RESUMO
Trauma surgical care in Germany faces major challenges. The increasing number of cases due to demographic change, combined with reduced bed capacity, requires a rethink in many areas. In order to continue to ensure basic and standard care at a high level and across the board in the future, economic incentives must be created to maintain sufficient locations for trauma care. At the same time, there is a shortage of skilled workers that will worsen in the coming years if appropriate measures are not taken to counteract it. Structural changes will also be needed to improve cross-sector networking between outpatient and inpatient care. With the increase in outpatient care, future shortages of both bed capacity and staff shortages may be buffered.
Assuntos
Previsões , Programas Nacionais de Saúde , Centros de Traumatologia , Alemanha , Humanos , Programas Nacionais de Saúde/tendências , Centros de Traumatologia/organização & administração , Centros de Traumatologia/tendências , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/terapia , Necessidades e Demandas de Serviços de Saúde/tendências , Número de Leitos em Hospital , Colaboração Intersetorial , Dinâmica Populacional , Comunicação Interdisciplinar , Traumatologia/tendências , Traumatologia/organização & administraçãoRESUMO
BACKGROUND: The COVID-19 pandemic has highlighted the critical importance of robust healthcare capacity planning and preparedness for emerging crises. However, healthcare systems must also adapt to more gradual temporal changes in disease prevalence and demographic composition over time. To support proactive healthcare planning, statistical capacity forecasting models can provide valuable information to healthcare planners. This systematic literature review and evidence mapping aims to identify and describe studies that have used statistical forecasting models to estimate healthcare capacity needs within hospital settings. METHOD: Studies were identified in the databases MEDLINE and Embase and screened for relevance before items were defined and extracted within the following categories: forecast methodology, measure of capacity, forecast horizon, healthcare setting, target diagnosis, validation methods, and implementation. RESULTS: 84 studies were selected, all focusing on various capacity outcomes, including number of hospital beds/ patients, staffing, and length of stay. The selected studies employed different analytical models grouped in six items; discrete event simulation (N = 13, 15 %), generalized linear models (N = 21, 25 %), rate multiplication (N = 15, 18 %), compartmental models (N = 14, 17 %), time series analysis (N = 22, 26 %), and machine learning not otherwise categorizable (N = 12, 14 %). The review further provides insights into disease areas with infectious diseases (N = 24, 29 %) and cancer (N = 12, 14 %) being predominant, though several studies forecasted healthcare capacity needs in general (N = 24, 29 %). Only about half of the models were validated using either temporal validation (N = 39, 46 %), cross-validation (N = 2, 2 %) or/and geographical validation (N = 4, 5 %). CONCLUSION: The forecasting models' applicability can serve as a resource for healthcare stakeholders involved in designing future healthcare capacity estimation. The lack of routine performance validation of the used algorithms is concerning. There is very little information on implementation and follow-up validation of capacity planning models.
Assuntos
COVID-19 , Previsões , Humanos , COVID-19/epidemiologia , Necessidades e Demandas de Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Pandemias , SARS-CoV-2 , Atenção à Saúde/tendências , Aprendizado de MáquinaRESUMO
BACKGROUND: To strengthen palliative care for children in the Nordic countries, an updated status of current needs, resources, clinical services, education, and research is necessary to align and consolidate future research. A Nordic research collaboration initiative for children with palliative care needs was assembled in 2023. Building on this initiative, this paper presents an overview of pediatric palliative care (PPC) in the Nordic countries' (a) population characteristics, (b) care models and setting of care, (c) education and training, and (d) research. METHODS: The Nordic initiative researchers collaboratively gathered and assessed available data on the characteristics of PPC within Denmark, Finland, Greenland, Iceland, Norway, the Faroe Islands, Sweden, and Åland. Data were compiled in a matrix with population characteristics, models- and setting of care, education and training, and areas of research in a Nordic context. The findings are narratively and descriptively presented, providing an overview of Nordic PPC. RESULTS: In total, the Nordic child population comprises around six million children (0-19 years), of which about 41.200 are estimated to be living with a life-limiting and/or life-threatening condition. Healthcare services are provided through various care models, ranging from specialized care to homecare settings. Overall, there remain few opportunities for education and training with some exceptions. Also, Nordic research within PPC has been shown to be a growing field although much remains to be done. CONCLUSION: This overview is the first outline of the current PPC in Nordic countries. Although some differences remain important to acknowledge, overall, the strengths and challenges faced within PPC in the Nordic countries are comparable and call for joint action to increase evidence, services, and education to better serve the children, families, and healthcare personnel within PPC. Despite the varying structural premises for PPC, research endeavors aiming to provide evidence in this field seem increasing, timely and relevant for the Nordic countries, as well as the international context.
Assuntos
Cuidados Paliativos , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/tendências , Cuidados Paliativos/normas , Países Escandinavos e Nórdicos , Criança , Lactente , Pré-Escolar , Adolescente , Recém-Nascido , Necessidades e Demandas de Serviços de Saúde/tendências , Pediatria/métodos , Pediatria/tendênciasAssuntos
Necessidades e Demandas de Serviços de Saúde , Programas de Rastreamento , Sífilis , Feminino , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Programas de Rastreamento/tendências , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Mudança Social , Sífilis/diagnóstico , Sorodiagnóstico da Sífilis , Sífilis Congênita/diagnóstico , Sífilis Congênita/prevenção & controleRESUMO
Importance: Following reductions in US ambulatory care early in the pandemic, it remains unclear whether care consistently returned to expected rates across insurance types and services. Objective: To assess whether patients with Medicaid or Medicare-Medicaid dual eligibility had significantly lower than expected return to use of ambulatory care rates than patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance. Design, Setting, and Participants: In this retrospective cohort study examining ambulatory care service patterns from January 1, 2019, through February 28, 2021, claims data from multiple US payers were combined using the Milliman MedInsight research database. Using a difference-in-differences design, the extent to which utilization during the pandemic differed from expected rates had the pandemic not occurred was estimated. Changes in utilization rates between January and February 2020 and each subsequent 2-month time frame during the pandemic were compared with the changes in the corresponding months from the year prior. Age- and sex-adjusted Poisson regression models of monthly utilization counts were used, offsetting for total patient-months and stratifying by service and insurance type. Exposures: Patients with Medicaid or Medicare-Medicaid dual eligibility compared with patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance, respectively. Main Outcomes and Measures: Utilization rates per 100 people for 6 services: emergency department, office and urgent care, behavioral health, screening colonoscopies, screening mammograms, and contraception counseling or HIV screening. Results: More than 14.5 million US adults were included (mean age, 52.7 years; 54.9% women). In the March-April 2020 time frame, the combined use of 6 ambulatory services declined to 67.0% (95% CI, 66.9%-67.1%) of expected rates, but returned to 96.7% (95% CI, 96.6%-96.8%) of expected rates by the November-December 2020 time frame. During the second COVID-19 wave in the January-February 2021 time frame, overall utilization again declined to 86.2% (95% CI, 86.1%-86.3%) of expected rates, with colonoscopy remaining at 65.0% (95% CI, 64.1%-65.9%) and mammography at 79.2% (95% CI, 78.5%-79.8%) of expected rates. By the January-February 2021 time frame, overall utilization returned to expected rates as follows: patients with Medicaid at 78.4% (95% CI, 78.2%-78.7%), Medicare-Medicaid dual eligibility at 73.3% (95% CI, 72.8%-73.8%), commercial at 90.7% (95% CI, 90.5%-90.9%), Medicare Advantage at 83.2% (95% CI, 81.7%-82.2%), and Medicare fee-for-service at 82.0% (95% CI, 81.7%-82.2%; P < .001; comparing return to expected utilization rates among patients with Medicaid and Medicare-Medicaid dual eligibility, respectively, with each of the other insurance types). Conclusions and Relevance: Between March 2020 and February 2021, aggregate use of 6 ambulatory care services increased after the preceding decrease in utilization that followed the onset of the COVID-19 pandemic. However, the rate of increase in use of these ambulatory care services was significantly lower for participants with Medicaid or Medicare-Medicaid dual eligibility than for those insured by commercial, Medicare Advantage, or Medicare fee-for-service.
Assuntos
Assistência Ambulatorial/tendências , COVID-19/epidemiologia , Pandemias , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Colonoscopia/estatística & dados numéricos , Colonoscopia/tendências , Bases de Dados Factuais , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/tendências , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Seguro Saúde/estatística & dados numéricos , Seguro Saúde/tendências , Masculino , Mamografia/estatística & dados numéricos , Mamografia/tendências , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Telemedicina/estatística & dados numéricos , Telemedicina/tendências , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: We aimed to predict practicing surgeon workforce size across ten specialties to provide an up-to-date, national perspective on future surgical workforce shortages or surpluses. METHODS: Twenty-one years of AMA Masterfile data (1997-2017) were used to predict surgeons practicing from 2030 to 2050. Published ratios of surgeons/100,000 population were used to estimate the number of surgeons needed. MGMA median wRVU/surgeon by specialty (2017) was used to determine wRVU demand and capacity based on projected and needed number of surgeons. RESULTS: By 2030, surgeon shortages across nine specialties: Cardiothoracic, Otolaryngology, General Surgery, Obstetrics-Gynecology, Ophthalmology, Orthopedics, Plastics, Urology, and Vascular, are estimated to increase clinical workload by 10-50% additional wRVU. By 2050, shortages in eight specialties are estimated to increase clinical workload by 7-61% additional wRVU. CONCLUSIONS: If historical trends continue, a majority of surgical specialties are estimated to experience workforce deficits, increasing clinical demands substantially.
Assuntos
Previsões , Necessidades e Demandas de Serviços de Saúde/tendências , Mão de Obra em Saúde/estatística & dados numéricos , Especialidades Cirúrgicas/tendências , Cirurgiões/provisão & distribuição , Eficiência , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Especialidades Cirúrgicas/organização & administração , Especialidades Cirúrgicas/estatística & dados numéricos , Cirurgiões/tendências , Estados Unidos , Carga de Trabalho/estatística & dados numéricosRESUMO
Objetivo: conhecer as demandas de cuidado em saúde mental de jovens homoafetivos. Método: pesquisa qualitativa, realizada com 18 jovens homoafetivos, estudantes universitários, em Santa Catarina. A produção de informações ocorreu em 2016, por meio de entrevista semiestruturada, com questões sobre percepções em relação à própria saúde mental, a homoafetividade e expectativas frente ao cuidado de saúde. As informações foram interpretadas mediante análise de conteúdo. Resultados: foram identificadas vulnerabilidades individuais, sociais e programáticas dos jovens homoafetivos, que podem interferir na saúde mental, levando-os a buscar suporte profissional. Foram relatadas fragilidades dos serviços de saúde para este cuidado. Considerações finais: os jovens homoafetivos vivenciam situações de vulnerabilidades, havendo demandas de cuidados que são negligenciadas nos serviços de saúde. Eles carecem de inovações, sobretudo em saúde mental, uma vez que sofrem agressões, opressões e estigmas, que colaboram para o uso de drogas. Ainda, questionam sobre atendimentos igualitários, resolutivos, livres de preconceitos e assistência humanizada.
Objetivo: conocer las demandas de cuidado en salud mental de jóvenes homoafectivos. Método: investigación cualitativa, realizada con 18 jóvenes homoafectivos, estudiantes universitarios, en Santa Catarina. La producción de información ocurrió en 2016, por medio de entrevista semiestructurada, con cuestiones sobre percepciones en relación a la propia salud mental, la homoafectividad y expectativas frente al cuidado de salud. La información se ha interpretado mediante análisis de contenido. Resultados: se identificaron vulnerabilidades individuales, sociales y programáticas de los jóvenes homoafectivos, que pueden interferir en la salud mental, llevándolos a buscar apoyo profesional. Se han reportado debilidades de los servicios de salud para este cuidado. Consideraciones finales: los jóvenes homoafectivos experimentan situaciones de vulnerabilidad, habiendo demandas de atención que son descuidadas en los servicios de salud. Carecen de innovaciones, sobre todo en salud mental, ya que sufren agresiones, opresiones y estigmas, que colaboran para el uso de drogas. Aún, cuestionan sobre atenciones igualitarias, resolutivos, libres de prejuicios y asistencia humanizada.
Objective: to know the demands of mental health care of young homosexuals. Method: qualitative research, conducted with 18 young homoaffective, university students in Santa Catarina. The production of information occurred in 2016, through semi-structured interviews, with questions about perceptions regarding mental health, homoaffectivity and expectations regarding health care. The information was interpreted through content analysis. Results: individual, social and programmatic vulnerabilities of young homosexuals were identified, which can interfere with mental health, leading them to seek professional support. Weaknesses of health services for this care were reported. Final considerations: young homosexuals experience situations of vulnerability, with demands for care that are neglected in health services. They lack innovations, especially in mental health, since they suffer aggression, oppression and stigma, which contribute to drug use. Still, they question about equal care, problem-solving, free of prejudice and humanized assistance.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Homossexualidade/psicologia , Assistência à Saúde Mental , Necessidades e Demandas de Serviços de Saúde/tendências , Pesquisa QualitativaRESUMO
The number of patients with cancer in Africa has been predicted to increase from 844â279 in 2012 to more than 1·5 million in 2030. However, many countries in Africa still lack access to radiotherapy as a part of comprehensive cancer care. The objective of this analysis is to present an updated overview of radiotherapy resources in Africa and to analyse the gaps and needs of the continent for 2030 in the context of the UN Sustainable Development Goals. Data from 54 African countries on teletherapy megavoltage units and brachytherapy afterloaders were extracted from the Directory for Radiotherapy Centres, an electronic, centralised, and continuously updated database of radiotherapy centres. Cancer incidence and future predictions were taken from the GLOBOCAN 2018 database of the International Agency for Research on Cancer. Radiotherapy need was estimated using a 64% radiotherapy utilisation rate, while assuming a machine throughput of 500 patients per year. As of March, 2020, 28 (52%) of 54 countries had access to external beam radiotherapy, 21 (39%) had brachytherapy capacity, and no country had a capacity that matched the estimated treatment need. Median income was an important predictor of the availability of megavoltage machines: US$1883 (IQR 914-3269) in countries without any machines versus $4485 (3079-12480) in countries with at least one megavoltage machine (p=0·0003). If radiotherapy expansion continues at the rate observed over the past 7 years, it is unlikely that the continent will meet its radiotherapy needs. This access gap might impact the ability to achieve the Sustainable Development Goals, particularly the target to reduce preventable, premature mortality by a third, and meet the target of the cervical cancer elimination strategy of 90% with access to treatment. Urgent, novel initiatives in financing and human capacity building are needed to change the trajectory and provide comprehensive cancer care to patients in Africa in the next decade.
Assuntos
Recursos em Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Radioterapia/tendências , África/epidemiologia , Previsões , Recursos em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Agências Internacionais , Neoplasias/epidemiologia , Neoplasias/radioterapia , Radioterapia/estatística & dados numéricos , Desenvolvimento SustentávelRESUMO
Amidst the unexpected losses and challenges of 2020, healthcare disparities and health equity have presided as noteworthy topics of national discussion among healthcare workers, governmental officials, and society at large. Health equity, defined as the opportunity for everyone to be as healthy as possible, may be achieved through the alleviation of healthcare disparities. Healthcare disparities are defined as "preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations." While these concepts may be perceived as a departure from the core responsibility of plastic surgeons, it is of paramount importance to recognize how race, socioeconomic status (SES), and physical environment impact access to care, surgical outcomes, and postoperative recovery for vulnerable populations. In this communication, our purpose is two-fold: 1) to elucidate the existent healthcare disparities and associations with race and SES in craniofacial, trauma, breast, hand, and gender-affirming reconstruction; and 2) provide tangible recommendations to incorporate the concepts of health equity and healthcare disparities in clinical, research, community, and recruitment settings for plastic surgeons. Through such knowledge, plastic surgeons may glean important insights that may enhance the delivery of equitable and accessible care for patients.
Assuntos
Equidade em Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Papel do Médico , Procedimentos de Cirurgia Plástica , Cirurgia Plástica/tendências , Acessibilidade aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Melhoria de Qualidade/tendênciasAssuntos
COVID-19 , Padrões de Prática Médica/tendências , Cirurgiões/tendências , Procedimentos Cirúrgicos Vasculares/tendências , Boston , Prestação Integrada de Cuidados de Saúde/tendências , Procedimentos Cirúrgicos Eletivos/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Sistema de Registros , Fatores de TempoRESUMO
Objectives Stroke and post-stroke complications are associated with high morbidity, mortality, and cost. Our objective was to examine healthcare utilization and hospice enrollment for stroke patients at the end of life. Materials and methods The 2014 Nationwide Readmissions Database is a national database of > 14 million admissions. We used validated ICD-9 codes to identify fatal ischemic stroke, summarized demographics and hospitalization characteristics, and examined healthcare use within 30 days before fatal stroke admission. We used de-identified 2014 Medicare hospice data to identify stroke and non-stroke patients admitted to hospice. Results Among IS admissions in 2014 (n = 472,969), 22652 (4.8%) had in-hospital death. 28.2% with fatal IS had two or more hospitalizations in 2014. Among those with fatal IS admission, 13.0% were admitted with cerebrovascular disease within 30 days of fatal IS admission. Half of stroke patients discharged to hospice from the Medicare dataset were hospitalized with cerebrovascular disease within the thirty days prior to hospice enrollment. Within the study year, 6.9% of hospice enrollees had one or more emergency room visits, 31.7% had one or more inpatient encounters, and 5.2% had one or more nursing facility encounters (compared to 21.4%, 70.6%, and 27.2% respectively in the 30-day period prior to enrollment). Conclusions High rates of readmission prior to fatal stroke may indicate opportunity for improvement in acute stroke management, secondary prevention, and palliative care involvement as encouraged by AHA/ASA guidelines. For patients who are expected to survive 6 months or less, hospice may offer goal-concordant services for patients and caregivers who desire comfort-focused care.
Assuntos
Recursos em Saúde/tendências , Cuidados Paliativos na Terminalidade da Vida/tendências , AVC Isquêmico/terapia , Cuidados Paliativos/tendências , Assistência Terminal/tendências , Idoso , Bases de Dados Factuais , Serviço Hospitalar de Emergência/tendências , Feminino , Necessidades e Demandas de Serviços de Saúde/tendências , Mortalidade Hospitalar/tendências , Humanos , AVC Isquêmico/diagnóstico , AVC Isquêmico/mortalidade , AVC Isquêmico/fisiopatologia , Masculino , Medicare , Readmissão do Paciente/tendências , Estudos Retrospectivos , Instituições de Cuidados Especializados de Enfermagem/tendências , Fatores de Tempo , Estados UnidosAssuntos
Congressos como Assunto , Oncologia , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/organização & administração , Ensaios Clínicos como Assunto/normas , Terapia Combinada , Congressos como Assunto/organização & administração , Congressos como Assunto/tendências , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/tendências , História do Século XXI , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Oncologia/métodos , Oncologia/organização & administração , Oncologia/tendências , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/terapia , Prognóstico , Sociedades Médicas/organização & administração , Sociedades Médicas/tendências , Fatores Socioeconômicos , Terapias em Estudo/métodos , Terapias em Estudo/tendências , Estados UnidosAssuntos
COVID-19 , Controle de Doenças Transmissíveis , Transmissão de Doença Infecciosa , Pandemias , Tuberculose , COVID-19/epidemiologia , COVID-19/terapia , COVID-19/transmissão , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Índia/epidemiologia , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/estatística & dados numéricos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , SARS-CoV-2 , Tuberculose/epidemiologia , Tuberculose/terapia , Tuberculose/transmissão , Organização Mundial da SaúdeAssuntos
Cardiomiopatias/terapia , Cardiopatias Congênitas/terapia , Coração Artificial/tendências , Padrões de Prática Médica/tendências , Implantação de Prótese/tendências , Adolescente , Fatores Etários , Cardiomiopatias/diagnóstico , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Criança , Pré-Escolar , Necessidades e Demandas de Serviços de Saúde/tendências , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/tendências , Coração Auxiliar/tendências , Humanos , Desenho de Prótese/tendências , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/mortalidade , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
ObjectivesãThe purpose of this study was to identify the changes in trends of leading diseases that require long-term care within a 5-year period in an area with a rapidly growing aging population.MethodsãData were obtained from newly registered primary insured individuals for long-term care insurance in Sapporo Minami Ward. There were 2,538 participants in FY2018 and 4,089 in FY2013 and FY2014.ãDisorders diagnosed by a primary doctor were categorized into groups using a long-term care questionnaire survey from the Comprehensive Survey of Living Conditions. The difference in the frequency of diseases between the survey years was examined using a chi-square test.ResultsãIn men, there was no significant change in the frequency of diseases that require long-term care within the 5-year period. In women, the frequency of cerebrovascular diseases significantly reduced (7.8% for FY2013 and 2014 vs. 5.6% for FY2018; P=0.008) and fractures and falls significantly increased (9.5% vs. 13.8%; P=0.001).ãRegarding the diseases in the severe-level category of long-term care insurance, malignancy was the most frequent disorder in men, followed by stroke. In women, the frequency of fractures and falls increased (10.5% vs. 17.7%; P=0.002) and subsequently became the most frequently occurring disorder. Similarly, the frequency of fractures and falls increased significantly (9.2% vs. 12.5%; P=0.004) in the mild-level long-term care insurance category.ConclusionãFor women, fractures and falls increased within the 5-year period, indicating the need to introduce a prompt preventive program. Lifestyle-related diseases such as malignancy and cerebrovascular diseases have become the main reason for shortening a healthy lifespan. This finding highlights the importance of preventing lifestyle-related diseases.
Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Assistência de Longa Duração/estatística & dados numéricos , Assistência de Longa Duração/tendências , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/prevenção & controle , Feminino , Estilo de Vida Saudável , Humanos , Expectativa de Vida , Estilo de Vida , Masculino , Neoplasias/prevenção & controle , Inquéritos e Questionários , Fatores de TempoAssuntos
Técnicas Cosméticas , Acessibilidade aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Hialuronoglucosaminidase/provisão & distribuição , Hialuronoglucosaminidase/uso terapêutico , Procedimentos de Cirurgia Plástica , Adjuvantes Farmacêuticos/uso terapêutico , Anestesia Local/métodos , Técnicas Cosméticas/efeitos adversos , Técnicas Cosméticas/tendências , Preenchedores Dérmicos/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/tratamento farmacológico , Humanos , Ácido Hialurônico/efeitos adversos , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Procedimentos de Cirurgia Plástica/tendências , Reino UnidoRESUMO
OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in hospital resource utilization and the need to defer nonurgent cardiac surgery procedures. The present study aims to report the regional variations of North American adult cardiac surgical case volume and case mix through the first wave of the COVID-19 pandemic. METHODS: A survey was sent to recruit participating adult cardiac surgery centers in North America. Data in regard to changes in institutional and regional cardiac surgical case volume and mix were analyzed. RESULTS: Our study comprises 67 adult cardiac surgery institutions with diverse geographic distribution across North America, representing annualized case volumes of 60,452 in 2019. Nonurgent surgery was stopped during the month of March 2020 in the majority of centers (96%), resulting in a decline to 45% of baseline with significant regional variation. Hospitals with a high burden of hospitalized patients with COVID-19 demonstrated similar trends of decline in total volume as centers in low burden areas. As a proportion of total surgical volume, there was a relative increase of coronary artery bypass grafting surgery (high +7.2% vs low +4.2%, P = .550), extracorporeal membrane oxygenation (high +2.5% vs low 0.4%, P = .328), and heart transplantation (high +2.7% vs low 0.4%, P = .090), and decline in valvular cases (high -7.6% vs low -2.6%, P = .195). CONCLUSIONS: The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix.
Assuntos
COVID-19 , Procedimentos Cirúrgicos Cardíacos/tendências , Disparidades em Assistência à Saúde/tendências , Padrões de Prática Médica/tendências , Regionalização da Saúde/tendências , Cirurgiões/tendências , Procedimentos Cirúrgicos Eletivos/tendências , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Avaliação das Necessidades/tendências , América do Norte , Fatores de TempoRESUMO
BACKGROUND: During a pandemic, it is paramount to understand volume changes in Level I trauma so that with appropriate planning and reallocation of resources, these facilities can maintain and even improve life-saving capabilities. Evaluating nonaccidental and accidental trauma can highlight potential areas of improvement in societal behavior and hospital preparedness. These critical questions were proposed to better understand how healthcare leaders might adjust surgeon and team coverage of trauma services as well as prepare from a system standpoint what resources will be needed during a pandemic or similar crisis to maintain services. QUESTIONS/PURPOSES: (1) How did the total observed number of trauma activations, defined as patients who meet mechanism of injury requirements which trigger the notification and aggregation of the trauma team upon entering the emergency department, change during a pandemic and stay-at-home order? (2) How did the proportion of major mechanisms of traumatic injury change during this time period? (3) How did the proportion and absolute numbers of accidental versus nonaccidental traumatic injury in children and adults change during this time period? METHODS: This was a retrospective study of trauma activations at a Level I trauma center in New Orleans, LA, USA, using trauma registry data of all patients presenting to the trauma center from 2017 to 2020. The number of trauma activations during a government mandated coronavirus 2019 (COVID-19) stay-at-home order (from March 20, 2020 to May 14, 2020) was compared with the expected number of activations for the same time period from 2017 to 2019, called "predicted period". The expected number (predicted period) was assumed based on the linear trend of trauma activations seen in the prior 3 years (2017 to 2019) for the same date range (March 20, 2020 to May 14, 2020). To define the total number of traumatic injuries, account for proportion changes, and evaluate fluctuation in accidental verses nonaccidental trauma, variables including type of traumatic injury (blunt, penetrating, and thermal), and mechanism of injury (gunshot wound, fall, knife wound, motor vehicle collision, assault, burns) were collected for each patient. RESULTS: There were fewer total trauma activations during the stay-at-home period than during the predicted period (372 versus 532 [95% CI 77 to 122]; p = 0.016). The proportion of penetrating trauma among total activations was greater during the stay-at-home period than during the predicted period (35% [129 of 372] versus 26% [141 of 532]; p = 0.01), while the proportion of blunt trauma was lower during the stay-at-home period than during the predicted period (63 % [236 of 372] versus 71% [376 of 532]; p = 0.02). The proportion of gunshot wounds in relation to total activations was greater during the stay-at-home period than expected (26% [97 of 372] versus 18% [96 of 532]; p = 0.004). There were fewer motor vehicle collisions in relation to total activations during the stay-at-home period than expected (42% [156 of 372] versus 49% [263 of 532]; p = 0.03). Among total trauma activations, the stay-at-home period had a lower proportion of accidental injuries than the predicted period (55% [203 of 372] versus 61% [326 of 532]; p = 0.05), and there was a greater proportion of nonaccidental injuries than the predicted period (37% [137 of 372] versus 27% [143 of 532]; p < 0.001). In adults, the stay-at-home period had a greater proportion of nonaccidental injuries than the predicted period (38% [123 of 328] versus 26% [123 of 466]; p < 0.001). There was no difference between the stay-at-home period and predicted period in nonaccidental and accidental injuries among children. CONCLUSION: Data from the trauma registry at our region's only Level I trauma center indicate that a stay-at-home order during the COVID-19 pandemic was associated with a 70% reduction in the number of traumatic injuries, and the types of injuries shifted from more accidental blunt trauma to more nonaccidental penetrating trauma. Non-accidental trauma, including gunshot wounds, increased during this period, which suggest community awareness, crisis de-escalation strategies, and programs need to be created to address violence in the community. Understanding these changes allows for adjustments in staffing schedules. Surgeons and trauma teams could allow for longer shifts between changeover, decreasing viral exposure because the volume of work would be lower. Understanding the shift in injury could also lead to a change in specialists covering call. With the often limited availability of orthopaedic trauma-trained surgeons who can perform life-saving pelvis and acetabular surgery, this data may be used to mitigate exposure of these surgeons during pandemic situations. LEVEL OF EVIDENCE: Level III, therapeutic study.
Assuntos
COVID-19/prevenção & controle , Serviço Hospitalar de Emergência/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Controle de Infecções/tendências , Avaliação das Necessidades/tendências , Centros de Traumatologia/tendências , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/transmissão , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nova Orleans/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Adulto JovemRESUMO
OBJECTIVE: To determine the demand for colposcopy in the Cervical Screening Wales programme after the introduction of human papillomavirus (HPV) cervical screening, which coincided with the start of screening of women vaccinated against HPV types 16/18. DESIGN: The study used a computational model that assigns screening and screening-related colposcopy events to birth cohorts in individual calendar years. SETTING: Cervical Screening Wales. POPULATION: Women aged 25-64 years from birth cohorts 1953-2007. METHODS AND MAIN OUTCOME MEASURES: We estimated the numbers of colposcopies and high-grade cervical intraepithelial lesions (CIN2+) within Cervical Screening Wales in 2018-32, using official population projections for Wales and published estimates of the effects of HPV screening and vaccination. RESULTS: Vaccination will reduce the number of colposcopies by 10% within the first 3-4 years after the national roll-out of HPV screening, and by about 20% thereafter. The number of screening colposcopies is estimated to increase from 6100 in 2018 and peak at 8000 (+31%) in 2021, assuming current screening intervals are maintained. The numbers of CIN2+ lesions follow similar patterns, stabilising at around 1000 diagnoses per year by 2026, approximately 60% lower than at present. Extending the screening intervals to 5 years for all women shows similar trends but introduces peaks and troughs over the years. CONCLUSIONS: Vaccination will not fully prevent an increase in colposcopies and detected CIN2+ lesions during the first 2-3 years of HPV-based screening but the numbers are expected to decrease substantially after 5-6 years. TWEETABLE ABSTRACT: HPV-based cervical screening will initially increase colposcopy referral. In 6 years, this increase will be reversed, partly by HPV vaccination.