Elective Treatments Research Articles

Quorum Sensing in Gram-Negative Bacteria: Strategies to Overcome Antibiotic Resistance in Ocular Infections.

Truly miraculous medications and antibiotics have helped save untold millions of lives. Antibiotic resistance, however, is a significant issue related to health that jeopardizes the effectiveness of antibiotics and could harm everyone's health. Bacteria, not humans or animals, become antibiotic-resistant. Bacteria use quorum-sensing communication routes to manage an assortment of physiological exercises. Quorum sensing is significant for appropriate biofilm development. Antibiotic resistance occurs when bacteria establish a biofilm on a surface, shielding them from the effects of infection-fighting drugs. Acylated homoserine lactones are used as autoinducers by gram-negative microscopic organisms to impart. However, antibiotic resistance among ocular pathogens is increasing worldwide. Bacteria are a significant contributor to ocular infections around the world. Gram-negative microscopic organisms are dangerous to ophthalmic tissues. This review highlights the use of elective drug targets and treatments, for example, combinational treatment, to vanquish antibiotic-resistant bacteria. Also, it briefly portrays anti-biotic resistance brought about by gram-negative bacteria and approaches to overcome resistance with the help of quorum sensing inhibitors and nanotechnology as a promising medication conveyance approach to give insurance of anti-microbials and improve pathways for the administration of inhibitors of quorum sensing with a blend of anti-microbials to explicit target destinations and penetration through biofilms for treatment of ocular infections. It centres on the methodologies to sidestep the confinements of ocular anti-biotic delivery with new visual innovation.

The cost of keeping patients waiting: retrospective treatment-control study of additional healthcare utilisation for UK patients awaiting elective treatment.

Long waiting times for elective hospital treatments are common in many countries. This study seeks to address a deficit in the literature concerning the effect of long waits on the wider consumption of healthcare resources. We carried out a retrospective treatment-control study in a healthcare system in South West England from 15 June 2021 to 15 December 2021. We compared weekly contacts with health services of patients waiting over 18 weeks for treatment ('Treatments') and people not on a waiting list ('Controls'). Controls were matched to Treatments based on age, sex, deprivation and multimorbidity. Treatments were stratified by the clinical specialty of the awaited hospital treatment, with healthcare usage assessed over various healthcare settings. Wilcoxon signed-rank tests assessed whether there was an increase in healthcare utilisation and bootstrap resampling was used to estimate the magnitude of any differences. A total of 44,616 patients were waiting over 18 weeks (the constitutional target in England) for treatment during the study period. There was an increase (p < 0.0004) in healthcare utilisation for all specialties. Patients in the Cardiothoracic Surgery specialty had the largest increase, with 17.9 [interquartile-range: 4.3, 33.8] additional contacts with secondary care and 17.3 [-1.1, 34.1] additional prescriptions per year. People waiting for treatment consume higher levels of healthcare than comparable individuals not on a waiting list. These findings are relevant for clinicians and managers in better understanding patient need and reducing harm. Results also highlight the possible 'false economy' in failing to promptly resolve long elective waits.

Inequalities in waiting times for elective hospital care: what can routine health data and standard analytical methods tell us?

Background/Aims Identifying health inequalities can require substantial data and analytical resources. A healthcare setting that may be particularly exposed to inequality is elective care, where hospital waiting times have substantially lengthened since the COVID-19 pandemic. This study aimed to investigate how routine health data and standard analytical methods could be used to identify inequalities in waiting times relating to age, sex, ethnicity and socioeconomic deprivation. Methods Decision trees were fitted to data on waiting times for 78 510 completed elective treatments from a large NHS organisation in England for the calendar year of 2021. Data were sourced from the Waiting List Minimum Dataset and combined with a local dataset on patient attributes. Analysis was stratified by treatment specialty and whether the treatment was delivered in an outpatient or inpatient setting. A decision tree was fitted to the data at each stratum to assess three questions: To what extent can variation in waiting times be explained by age, sex, ethnicity and socioeconomic deprivation? Which variables are most explanatory? In what ‘direction’ is this explanation (eg for sex, did male or female patients wait longer?). Results Across the elective hospital specialties assessed, a maximum of 12% of variation in waiting times could be explained by age, sex, ethnicity and socioeconomic deprivation. For all decision trees, age appeared as the most important explanative ‘branching’ variable in 54% of cases, followed by socioeconomic deprivation (2%) and sex (1%). Ethnicity was not a statistically significant explanatory variable. Where variation did exist, waiting times were longer for younger patients, female patients and those from areas with greater socioeconomic deprivation. Conclusions According to the approach taken in this study, there is little evidence of significant waiting time inequality dependent on sex, socioeconomic deprivation and ethnicity. Analysis of this nature does not confirm a causal association between younger age and longer waiting time, but instead highlights the need for further explorative analysis. Healthcare managers should be cautious about the use of routine health data and standard analytical methods in efforts to identify health inequalities.

A Review of Policies to Reduce Waiting Times for Health Services across OECD Countries

Waiting times for health services are a significant policy issue in most OECD countries, where improving the experience and patient satisfaction with the health system is a key objective. Waiting times in publicly-funded systems arise from the imbalance between demand for and supply of health services. This study reviews policies aimed at reducing waiting times in OECD countries across different health services: specialist consultations and elective treatments; consultations with primary care providers; cancer care; and mental health services. A policy questionnaire was sent by the OECD in May 2019. For each area it asked information on a) policies, its objectives and actions, b) the extent to which they were regularly evaluated or assessed, and c) main results of the evaluation. 33 countries provided at least a partial response, with 24 countries providing detailed information about the policies, which are reviewed in this study. Our key findings are as follows. Countries often start by specifying maximum waiting times across a range of services, which can be used as a guarantee for patients and/or targets for providers. Policies for elective care include improving demand management by prioritising patients on the list, and improving coordination between primary and secondary care. For primary care, policies focus on increasing the supply of general practitioners and advanced practice nurses, and encouraging the use of new technologies (e.g. teleconsultations). For cancer care, countries have developed national strategies to ensure timely access to diagnosis and treatment, including fast-track pathways, which rationalise and coordinate different types of cancer services, facilitated by dedicated capacity. Policies for mental health focus on better meeting demand through increased volume or scope with, in some cases, targets driving better access. In summary, policymakers have several levers to reduce waiting times along the patient pathway to improve responsiveness and make health systems more people centred.

Antiplatelet, anticoagulation, and elective aneurysm treatments in neurological patients

Developing more specialized care for neurological disorders, such as aneurysms, arteriovenous malformations, and strokes, can revolutionize patient healthcare and outcomes. With the advent of surgical techniques such as flow diversion, non-stent- and stent-assisted coiling, and catheter embolization for elective aneurysm treatment in neurological patients, the adverse effects and morbidities associated with aneurysms can be reduced. This paper aims to highlight three specific strengths and weaknesses of the newly emerged techniques. Flow diversion devices involve placing a stent in the parent artery, whereas Woven EndoBridge embolization involves manipulation of the wall of the artery without the administration of dual-antiplatelet therapy. In addition to aneurysm treatment, the administration of antiplatelets and anticoagulants is helpful in disrupting the coagulation cascade. As stated in the new and enhanced guidelines released by the American Heart Association, the administration of dual anticoagulants is beneficial to the patients if they have low ischemic severity. Understanding the various benefits and complications associated with each treatment can allow clinicians to gain insight into the potential trajectory of treatment for different patients.

How did the COVID-19 pandemic affect inpatient care for children in Germany? An exploratory analysis based on national hospital discharge data

BackgroundThe delivery of health services around the world faced considerable disruptions during the COVID-19 pandemic. While this has been discussed for a number of conditions in the adult population, related patterns have been studied less for children. In light of the detrimental effects of the pandemic, particularly for children and young people under the age of 18, it is pivotal to explore this issue further.MethodsBased on complete national hospital discharge data available via the German National Institute for the Reimbursement of Hospitals (InEK) data browser, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020, 2021 and 2022. We analyse the development of monthly admissions between January 2019 and December 2022 for three tracers of variable time-sensitivity: acute lymphoblastic leukaemia (ALL), appendicitis/appendectomy and tonsillectomy/adenoidectomy.ResultsCompared to 2019, total admissions were approximately 20% lower in 2020 and 2021, and 13% lower in 2022. The composition of the most frequent principal diagnoses remained similar across years, although changes in rank were observed. Decreases were observed in 2020 for respiratory and gastrointestinal infections, with cases increasing again in 2021. The number of ALL admissions showed an upward trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions decreased by about 9% in 2020 and a further 8% in 2021 and 4% in 2022, while tonsillectomies/adenoidectomies decreased by more than 40% in 2020 and a further 32% in 2021 before increasing in 2022; for these tracers, monthly changes are in line with pandemic waves.ConclusionsHospital care for critical and urgent conditions among patients under the age of 18 was largely upheld in Germany during the COVID-19 pandemic, potentially at the expense of elective treatments. There is an alignment between observed variations in hospitalisations and pandemic mitigation measures, possibly also reflecting changes in demand. This study highlights the need for comprehensive, intersectoral data that would be necessary to better understand changing demand, unmet need/foregone care and shifts from inpatient to outpatient care, as well as their link to patient outcomes and health care efficiency.

Related variations: A novel approach for detecting patterns of regional variations in healthcare utilisation rates.

Regional variations in healthcare utilisation rates are ubiquitous and persistent. In settings where an aggregate national health service budget is allocated primarily on a per capita basis, little regional variation in total healthcare utilisation rates will be observed. However, for specific treatments, large variations in utilisation rates are observed, iymplying a substitution effect at some point in service delivery. The current paper investigates the extent to which this substitution effect occurs within or between specialties, particularly distinguishing between emergency versus elective care. We used data from Statistics Norway and the Norwegian Patient Registry on eight somatic surgeries for all patients treated from 2010 to 2015. We calculated Diagnosis-Related Group (DRG) -weight per capita in 19 hospital regions. We applied principal component analysis (PCA) to demonstrate patterns in DRG-weight, annual relative changes in DRG-weight, and DRG-weight production for elective care. We show that treatments with similar characteristics cluster within regions. Treatment frequency explains 29% of the total variation in treatment rates. In a dynamic model, treatments with a high degree of emergency care are negatively correlated with treatments with a high degree of elective care. Furthermore, when considering only elective care treatments, the substitution effect occurs between specialties and explains 49% of the variation. When designing policies aimed at reducing regional variations in healthcare utilisation, a distinction between elective and emergency care as well as substitution effects need to be considered.

(264) Reasons of Discontinuation from Collagenase Clostridium histolyticum treatments in Peyronie’s Disease

Abstract Introduction Peyronie’s disease is an acquired fibrotic condition that impacts quality of life and sexual function. Intralesional Collagenase Clostridium histolyticum (CCH) is the only FDA approved medication to correct curvature. The treatment consists of 8 injections over 26 weeks and previous studies indicate that greater improvement is associated with a greater number of injections; however, reasons for early discontinuation are not well studied. Objective We aimed to understand the reasons for early discontinuation of CCH treatment in a major academic system. Methods We retrospectively reviewed charts of PD patients from October 2018 to October 2020 who underwent CCH treatment. Complete treatment consists of four cycles of two injections, each separated by approximately 5-6 weeks, for a total of 8 injections. Treatment completion was defined as receiving 8 injections or stopping because curvature decreased to &amp;lt;15 degrees. Patients who did not complete 8 injections were contacted and surveyed about reasons for discontinuation. Data was gathered and analyzed on Microsoft Excel. Results A total of 73 patients elected for CCH. Only 43 (58.9%) completed all 8 injections and another 5 (6.8%) stopped due to treatment satisfaction, for a total of 48 (66%) reaching endpoint. There was no significant difference in age, duration of symptoms or Peyronie’s Disease Questionnaire scores between patients who completed treatment and those who didn’t (Table 1). Similar number of patients dropped out in the first half and second half of treatment. Out of the 30 (41.1%) of patients who discontinued therapy before 8 injections, 4 (13.3%) wanted to try another treatment, 6 (20%) experienced side effects, 3 (10%) had insurance issues, 5 (16.7%) was satisfied after a few injections, 4 (13.3%) was disappointed in treatment and 8 (26.7%) were unable to be contacted to return to the hospital (Table 2). Conclusions We found that shifts in financial/insurance status and onset of adverse events, such as an autoimmune flair, were predictive of dropouts in our cohort. Most of the patients who wanted to attempt another treatment did so with the same surgeon but wanted a faster solution. Further, in our cohort, difficulty contacting patients was the biggest reason of discontinuation; this is likely skewed due to the COVID19 pandemic as patients relocated or underwent fewer elective treatments and procedures. To reduce CCH discontinuation, we propose that counseling should focus on potential adverse events, speed of change and financial assistance. Disclosure No

The impact of the pandemic on the perception of stress and danger, and the adjustment of psychiatric and general medical staff of German military hospitals.

The COVID-19 pandemic changed not only the working conditions but also the private conditions we live in. Health care professionals especially were confronted with multiple stressors, e.g., the risk of infection, lack of staff, and high workloads. To estimate some of the pandemic-related impacts this anonymous personnel survey was conducted in two German military hospitals (Hamburg and Berlin). This study presents a comparative analysis of the hospital staff in general vs. the psychiatric personnel (N = 685) at two measurement time points (MTPs) in April 2021 (n = 399) and December 2021 (n = 286). The survey contains the German version of the Covid Stress Scale (CSS) to assess the perceived level of pandemic-related stress, the Patient Health Questionnaire (German Version: PHQ-D) to screen for three major mental disorders, and the adjustment disorder-New Module (ADNM) to estimate the problems of adaptation to change. The results showed a process of adaptation over the two MTPs with significant stress reduction at MTP2 in the general staff. The psychiatric staff did not report significantly higher pandemic-related symptoms. Quite the contrary, not only did the CSS show significantly lower xenophobia, traumatic stress, and compulsive checking, but the PHQ also showed lower stress symptoms and somatic symptoms at both MTPs. Also, the ADNM scores delivered evidence for a more effective adaptation process in psychiatric personnel (e.g., depressive mood, avoidance, anxiety). The presented results must be interpreted while taking the unique situations of German military clinics into account. The supply of protective material was sufficient and there was no dramatic shortage of psychiatric staff during the pandemic. The inpatients were quite often (40%) elective treatments for trauma-related disorders, which could be discontinued in the case of a COVID-19 infection. The results of this study showed good adaptative skills among the psychiatric staff in military hospitals, which could be interpreted as a sign of good resilience. This might have led to lower stress-related symptoms during the COVID-19 pandemic.

Polytrauma care in air rescue in times of the COVID-19 pandemic: impact and development of case numbers

Changes in patient care occurred as aresult of the SARS-CoV‑2 virus, and both intrahospital and prehospital care were profoundly affected. Public shutdowns during lockdown periods were intended to prevent overstretching existing resources, resulting in noticeable changes in medical care for both elective treatments and emergency medicine. This study now considered the impact of the COVID19 pandemic on air ambulance services at acentral air ambulance site in 2020 compared to the previous 2years. Aretrospective evaluation of all missions of the rescue helicopter Christoph9 in the first COVID-19 pandemic year 2020 in comparison to the years 2018 and 2019 was performed. The mission logs were evaluated for the analysis. There was a20% reduction in the number of missions in 2020, with primarily internal medicine missions affected. Despite the lockdown periods and reduction in social life, the proportion of trauma deployments remained nearly the same. As expected, the proportion of occupational accidents decreased, and recreational activities resulted in accidents more frequently. Injury or illness severity showed no significant differences. In terms of internal diseases, there was areduction in alerts for acute coronary syndrome and respiratory emergencies. The proportion of suicide-related injuries remained constant over the years. During the COVID-19study period, adecrease in the number of deployments and aborted deployments was observed. However, no significant differences in deployment and injury characteristics were observed for trauma-related deployments. These results highlight the importance of air ambulance services to ensure patient care even during pandemic periods.

A Step-by-Step Dissection of Cerebral Pathologies for Neurosurgical Trainees: The Middle Cerebral Artery Bifurcation Aneurysm.

Aneurysmal subarachnoid hemorrhage remains one of the most prevalent causes of strokes in the young causing a high socioeconomic damage. Both emergent and elective treatments of intracranial aneurysms remain essential challenges for neurovascular centers. We aim to present conceptual education on clip ligation of middle cerebral artery bifurcation aneurysms in an accessible and structured way to maximize the educational takeaway of residents from aneurysm cases. After 30 years of experience of the senior author in cerebrovascular surgery in three centers, we closely reviewed an exemplary case of elective right middle cerebral artery bifurcation aneurysm clipping and contrasted it to an alternative microneurosurgical approach to illustrate key principles of microneurosurgical clip ligation for neurosurgical trainees. Dissection of the sylvian fissure, subfrontal approach to the optic-carotid complex, proximal control, aneurysm dissection, dissection of kissing branches, dissection of aneurysm fundus, temporary and permanent clipping, as well as aneurysm inspection and resection are highlighted as key steps of clip ligation. This proximal-to-distal approach is contrasted to the distal-to-proximal approach. Additionally, general principles of intracranial surgery such as use of retraction, arachnoid dissection, and draining of cerebrospinal fluid are addressed. Due to a constantly decreasing case load in the era of neurointerventionalism, the paradox of facing increased complexity with decreased experience must be met with a sophisticated practical and theoretical education of neurosurgical trainees early on and with a low threshold.

Implementing criteria-led discharge for acute admissions to facilitate the elective recovery from COVID-19: an example in acute tonsillitis

BackgroundHealthcare systems face unprecedented numbers of patients waiting for elective treatments in the wake of the COVID-19 pandemic. Hospitals must urgently optimise patient pathways and build capacity to meet the...

The effect of hospital choice and competition on inequalities in waiting times

We use a quasi difference-in-difference approach to examine whether the 2006 relaxation of constraints on patient choice of hospital in the English National Health Service (NHS) affected waiting times inequalities for three common elective treatments (coronary bypass, hip replacement and knee replacement) in hospitals which faced more potential competition (number of rivals) before the choice reform was introduced relative to those which faced less competition. After the 2006 choice reform hospitals which had more rivals before 2006 had longer waits for hip and knee replacement, with one additional rival increasing the median waiting time by 2.5% and 4.0%, and the 75th quantile waiting time by 4.2% and 7.1%. There was no effect on waiting times for coronary bypass patients up to the 75th quantile of the wait distribution. The choice reform and market structure had no effect on the standard deviation of waiting times within hospitals but did increase waiting time variation within small geographical areas. Older hip replacement patients had shorter waits pre-choice reform but the gradient disappeared after it and was not affected by market structure. Before the choice reform, more deprived patients had longer waits but post-reform there was no deprivation gradient in waiting times, and the reduction in the gradient was not affected by pre-reform market structure. Overall, the results suggest that the choice reform led to longer and more dispersed waiting times in more competitive areas but deprivation related inequity was smaller in the post-choice period.

Does the healthcare system know what to cut under the pandemic emergency pressure? An observational study on geographic variation of surgical procedures in Italy

ObjectivesDuring 2020 many countries reduced the number of elective surgeries to free up beds and cope with the COVID-19 outbreak. This situation led healthcare systems to prioritise elective interventions and...

What can we learn from the effects of the COVID-19 pandemic on hospital care for children in Germany?

Abstract The COVID-19 pandemic created substantial disruptions in the delivery of health services around the world. Reductions in hospital admissions have been reported for several conditions in the adult population; less evidence currently exists for children. To what extent such changes reflect a risk for patients due to unmet care needs, or a “correction” of previous overprovision of care has not been thoroughly examined yet. Based on complete national hospital discharge data, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020 and 2021 in Germany. We also analyse the development of monthly admissions between January 2019 and December 2021 for three tracers of variable urgency and severity. Total admissions were approximately 20% lower in 2020 and 2021 compared to 2019. The composition of the most frequent diagnoses did not change dramatically across years, although changes in rank were observed. The number of admissions for acute lymphoblastic leukaemia (tracer 1) showed a slight increasing trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions (tracer 2) decreased by about 9% in 2020 and a further 8% in 2021, while tonsillectomies/adenoidectomies (tracer 3) decreased by more than 40% in 2020 and a further 30% in 2021; for these tracers, monthly changes are in line with pandemic waves. Observed variations in child hospitalisations reflect the effects of pandemic mitigation measures and/or changes in demand. In Germany, inpatient care for critical conditions appears to have been largely upheld, potentially at the expense of elective treatments. Complementary data on ambulatory care and health outcomes would enable a better understanding of change in healthcare patterns and effects on children's health.

Evaluation of the Physical and Chemical Treatment of Wastewater for the Dairy Industry

Dairy wastewater generally contains fats, lactose, whey proteins, and nutrients. Casein precipitation causes the effluent to decompose into a dark, strong-smelling sludge. Fluid waste contains soluble organic matter, suspended solids, and gaseous organic matter, which cause undesirable taste and smell, grant tone and turbidity, and advance eutrophication, which plays an essential role in increasing biological oxygen demand (BOD) in water. It also contains detergents and disinfecting agents from the rinses and washing processes, which increase the need for chemical oxygen (COD). One of the characteristics of dairy effluents is their relatively high temperature, high organic contents, and wide pH range, so the discharge of wastewater into water bodies without treatment leads to deterioration of water quality and ecological imbalance, and therefore treatment is required. To remove or reduce environmental damage. Dairy wastewater treatment includes mechanical, physical, chemical, and biological methods. Organic treatment techniques are reasonable for treating wastewater from the dairy business because of their high biodegradability. Notwithstanding, the long-chain unsaturated fats framed during lipid hydrolysis show an inhibitory impact during anaerobic treatment. Chain block reactors (SBR) and top stream anaerobic slop cover of sludge (UASB) frameworks are the most encouraging advancements for the organic treatment of dairy wastewater. Many papers have applied high-impact exercise and technical methods to the dairy business's anaerobic wastewater treatment of dairy wastewater. However, the two techniques actually have a few disadvantages. The most vital objective of these studies is to track down savvy and naturally manageable ways to deal with and empower the reuse and management of wastewater and waste. Consequently, elective treatments to organic treatment are physical and substance techniques, for example, coagulation, retention, layer cycles, and electrolysis. This section gives a primary survey zeroing in on physical and compound treatment strategies for dairy wastewater treatment. It is under study and checked for its viability.

COVID-19 as an opportunity for minimally-invasive dentistry: a national cross-sectional survey

BackgroundDuring the COVID19 pandemic, the Latvian government issued first absolute restrictions (elective treatments prohibited, only emergency care) and later relative restrictions (preference for non-aerosol-generating procedures (AGP) and emergency care) on dental care. This study aims to assess the impact of these restrictions on the decision made by Latvian dentists about caries treatment.MethodsA Survey-based cross-sectional study was used. A minimum sample size of 174 dentists was estimated for national representativeness (N = 1524). The questionnaire was developed by experts and sent three times via email to Latvian dentists from July to September 2020 and was also delivered in printed form at two national conferences in September and October 2020. Descriptive statistics were calculated.ResultsWe received 373 completed questionnaires, with a total response rate of 24.5%. Under the recommendation to reduce AGP for the treatment of uncomplicated caries, 10% of the dentists stated that they would stop attending, 54% would only attend emergencies, and 36% would attend as usual. Under prohibition, the percentages are 15%, 74%, and 11%, respectively. Regarding the type of treatment, more than 75% would opt to proceed with selective caries removal for both primary and permanent teeth and 10% for extraction.ConclusionLatvian dentists are willing to treat patients with caries during the pandemic and state that they prefer to use non- or minimally invasive and less aerosol-generating methods for caries treatment.

A predictive model for the post-pandemic delay in elective treatment

The COVID-19 pandemic had a major impact on healthcare systems across the world. In the United Kingdom, one of the strategies used by hospitals to cope with the surge in patients infected with SARS-Cov-2 was to cancel a vast number of elective treatments planned and limit its resources for non-critical patients. This resulted in a 30% drop in the number of people joining the waiting list in 2020–2021 versus 2019–2020. Once the pandemic subsides and resources are freed for elective treatment, the expectation is that the patients failing to receive treatment throughout the pandemic would trigger a significant backlog on the waiting list post-pandemic with major repercussions to patient health and quality of life. As the nation emerges from the worst phase of the pandemic, hospitals are focusing on strategies to prioritise patients for elective treatments. A key challenge in this context is the ability to quantify the expected backlog and predict the delays experienced by patients as an outcome of the prioritisation policies. This study presents an approach based on discrete-event simulation to predict the elective waiting list backlog along with the delay in treatment based on a predetermined prioritisation policy. The model is demonstrated using data on the endoscopy waiting list at Cambridge University Hospitals. The model shows that 21% of the patients on the waiting list will experience a delay less than 18-weeks, the acceptable threshold set by the National Health Service (NHS). A longer-term scenario analysis based on the model reveals investment in NHS resources will have a significant positive outcome for addressing the waiting lists. The model presented in this paper has the potential to be an invaluable tool for post-pandemic planning for hospitals around the world that are facing a crisis of treatment backlog.

Novel Corona Virus (COVID-19): Assessing Prevalence of SARS-CoV-2 and Infection.

The World Health Organization (WHO) declared severe acute respiratory syndrome coronavirus 2 a pandemic on March 11, 2020. Corona virus disease 2019 (COVID-19) is commonly transmitted from human-to-human via close contacts and touching surfaces. Reports indicated that many medical staff got infected on working with infected individuals. Likewise, dentists are at a higher risk for the virus transmission due to close proximity to patients and the nature of dental procedures. Despite all of the protections and disinfections, there were some reports of infected dentists. In this study, we evaluated the prevalence of infected dentists and the rate of using protection protocols by them in Iran. This survey was a cross-sectional descriptive and web-based study in which a questionnaire designed and uploaded on Google forms. The link of the form was shared among dentists in Iran via some social media groups and personal messages. A total of 945 dentists participated in this survey. A higher proportion of participants had their own private practice. About one third reported fatigue, malaise, or headaches since the COVID-19 got epidemic in Iran. Most of the respondents had provided emergency and elective dental treatments, used face shields, and surgical masks. The 26.3% of respondents were positive for COVID-19. According to our analysis, about 26% of dentists had been infected with COVID -19 and most of them reported that they used the CDC's currently recommended infection prevention and control procedures in dental offices. However, the prevalence of infection was higher than prevalence of infection in the whole population of Iran (approximately 1%) and it showed that dentists were at high risk despite using infection control and personal protection equipment (PPE).

Economic Effects of the SARS-CoV-2 Pandemic in 2020.

In 2020, the SARS-CoV-2 pandemic necessitated an adjustment to the care structure in all medical facilities in Germany. In this study we analysed the effects of the SARS-CoV-2 pandemic using the data from the annual balance sheet of a university department and maximum care provider for orthopaedics and trauma surgery. Data analysis was performed on the clinic's performance parameters from 2019 and 2020. The analysis included 52943 outpatient and 7980 inpatient cases, together with the Case Mix Index (CMI), and the costs and revenues. As a result of the reduction in scheduled surgeries, the mean number of inpatients in March and April 2020 decreased by 10.4% (p = 0.004). Due to the focus on complex cases, the CMI increased by 29.5% (p = 0.007). The number of outpatient surgical procedures increased by 16.9% (n = 84). Rising costs of consumables due to the purchase of protective equipment were offset by a reduced need for orthopaedic implants. By reducing the number of elective inpatient surgical treatments, the focus was shifted to treating complex cases; this is reflected in the increased CMI. Due to internal compensation mechanisms, the clinic was able to conserve intensive care capacities while still achieving an increase in revenue.