Deferral of Non-Emergency Cardiovascular Interventions Triggers Increased Cardiac Emergency Admissions-Analysis of the COVID-19 Related Lockdown.

BACKGROUND: Data on the relation between non-emergency and emergency cardiac admission rates during the COVID-19 lockdown and post-lockdown period are sparse. METHODS: Consecutive cardiac patients admitted to our tertiary heart center between 1 January and 30 June 2020 were included. The observation period of 6 months was analyzed in total and divided into three defined time periods: the pre-lockdown (1 January-19 March), lockdown (20 March-19 April), and post-lockdown (20 April-30 June) period. These were compared to the reference periods 2019 and 2022 using daily admission rates and incidence rate ratios (IRR). RESULTS: Over the observation period from 1 January to 30 June, cardiac admissions (including non-emergency and emergency) were comparable between 2019, 2020, and 2022 (n = 2889, n = 2952, n = 2956; p = 0.845). However, when compared to the reference period 2019, non-emergency admissions decreased in 2020 (1364 vs. 1663; p = 0.02), while emergency admissions significantly increased (1588 vs. 1226; p < 0.001). Further analysis of the lockdown period revealed that non-emergency admissions dropped by 82% (IRR 0.18; 95%-CI 0.14-0.24; p < 0.001) and 42% fewer invasive cardiac interventions were performed (p < 0.001), whereas the post-lockdown period showed a 52% increase of emergency admissions (IRR 1.47; 95%-CI 1.31-1.65; p < 0.001) compared to 2019. CONCLUSIONS: We demonstrate a drastic surge of emergency cardiac admissions post-COVID-19 related lockdown suggesting that patients who did not keep their non-emergency appointment had to be admitted as an emergency later on.

Transportation barriers to care among frequent health care users during the COVID pandemic.

BACKGROUND: Transportation problems are known barriers to health care and can result in late arrivals and delayed or missed care. Groups already prone to greater social and economic disadvantage, including low-income individuals and people with chronic conditions, encounter more transportation barriers and experience greater negative health care consequences. Addressing transportation barriers is important not only for mitigating adverse health care outcomes among patients, but also for avoiding additional costs to the health care system. In this study, we investigate transportation barriers to accessing health care services during the COVID-19 pandemic among high-frequency health care users. METHODS: A web-based survey was administered to North Carolina residents aged 18 and older in the UNC Health system who were enrolled in Medicaid or Medicare and had at least six outpatient medical appointments in the past year. 323 complete responses were analyzed to investigate the prevalence of reporting transportation barriers that resulted in having arrived late to, delayed, or missed care, as well as relationships between demographic and other independent variables and transportation barriers. Qualitative analyses were performed on text response data to explain transportation barriers. RESULTS: Approximately 1 in 3 respondents experienced transportation barriers to health care between June 2020 and June 2021. Multivariate logistic regressions indicate individuals aged 18-64, people with disabilities, and people without a household vehicle were significantly more likely to encounter transportation barriers. Costs of traveling for medical appointments and a lack of driver or car availability emerged as major transportation barriers; however, respondents explained that barriers were often complex, involving circumstantial problems related to one's ability to access and pay for transportation as well as to personal health. CONCLUSIONS: To address transportation barriers, we recommend more coordination between transportation and health professionals and the implementation of programs that expand access to and improve patient awareness of health care mobility services. We also recommend transportation and health entities direct resources to address transportation barriers equitably, as barriers disproportionately burden younger adults under age 65 enrolled in public insurance programs.

A medical ethics review of elective orthopaedic surgery management during the pandemic COVID-19 Era.

Introduction: Orthopaedic surgeons may wonder what preparation and recuperation would be like during pandemics. We are concerned about the patient's safety during the operation. All surgical centres have received instructions to discontinue all elective surgery operations, although urgent surgical cases are still being carried out. This procedure should not be delayed in orthopaedic issues such as fracture repositioning surgery, as the unionization process is ongoing. Methods: We gather review articles from a variety of sources. The keywords "Ethics," "COVID-19," "Elective Surgery," and "Orthopedic Surgery" were used to filter the documents. We found 863 documents and then set the criteria for including documents that we thought eligible for review articles, such as research journals and newspaper pieces from reliable sources, resulting in the discovery of 40 papers that met our requirements. Result: We will discuss four basic principles of medical ethics: beneficence, nonmaleficence, autonomy, and justice. Orthopaedic surgeons will face many decisions that will challenge these ethical principles, especially in performing elective surgery during a pandemic. Conclusion: Physicians must protect the most vulnerable, but they are under no obligation to administer treatment they believe to be ineffective. In individuals who are positive for COVID-19, orthopaedic surgical procedures have a significant mortality rate. Surgical leaders must remain attentive, and surgical services must be reintroduced gradually and carefully. A good option is to carry out treatment at a different place and time and ensure that the patient has tested negative for COVID-19 before the procedure, thereby creating safety for patients and health workers.

Clustering-based iterative heuristic framework for a non-emergency patients transportation problem.

Introduction: Non-emergency patient transportation (NEPT) services are particularly important nowadays due to the aging population and contagious disease outbreaks (e.g., Covid-19 and SARS). In this work, we study a NEPT problem with a case study of patient transportation services in Hong Kong. The purpose of this work is to study the discomfort and inconvenience measures (e.g., waiting time and extra ride time) associated with the transportation of non-emergency patients while optimizing the operational costs and utilization of NEPT ambulances. Methods: A mixed-integer linear programming (MILP) formulation is developed to model the NEPT problem. This MILP model contributes to the existing literature by not only including the patient inconvenience measures in the objective function but also illustrating a better trade-off among different performance measures through its specially customized formulation and real-life characteristics. CPLEX is used to find the optimal solutions for the test instances. To overcome the computational complexity of the problem, a clustering-based iterative heuristic framework is designed to solve problems of practical sizes. The proposed framework distinctively exploits the problem-specific structure of the considered NEPT problem in a novel way to enhance and improve the clustering mechanism by repeatedly updating cluster centers. Results: The computational experiments on 19 realistic problem instances show the effective execution of the solution method and demonstrate the applicability of our approach. Our heuristic framework observes an optimality gap of less than 5% for all those instances where CPLEX delivered the result. The weighted objective function of the proposed model supports the analysis of different performance measures by setting different preferences for these measures. An extensive sensitivity analysis performed to observe the behavior of the MILP model shows that when operating costs are given a weightage of 0.05 in the objective function, the penalty value for user inconvenience measures is the lowest; when the weightage value for operating costs varies between 0.8 and 1.0, the penalty value for the same measures is the highest. Conclusions: This research can assist decision-makers in improving service quality by balancing operational costs and patient discomfort during transportation.

Influence of COVID-19 pandemic on paediatric dental attendance.

OBJECTIVES: This retrospective study aimed to evaluate the effect of COVID-19 pandemic on dental attendance and emergency/non-emergency visits of children during the outbreak, compared to the same period of 2019. MATERIALS AND METHODS: Patients who visited the paediatric department clinic during the observed period were included in this study. The patient's demographic data, purpose of visit, and treatment type were evaluated retrospectively from patient examination records. The Pearson chi-square and t-tests were used for comprehensive statistical analysis. RESULTS: A total of 1454 patient files (1184/270 cases from non-pandemic/pandemic period) were assessed. A significant reduction was found in aggregated emergency/non-emergency visits during the pandemic period (p < 0.01). During the pandemic, average daily visits for emergency dental care were observed to have a decrease to half of the non-pandemic period. Non-emergency routine dental visits have also exhibited a drastic decline. Severe dental pain due to pulpal inflammation and abscess/swelling were the most frequently reported urgent dental complaints that patients applied to the paediatric dental clinic during the pandemic period. CONCLUSION: COVID-19 pandemic has a significant influence on patients' attendance to paediatric dental clinic. Therefore, concerning a potential post-pandemic increase in treatment demand, meticulous future planning and proper regulation of dental care should be provided for better oral health and children's quality of life. CLINICAL RELEVANCE: This study's importance is the observation of dramatically reduced number of patient visits during the pandemic period which may yield increased number of oral health-related complications in the long run.

How is the COVID-19 pandemic shaping transportation access to health care?

The Coronavirus disease 19 (COVID-19) pandemic has disrupted both transportation and health systems. While about 40% of Americans have delayed seeking medical care during the pandemic, it remains unclear to what extent transportation is contributing to missed care. To understand the relationship between transportation and unmet health care needs during the pandemic, this paper synthesizes existing knowledge on transportation patterns and barriers across five types of health care needs. While the literature is limited by the absence of detailed data for trips to health care, key themes emerged across populations and settings. We find that some patients, many of whom already experience transportation disadvantage, likely need extra support during the pandemic to overcome new travel barriers related to changes in public transit or the inability to rely on others for rides. Telemedicine is working as a partial substitute for some visits but cannot fulfill all health care needs, especially for vulnerable groups. Structural inequality during the pandemic has likely compounded health care access barriers for low-income individuals and people of color, who face not only disproportionate health risks, but also greater difficulty in transportation access and heightened economic hardship due to COVID-19. Partnerships between health and transportation systems hold promise for jointly addressing disparities in health- and transportation-related challenges but are largely limited to Medicaid-enrolled patients. Our findings suggest that transportation and health care providers should look for additional strategies to ensure that transportation access is not a reason for delayed medical care during and after the COVID-19 pandemic.