A costing and health-related quality of life study of high intensity focused ultrasound in primary treatment of localized low or intermediate risk prostate cancer in Ontario.

INTRODUCTION: Prostate cancer is the third leading cause of death from cancer among Canadian men. High intensity focused ultrasound (HIFU) is a novel approach for primary treatment of localized prostate cancer. Little is known, however, about its costs. We aimed to collect the direct costs and health-related quality of life (HRQoL) data of HIFU in primary treatment of localized low and intermediate risk prostate cancer in Ontario. MATERIALS AND METHODS: We collected direct costs and HRQoL data of 20 patients with localized low or intermediate risk prostate cancer who received whole-gland HIFU at a privately owned clinic in Ontario. We compared the direct costs of HIFU, open radical prostatectomy (ORP), robot assisted radical prostatectomy (RARP), and external beam radiation therapy (RT) in primary treatment of localized low and intermediate risk prostate cancer. RESULTS: The average direct costs of HIFU, ORP, RARP, and RT per case in 2023 are $14,886.78, $14,192.26, $21,794.55, and $17,377.51, respectively. The median and interquartile range (IQR) of the study participants' age and HRQoL data prior to the HIFU procedure were 64.5 (11.25) years, 94.5 (8.65), 38.5 (4), 6.0 (4.46), and 22.5 (8.32), respectively. CONCLUSION: Our healthcare payer's perspective costing study revealed median direct costs per case of HIFU and favorable HRQoL outcomes compared to other treatment options for primary treatment of localized low and intermediate risk prostate cancer in Ontario. A health economic model is warranted to analyze the cost-effectiveness of HIFU compared to other treatment options in primary treatment of localized low and intermediate risk prostate cancer.

The telehealth surge: Speech-language pathology mode of service delivery and consumer characteristics during COVID-19.

PURPOSE: To examine the characteristics of speech-language pathology (SLP) consumers prior to and during the COVID-19 pandemic, with respect to the mode of service delivery within a local health district in New South Wales, Australia, to inform future health service planning. METHOD: Observational study examining SLP occasions of service data pre-COVID-19 (2019-2019; n = 6413) and during the COVID-19 pandemic (2020-2021; n = 6908). Spatial mapping and multilevel models were used to examine associations between sociodemographic characteristics, telehealth utilisation, and videoconferencing. RESULT: During COVID-19, SLP occasions of service increased by 7.7% compared to pre-COVID-19. Model 1 found odds of adopting telehealth (telephone or videoconference) during COVID-19 were significantly higher for those aged 0-4 and 5-17 years compared to older age groups. Consumers in inner regional areas were significantly less likely to adopt telehealth than in major city areas, whereas females were significantly more likely to adopt telehealth. Those living in areas experiencing higher relative disadvantage were less likely to use telehealth. Model 2 found odds of adopting videoconferencing only were also significantly higher for the younger age groups (0-4 and 5-17 years) and females. CONCLUSION: A rapid transition to a virtual model of care was critical to the successful delivery of SLP services during COVID-19. Immediate prioritisation and integration of targeted models of care, where suitability is high and benefits most likely to be experienced, is feasible.

A Secret Shopper Study of Language Accessibility of Community-based Behavioral Health Services for Children in Families Who Speak Spanish and English.

OBJECTIVE: To compare outpatient behavioral health scheduling for children in Spanish-speaking families in Pennsylvania with that for children in families who speak English. STUDY DESIGN: We made paired English and Spanish telephone calls to outpatient behavioral health facilities using a standardized script, describing a simulated, stable, Medicaid-insured child. Facilities were identified using the Pennsylvania Department of Human Services Online Provider Directory for Mental Health and Substance Abuse Services, which had 288 outpatient facilities with non-duplicate telephone numbers. An English-language caller following a script made up to two call attempts per facility from December 2019 through February 2020. The 126 facilities that did not answer the phone, accept Medicaid, or see children were removed. A Spanish-language caller then made up to two scripted call attempts to the 162 remaining facilities. The primary outcome was whether the facility tried to schedule an appointment for the simulated adolescent. RESULTS: 125 facilities answered both English- and Spanish-language calls. For the English-language caller, 71% of facilities attempted to schedule an appointment and 100% communicated in the caller's preferred language. For the Spanish-language caller, 24% attempted to schedule an appointment (P<0.001) and 25% communicated in the caller's preferred language (P<0.001). CONCLUSIONS: Among outpatient behavioral health facilities for Medicaid-insured children in Pennsylvania, there were inequities in access to appointments for families who speak Spanish compared with English. This a modifiable barrier to care. Community-based behavioral health care for children should strengthen language access training, contracting, and oversight.

Expedited versus standard postpartum discharge in patients with hypertensive disorders of pregnancy and its effect on the postpartum course.

BACKGROUND: Hospital stay after an uncomplicated delivery is typically 2 days for vaginal birth and 3 days for cesarean birth. Health maintenance organizations and third-party payers have encouraged shorter maternity stays. The safety of earlier discharge is unclear particularly when it comes to patients diagnosed with hypertensive disorders of pregnancy (HDP). OBJECTIVE: To examine whether expedited discharge amongst patients with HDP will have a negative effect on postpartum readmission rate and blood pressure related complications. STUDY DESIGN: This was a single academic center retrospective cohort study of patients with HDP (gestational hypertension, preeclampsia, or chronic hypertension) during 2 epochs: 2015-2018, prior to implementation of an expedited discharge policy, and 2019-2020 after hospital wide implementation of expedited postpartum discharge. The expedited discharge policy entailed patients being discharged home as soon as day 1 after a vaginal delivery and day 2 after a cesarean delivery. The primary outcome was unplanned health care utilization postpartum, defined as Emergency Department (ED) visits, unscheduled clinic visits, and hospital readmission. Secondary outcomes were planned postpartum visits attendance, antihypertensive medication initiation after discharge, and blood pressure control throughout the first year. Bivariable and multivariable logistic regression analyses were run to evaluate the association between expedited discharge and primary and secondary outcomes. RESULTS: A total of 1,441 patients were included in the analysis. There were no statistically significant differences in the rate of unplanned health care utilization (11.3% in the standard postpartum discharge group vs. 13.8% in the expedited discharge group, p=0.17). Systolic and diastolic blood pressures did not differ between the groups at 1-2 weeks, six weeks, and one year postpartum. Patients in the expedited discharge group were more likely to attend the 1-2-week postpartum blood pressure check (58.7% vs. 51.7%, p=0.02, adjusted OR 1.33, 95% CI 1.08-1.77). Other secondary outcomes did not differ between the two cohort groups. CONCLUSION: In this single academic center study, expedited discharge after delivery in patients with HDP was not associated with a higher rate of unplanned healthcare utilization postpartum.

Social Vulnerability and National Diabetes Prevention Program Recognition Status.

INTRODUCTION: The CDC National Diabetes Prevention Program (National DPP) aims to reduce the incidence of diabetes in the U.S. Organizations delivering the National DPP receive pending, preliminary, full, or full-plus recognition status based on specific program criteria and outcomes. Achieving full/full-plus recognition is critical for organizations to sustain the program and receive reimbursements to cover costs, but organizations in disadvantaged areas may face barriers to obtaining this level of recognition. This study examined the association between county-level social vulnerability and full/full-plus recognition status within the National DPP. METHODS: Using the 2022 National DPP registry and the 2018 CDC Social Vulnerability Index (SVI), a three-level categorical dependent variable was created (n=843): counties without organizations having full/full-plus recognition, counties with at least one organization not having full/full-plus recognition, and counties with all organizations having full/full-plus recognition. A multinomial logit model was analyzed in 2023 to examine the association between SVI and in-person full/full-plus recognition organizations at the county level, adjusting for confounders. RESULTS: Compared to counties with low social vulnerability, counties with higher social vulnerability had significantly higher odds of having no organizations with full/full-plus recognition. For example, counties with high SVI had 2.63 (95% CI: 1.55-4.47) times higher odds of having no organizations with full/full-plus recognition compared to having all organizations with full/full-plus CDC recognition. CONCLUSIONS: The findings suggest disparities in the National DPP recognition status among organizations in vulnerable communities. Developing strategies to ensure organizations in high social vulnerability areas achieve at least full recognition status is critical for program sustainability and reducing diabetes-related health disparities.

[The manager-IPA pair in mental health: experimenting with a new form of collaboration]. / Le binôme cadre-IPA en santé mentale : expérimenter une nouvelle collaboration.

In 2021, the first advanced practice nurses (APNs) specializing in psychiatry and mental health will have entered the vast field of practice of this discipline. Two years on, the missions entrusted to them within the establishments that have supported the development of their new skills are as varied as ever. While their scope of action remains to be defined in some places, the fact remains that collaboration between the APN and the local health executive is already proving to be a powerful lever for the successful completion of large-scale projects aimed at the continuous improvement of care in their shared field of practice. A look back at the deployment of a quality tool to improve care safety.

The statue of Matron Alice Cashin (1870-1939).

Alice Alanna Cashin (1870-1939) was a pioneering Australian nurse whose career spanned both conflict and humanitarian service. Born to Irish immigrants in Australia, Cashin trained at St. Vincent's Hospital, Sydney, before expanding her expertise in London and joining the British Red Cross during World War I. Her service included critical roles in France and Egypt, and she was eventually promoted to 'seas-matron' on the HMHS Gloucester Castle. During a torpedo attack by a German U-Boat, Cashin displayed extraordinary bravery, overseeing the evacuation of over 399 patients and ensuring their safety before leaving on the last lifeboat. After the war, she managed a military hospital in England before returning to Australia to care for her ailing father and later her elderly uncle. Cashin's post-war years included a modest stint running a stationery shop and her retirement in Victoria Road. Her exemplary service earned her multiple accolades, including the Star Medal and the Royal Red Cross Medal, the latter being the first awarded to an Australian. She was also honoured with multiple mentions in dispatches and personal invitations to Buckingham Palace. Alice Cashin's legacy is memorialised at the Woronora Cemetery, with her medals and accolades displayed at the ANZAC Memorial in Sydney, reflecting her enduring impact on the nursing profession and her remarkable dedication to service and care.

Excruciating existential suffering and complicated grief: The essence of surviving the suicide of a son or daughter.

BACKGROUND: Suicide is the fourth most common cause of death for the 15-29 age group. Research on the impact of suicide on parents is scarce and, therefore, poorly understood. AIM: To explore parents' experiences who have lost a son or a daughter due to suicide and their experience of the services available to them. METHODS: This phenomenological study involved 1-2 interviews with ten parents aged 40-65, seven mothers and three fathers in all 13 interviews. The age range of their sons and daughters was 17-37 years when they died. RESULTS: For the parents, losing a son or a daughter to suicide is an overwhelming life experience characterised by Excruciating existential suffering and complicated grief where they are confronted with deep meaning-making and existential questions without answers since the person who can answer most of them is no longer alive. They, therefore, felt stuck in their grief for up to 4 years. The initial experience was an immense paralysing shock and sense of unreality. The subsequent period was a blur, and they were numb. Then, their psyche and bodies collapsed, and for a long time, they felt no grief processing was taking place. They sorely needed long-term professional trauma-informed support and felt that, in too many cases, they had to reach out for help themselves. They would have liked to see the healthcare system embrace them with more open arms, offer help and be met with information and individualised support. CONCLUSIONS: Standard operating procedures must be installed to support suicide-bereaved parents better. Long-term professional support and trauma-focused care are required following such major trauma, and providing such support could help to reduce their adverse health impacts. Nurses and other health professionals must be better educated on existential suffering in this context.

Healthcare practitioners' experiences in managing HIV among young people in Namibia.

BACKGROUND:  Low viral load suppression rates among older adolescents and young adults with HIV are a global challenge, including in Namibia. Healthcare providers struggle with managing these age groups due to their unique demographic characteristics. Monitoring viral load suppression is vital for evaluating antiretroviral treatment effectiveness, making it essential to identify and address existing gaps. OBJECTIVES:  This study aimed to explore and describe healthcare practitioners' understanding and experiences in managing older adolescents and younger adults living with HIV in seven high-burden districts of Namibia. METHOD:  Qualitative descriptive phenomenological research was followed in this study. Healthcare practitioners directly managing older adolescents and younger adults living with HIV were purposively recruited. Telephonic individual interviews were conducted, and data saturation was achieved with the 29th participant. Colaizzi's seven-step analysis was used to analyse the data. RESULTS:  Two themes emerged from the study: (1) healthcare practitioners' knowledge of viral load management and (2) the strategies employed to manage high viral load in these age groups. These strategies included implementing differentiated service delivery, adopting interprofessional and Ubuntu approaches, psychosocial support, community engagement, enhancing adherence counselling, and support from implementing partners. CONCLUSION:  The findings revealed inadequate knowledge among healthcare practitioners regarding viral load management, which negatively impacts the provision of quality care and an effective HIV response within the spirit of Ubuntu.Contribution: This study enhances healthcare practitioners' capacity in viral load management and guides policy makers in supporting this unique population, thus improving their health outcomes.

Value based healthcare and Health Technology Assessment for emerging market countries: joint efforts to overcome barriers.

INTRODUCTION: This paper summarizes the results from a forum of healthcare experts, academia representatives, and public agency officials from emerging and established market countries on Value-Based Healthcare (VBHC) and Health Technology Assessment (HTA). Presentations from experts provided insights into current developments and challenges, followed by interactive roundtable discussions. Emerging markets have unique healthcare systems, patient populations, resource constraints and needs. AREAS COVERED: Each roundtable explored specific topics including the role of HTA and Real-world evidence (RWE) in healthcare decision-making, challenges in biosimilar value assessment and incorporating non-price criteria reflecting context-related specifications of emerging markets such as the multifaceted nature of value in healthcare decision-making, emphasizing stakeholder perspectives and system complexities. EXPERT OPINION: RWE emerged as important in understanding biosimilar value recognition and decision-making processes, with insights into its applications and challenges. Recommendations were provided for utilizing Multi-Criteria Decision Analysis (MCDA) in pharmaceutical procurement, particularly for off-patent medicines, underscoring the importance of comprehensive evaluation frameworks and adherence to value-based principles. Overall findings suggest avenues for collaboration between industry, academia, and public agencies to address implementation barriers and promote equitable, efficient, and high-quality healthcare systems in emerging markets through public-private partnerships, joint capacity building and training initiatives, and knowledge transfers.

Achieving Health Equity: Combatting the Disparities in American Access to Musculoskeletal Care : Disparities Exist in Every Aspect of Orthopaedic Care in the United States - Access to Outpatient Visits, Discretionary and Unplanned Surgical Care, and Postoperative Outcomes. What Can We Do?

PURPOSE OF REVIEW: Healthcare disparities influence multiple dimensions of orthopaedic care including access, burden and incidence of disease, and outcome in varying populations. These disparities impact healthcare at both the micro and macro scale of the healthcare experience from individual patient-physician relationships to reimbursement rates across the United States. This article provides a review of how healthcare disparities contribute to the landscape of orthopaedic care and specifically highlights how disparities affect outpatient visits, discretionary and unplanned surgical care, and postoperative outcomes. RECENT FINDINGS: Current research demonstrates the widespread presence of healthcare disparities in the field of orthopaedics and gives both objective and subjective evidence confirming disparities' measurable influence. The disparities most highlighted by our review include differences in orthopaedic care based on insurance type and race. Currently disparities in orthopaedic care are deeply connected to patient insurance status and race. In the outpatient setting insurance significantly impacts access to care, travel burden, and utilization of services. The emergent setting is similarly influenced with measurable differences in lack of access to acute care, rates of inappropriate triage, and timeliness of care based on insurance status and race. Additionally, the postoperative period is not immune to disparities with likelihood of follow up, experience of catastrophic medical expenses, and postoperative outcomes also being affected. Addressing these disparities is a pressing need and may include solutions like wider expansion and acceptance of publicly funded insurance and the development of readily available and easily measurable metrics for healthcare equity and quality in vulnerable populations.

Factors Associated with Venous Thromboembolism Pharmacoprophylaxis Initiation in Hospitalized Medical Patients: The Medical Inpatients Thrombosis and Hemostasis (MITH) Study.

BACKGROUND: Although guidelines recommend risk assessment for hospital-acquired venous thromboembolism (HA-VTE) to inform prophylaxis decisions, studies demonstrate inappropriate utilization of pharmacoprophylaxis in hospitalized medical patients. Predictors of pharmacoprophylaxis initiation in medical inpatients remain largely unknown. OBJECTIVE: To determine factors associated with HA-VTE pharmacoprophylaxis initiation in adults hospitalized on medical services. DESIGN: Cohort study using electronic health record data from adult patients hospitalized on medical services at four academic medical centers between 2016 and 2019. PARTICIPANTS: Among 111,550 admissions not on intermediate or full-dose anticoagulation, 48,520 (43.5%) received HA-VTE pharmacoprophylaxis on the day of or the day after admission. MAIN MEASURES: Candidate predictors of HA-VTE pharmacoprophylaxis initiation, including known HA-VTE risk factors, predicted HA-VTE risk, and bleeding diagnoses present on admission. KEY RESULTS: After adjustment for age, sex, race/ethnicity, and study site, the strongest clinical predictors of HA-VTE pharmacoprophylaxis initiation were malnutrition and chronic obstructive pulmonary disease. Thrombocytopenia and history of gastrointestinal bleeding were associated with decreased odds of HA-VTE pharmacoprophylaxis initiation. Patients in the highest two tertiles of predicted HA-VTE risk were less likely to receive HA-VTE pharmacoprophylaxis than patients in the lowest (1st) tertile (OR 0.84, 95% CI [0.81, 0.86] for 2nd tertile, OR 0.95, 95% CI [0.92, 0.98] for 3rd tertile). CONCLUSIONS: Among patients not already receiving anticoagulants, HA-VTE pharmacoprophylaxis initiation during the first two hospital days was lower in patients with higher predicted HA-VTE risk and those with risk factors for bleeding. Reasons for not initiating pharmacoprophylaxis in those with higher predicted risk could not be assessed.

Asthma exacerbations in Aspergillus fumigatus-sensitized adults with asthma differs by race.

BACKGROUND: Allergic sensitization to mold is a risk factor for poor asthma outcomes, but whether it accounts for disparities in asthma outcomes according to race or socioeconomic status is not well-studied. OBJECTIVE: We sought to 1) identify factors associated with allergic sensitization to molds and 2) evaluate associations of sensitization to molds with asthma exacerbations after stratifying by race. METHODS: We conducted a retrospective cohort study of adults with asthma who had an outpatient visit in a large health system between 1/1/2017-6/30/2023 and received aeroallergen testing to Aspergillus fumigatus, Penicillium, Alternaria, and Cladosporium. We used logistic regression models to evaluate factors associated with 1) mold sensitization and 2) the effect of mold sensitization on asthma exacerbations in the 12 months before testing, overall and then stratified by race. RESULTS: 2,732 patients met inclusion criteria. Sensitization to each mold was negatively associated with being a woman (odds ratios (ORs)≤0.59, p≤0.001 in five models) and positively associated with Black race (ORs≥2.16 versus White, p<0.0005 in five models). In the full cohort, sensitization to molds were not associated with asthma exacerbations (ORs 0.95-1.40, p≥0.003 in five models and all above the corrected p-value threshold). Among 1,032 Black patients, sensitization to Aspergillus fumigatus, but not to other molds, was associated with increased odds of asthma exacerbations (OR 2.04, p<0.0005). CONCLUSION: Being a man and Black race were associated with allergic sensitization to molds. Sensitization to Aspergillus fumigatus was associated with asthma exacerbations among Black patients but not the overall cohort, suggesting that Aspergillus fumigatus allergy is a source of disparities in asthma outcomes according to race.

Changes in the Use of Hydrochlorothiazide and Other Antihypertensive Drugs in Switzerland in Association With the Swissmedic Safety Alert Regarding Non-melanoma Skin Cancer: An Interrupted Time-Series Analysis Using Swiss Claims Data.

PURPOSE: Long-term use of hydrochlorothiazide increases the risk of non-melanoma skin cancer. We aimed to evaluate potential changes in the use of hydrochlorothiazide in Switzerland after a direct healthcare professional communication (DHPC) in November 2018 by Swissmedic. METHODS: We performed interrupted time-series analyses using a large Swiss healthcare claims database (2015-2021). Within monthly intervals, we quantified the total number of claims and the total dispensed 'defined daily doses' (DDD) for preparations containing (1) hydrochlorothiazide, (2) angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II-receptor blockers (ARB), (3) calcium-channel blockers (CCB) and (4) thiazide-like diuretics per 10 000 persons. Using segmented linear regression, we quantified the pre-DHPC trend, the immediate change and the post-DHPC change in trend for total claims and DDD for the four drug classes weighted for the demographic distribution of the Swiss population. RESULTS: ACE inhibitors and ARB were the most frequently claimed antihypertensive drugs with 300-400 claims per 10 000 persons, which increased by 5.4% during the study period. The average number of hydrochlorothiazide claims (157/10 000 persons in 2015) declined by 35% between 2015 and 2021. The decrease started prior to the DHPC, but the DHPC was associated with an immediate 6.1% decline and an accelerated decline in claims over time after the DHPC (similar results for DDD). This coincided with a 23% increase in claims of CCB (dihydropyridine type) over 7 years, whereas use of other antihypertensives increased less. CONCLUSION: Our results suggest that the DHPC by Swissmedic in 2018 accelerated a pre-existing decline in the use of hydrochlorothiazide in Switzerland.

Attitudes Towards Dementia Among a Diverse Group of Refugees Resettled in the United States.

BACKGROUND: Forced migration results in exposure to trauma, interrupted access to healthcare, and loss of social support and may increase dementia risk. Literature on refugees' knowledge of dementia and its risk factors is scant. This study investigates refugee perspectives on dementia and their access to cognitive healthcare in the United States (US). METHODS: We conducted 6 focus groups and 30 individual in-depth interviews (total of 69 participants) with Arab, African, and Afghan refugees resettled in San Diego, California. Data was coded using inductive thematic analysis. RESULTS: Organized by the socioecological model of health, the following themes emerged: (1) mental trauma due to migration was linked to dementia (individual); (2) fear of dementia and burdening caregivers due to limited support systems (interpersonal); (3) reliance on virtual communities for dementia information and the stress of local community loss increasing dementia risk (community); (4) healthcare providers, both in the US and in refugee camps, didn't address cognitive health concerns (institutions); and (5) discriminatory immigration and healthcare policies as barriers to healthy aging (policy). DISCUSSION: Despite being a heterogeneous group, refugees share specific experiences, knowledge gaps, and barriers to healthy aging. Tailored interventions and policies are needed to address this population's cognitive health needs. This includes addressing their mental health and social support concerns as well as training clinicians to screen for/discuss dementia with aging refugee patients.

One-year budget impact of InTandem™: a novel neurorehabilitation system for individuals with chronic stroke walking impairment.

Aim: Chronic stroke walking impairment is associated with high healthcare resource utilization (HCRU) costs. InTandem™ is a neurorehabilitation system that autonomously delivers a rhythmic auditory stimulation (RAS)-based intervention for the at-home rehabilitation of walking impairment in adults in the chronic phase of stroke recovery. This study was conducted to estimate the budget impact of InTandem in comparison with currently available intervention strategies for improvement of gait/ambulation in individuals with chronic stroke walking impairment. Methods & materials: A budget impact analysis (BIA) for InTandem was conducted based on a 1-million-member US third-party payer perspective over a 1-year time horizon. Key inputs for the budget impact model were: costs for each intervention strategy (InTandem, physical therapy, self-directed walking and no treatment), HCRU costs for persons with chronic stroke and anticipated HCRU cost offsets due to improvements in gait/ambulatory status as measured by self-selected comfortable walking speed (based on functional ability). In addition to the reference case analysis, a sensitivity analysis was conducted. Results: Based on the reference case, introduction of InTandem was projected to result in overall cost savings of $439,954 in one year. Reduction of HCRU costs (-$2,411,778) resulting from improved walking speeds with InTandem offset an increase in intervention costs (+$1,971,824). Demonstrations of cost savings associated with InTandem were robust and were consistently evident in nearly all scenarios evaluated in the sensitivity analysis (e.g., with increased/decreased patient shares, increased HCRU cost or increased InTandem rental duration). Conclusion: The InTandem system is demonstrated to improve walking and ambulation in adults in the chronic phase of stroke recovery after a five-week intervention period. The BIA predicts that introduction of InTandem will be associated with overall cost savings to the payer.

Carbon savings associated with changing surgical trends in total knee arthroplasty in England: a retrospective observational study using administrative data.

BACKGROUND: Best practice pathways for common surgical procedures, including total knee arthroplasty (TKA), have the potential to improve patient outcomes and reduce carbon emissions. We aimed to estimate the reduction in carbon emissions due to changing trends in the care of patients undergoing TKA in England. METHODS: This was a retrospective analysis of Hospital Episode Statistics data from 1 April 2013 to 31 March 2022 on adults undergoing elective primary TKA in England. The carbon footprint for each patient was calculated using carbon factors for multiple steps in the pathway, including ipsilateral knee arthroscopies in the year preceding the TKA, outpatient attendances, the index TKA, revisions of the TKA performed within 180 days of the index procedure, length of hospital stay and emergency readmissions. RESULTS: A total of 648,861 TKA operations were identified. Over the study period, the median length of stay reduced from four to three days, the proportion of patients undergoing ipsilateral knee arthroscopies performed within a year before TKA surgery fell from 5.9% to 0.5% and the number of early revisions and emergency readmissions also fell. The per-patient carbon footprint reduced from 378.8kgCO2e to 295.2kgCO2e over this time. If all the study patients had the same carbon footprint as the average patient in 2021/2022, 32.4kilotons CO2e would have been saved, enough to power 29,509 UK homes for one year. CONCLUSIONS: Practices that were introduced primarily to improve patient outcomes can contribute to a reduction in the carbon footprint.

Occupational stressors experienced by healthcare professionals in the course of the COVID-19 crisis.

The novel coronavirus has significantly impacted healthcare systems worldwide, exposing healthcare professionals (HCPs) to work-related stressors to prevent the spread of SARS-CoV-2. This study aimed to assess the occupational stress of HCPs in Lagos State, Nigeria, using a qualitative approach. The study involved nine HCPs from various departments, including doctors, nurses, and medical laboratory technicians. The main causes of stress were workload, policy changes, and extended use of personal protective gear. The study found high levels of occupational stress among HCPs, with workload being the main cause. The impact of the disease outbreak crisis on HCPs' lives and work demands was observed, with occupational demands categorized into safety risk at work and public perceptions. Employers and unions must respond to HCPs' needs for workplace protection and appropriate help to address stressors.

Le nouveau coronavirus a eu un impact significatif sur les systèmes de soins de santé dans le monde entier, exposant les professionnels de la santé (HCP) à des facteurs de stress liés au travail pour empêcher la propagation du SARS-CoV-2. Cette étude visait à évaluer le stress professionnel des HCP dans l'État de Lagos, au Nigeria, en utilisant une approche qualitative. L'étude a impliqué neuf HCP de divers départements, y compris des médecins, des infirmières et des techniciens de laboratoire médical. Les principales causes du stress étaient la charge de travail, les changements de politique et l'utilisation prolongée d'équipements de protection personnelle. L'étude a révélé des niveaux élevés de stress professionnel parmi les HCP, avec la charge de travail étant la principale cause. L'impact de la crise de l'épidémie sur la vie et les exigences professionnelles des HCP a été observé, les demandes de travail étant classées en catégories de risques pour la sécurité au travail et de perceptions du public. Les employeurs et les syndicats doivent répondre aux besoins des HCP en matière de protection des lieux de travail et d'aide appropriée pour faire face aux facteurs de stress.

The impact of COVID-19 on people with epilepsy: Global results from the coronavirus and epilepsy study.

OBJECTIVE: To characterize the experience of people with epilepsy and aligned healthcare workers (HCWs) during the first 18 months of the COVID-19 pandemic and compare experiences in high-income countries (HICs) with non-HICs. METHODS: Separate surveys for people with epilepsy and HCWs were distributed online in April 2020. Responses were collected to September 2021. Data were collected for COVID-19 infections, the effect of COVID-related restrictions, access to specialist help for epilepsy (people with epilepsy), and the impact of the pandemic on work productivity (HCWs). The frequency of responses for non-HICs and HICs were compared using non-parametric Chi-square tests. RESULTS: Two thousand one hundred and  five individuals with epilepsy from 53 countries and 392 HCWs from 26 countries provided data. The same proportion of people with epilepsy in non-HICs and HICs reported COVID-19 infection (7%). Those in HICs were more likely to report that COVID-19 measures had affected their health (32% vs. 23%; p < 0.001). There was no difference between non-HICs and HICs in the proportion who reported difficulty in obtaining help for epilepsy. HCWs in non-HICs were more likely to report COVID-19 infection than those in HICs (18% vs 6%; p = 0.001) and that their clinical work had been affected by concerns about contracting COVID-19, lack of personal protective equipment, and the impact of the pandemic on mental health (all p < 0.001). Compared to pre-pandemic practices, there was a significant shift to remote consultations in both non-HICs and HICs (p < 0.001). SIGNIFICANCE: While the frequency of COVID-19 infection was relatively low in these data from early in the pandemic, our findings suggest broader health consequences and an increased psychosocial burden, particularly among HCWs in non-HICs. Planning for future pandemics should prioritize mental healthcare alongside ensuring access to essential epilepsy services and expanding and enhancing access to remote consultations. PLAIN LANGUAGE SUMMARY: We asked people with epilepsy about the effects of COVID-19 on their health and healthcare. We wanted to compare responses from people in high-income countries and other countries. We found that people in high-income countries and other countries had similar levels of difficulty in getting help for their epilepsy. People in high-income countries were more likely to say that their general health had been affected. Healthcare workers in non-high-income settings were more likely to have contracted COVID-19 and have the care they deliver affected by the pandemic. Across all settings, COVID-19 associated with a large shift to remote consultations.