson regression model resulted in an IRR of 1.05 (95% CI: 0.85-1.29). CONCLUSION This study did not find any association between COVID-19 infection and one-year dementia incidence after controlling for all common risk factors for dementia. Because dementia is a progressive disease, which can be difficult to diagnose, a longer follow-up period might offer a better insight into a possible association between COVID-19 infection and an increased incidence of dementia cases in the future.
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Affiliation(s)
| | | | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, Barcelona, Spain
- Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, University Paris Cité, Paris, France
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Lee Smith
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, Barcelona, Spain
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Ambrosio G, Gensini GF, Stracci F. Virtual Outpatient Visits During COVID-19 Pandemic: So Distant, Yet So Close. J Am Heart Assoc 2023; 12:e028817. [PMID: 36734346 PMCID: PMC9973659 DOI: 10.1161/jaha.122.028817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Giuseppe Ambrosio
- Division of Cardiology, and Center for Clinical and Translational Research (CERICLET)University of Perugia School of MedicinePerugiaItaly
| | | | - Fabrizio Stracci
- Section of Public Health, and Center for Clinical and Translational Research (CERICLET)University of Perugia School of MedicinePerugiaItaly
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COVID-19 Continues to Burden General Practitioners: Impact on Workload, Provision of Care, and Intention to Leave. Healthcare (Basel) 2023; 11:healthcare11030320. [PMID: 36766895 PMCID: PMC9914234 DOI: 10.3390/healthcare11030320] [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: 12/12/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
General practitioners (GPs), already in a profession with a high workload, have been at the frontline of providing COVID-19-related healthcare in addition to routine care. Our study examined the impact of pandemic-related consultations and changes in practice organization on GPs' current workload and provision of healthcare in summer 2021 (May 2021-July 2021) and early 2022 (January 2022-February 2022). In total, 143 German GPs participated in an online survey in the summer of 2021. Of these, 51 GPs participated in the follow-up survey in 2022. Most GPs perceived an increase in consultation frequency, consultation times, and workload since the pandemic outbreak. Increased consultation times were related to the reduced provision of medical care to other patients with chronic diseases. More SARS-CoV-2 vaccination consultations were associated with reduced home visits, acute consultation times, and cancer screenings. A quarter of GPs considered leaving their job. Pandemic-related bureaucracy, restricted access to therapy and rehabilitation services specialized on COVID-19, unreliable vaccine deliveries, mandatory telematics-infrastructure implementation, and frequent changes in official regulations were the main reasons reported for dissatisfaction. Our results provide insights into how the pandemic continues to burden GPs' work routines and how better working conditions in times of high demand could be achieved in future pandemics.
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