Availability Of Hospital Beds Research Articles

An analysis of order utilization and overall costs secondary to an extended length of stay in hospitalized patients pending discharge to long term care facilities during the peak of Omicron

During the covid pandemic there was an influx of patients admitted to hospitals worldwide. This resulted in a presumptive overuse of resources, increased utilization costs, and decrease in hospital bed availability. This study focuses on patients admitted with a positive covid test, who required transfer to a long-term health facility after the acuity of their symptoms no longer required hospitalization but necessitated an extended length of stay due to acceptance into these facilities. Such facilities included: alternative living facility, skilled nursing facility, psychiatric institutions, or hospice. Wherein these facilities required a negative Covid PCR test or required a certain time frame to have elapsed after a positive test prior to accepting or recovering a patient. This study utilized patient records from Keralty Hospital, with admission during the 2022 peak of Omicron (January 31, 2022- February 13, 2022). Patient inclusion criteria was if they had a positive covid test on admission and experienced an extended length of stay over 2 days pending discharge to a long-term care facility. A quantitative/qualitative analysis was conducted of all orders placed subsequent to the first discharge order, and the number of additional days spent at the hospital. Correlations regarding total bed cost, and total overall, were then calculated using single tailed p values utilizing Prism 9 GraphPad software. Our research findings indicate there was a significant correlation between the number of extended hospitalization days and total bed costs but no correlation in the total overall costs or initial length of stay for each patient.

AI-Based Medical Chatbot for Disease Prediction By IJISRT

This research paper presents the development and implementation of an AI-based medical chatbot for disease prediction. Leveraging machine learning and artificial intelligence technologies, the chatbot utilizes natural language processing (NLP) to understand user queries and provide accurate information, guidance, and assistance for various infectious diseases. Motivated by the global spread of infectious diseases and the need for accessible healthcare support, the paper outlines the objectives, algorithm design, dataset description, and application of the chatbot. The algorithm involves receiving user input, extracting symptoms, classifying diseases, and suggesting prevention measures. The dataset, structured in JSON format, facilitates training and pattern recognition. The chatbot interface, accessible across platforms, offers information on symptoms, prevention measures, hospital bed availability, and medication options. In conclusion, the research highlights the potential of AI-based chatbots in revolutionizing healthcare accessibility and personalized diagnosis, thereby bridging the gap between users and healthcare systems.

GIS-Enabled Multi-Criteria Assessment for Hospital Site Suitability: A Case Study of Tehran

In developing countries, the interaction between rapid urban expansion and population growth brings forth a host of challenges, particularly concerning essential services like healthcare. While interest in site suitability analysis for identifying optimal hospital locations to ensure equitable and secure healthcare access is on the rise, the absence of a holistic study that encompasses social and environmental aspects in the assessment of hospital site suitability is evident. The objective of this research is to introduce a hybrid methodology that combines Geographic Information Systems (GIS) with Multi-Criteria Decision-Making (MCDM) weighting methods. This methodology aims to create hospital site suitability maps for districts 21 and 22 in Tehran, taking into account socio-environmental factors. In addition to the conventional Analytical Hierarchical Process (AHP) weighting method, this study employs two relatively less-explored methods, the Best-Worst Method (BWM) and Step-wise Weight Assessment Ratio Analysis (SWARA), to enhance the analysis of hospital site suitability. In the SWARA method, there are minimal variations in weights among criteria, indicating that all socio-environmental factors (e.g., distance from existing hospitals, distance from main roads, distance from green spaces) hold significant importance in the decision-making process. Additionally, the findings indicate that the western part of the study area is the most suitable location for the construction of a new hospital. To achieve the average hospital bed availability in Tehran, an additional 2206 beds are required in the studied area, in addition to the existing facilities. Considering the ongoing urban development, population growth, and the potential for natural disasters and epidemics, it becomes essential to enhance the healthcare system by increasing the number of hospitals and available hospital beds. The sensitivity analysis showed that GIS-based SWARA-WLC was the most suitable and stable model for determining hospital site suitability in the study area. This methodology can be adapted for use in other regions and further improved by incorporating additional criteria. In conclusion, the study recommended three specific alternative sites for establishing a new hospital in the study area.

Geographic variation in inpatient medical expenditure among older adults aged 75 years and above in Japan: a three-level multilevel analysis of nationwide data.

In Japan, a country at the forefront of population ageing, significant geographic variation has been observed in inpatient medical expenditures for older adults aged 75 and above (IMEP75), both at the small- and large-area levels. However, our understanding of how different levels of administrative (geographic) units contribute to the overall geographic disparities remains incomplete. Thus, this study aimed to assess the degree to which geographic variation in IMEP75 can be attributed to municipality-, secondary medical area (SMA)-, and prefecture-level characteristics, and identify key factors associated with IMEP75. Using nationwide aggregate health insurance claims data of municipalities for the period of April 2018 to March 2019, we conducted a multilevel linear regression analysis with three levels: municipalities, SMA, and prefectures. The contribution of municipality-, SMA-, and prefecture-level correlates to the overall geographic variation in IMEP75 was evaluated using the proportional change in variance across six constructed models. The effects of individual factors on IMEP75 in the multilevel models were assessed by estimating beta coefficients with their 95% confidence intervals. We analysed data of 1,888 municipalities, 344 SMAs, and 47 prefectures. The availability of healthcare resources at the SMA-level and broader regions to which prefectures belonged together explained 57.3% of the overall geographic variance in IMEP75, whereas the effects of factors influencing healthcare demands at the municipality-level were relatively minor, contributing an additional explanatory power of 2.5%. Factors related to long-term and end-of-life care needs and provision such as the proportion of older adults certified as needing long-term care, long-term care benefit expenditure per recipient, and the availability of hospital beds for psychiatric and chronic care and end-of-life care support at home were associated with IMEP75. To ameliorate the geographic variation in IMEP75 in Japan, the reallocation of healthcare resources across SMAs should be considered, and drivers of broader regional disparities need to be further explored. Moreover, healthcare systems for older adults must integrate an infrastructure of efficient long-term care and end-of-life care delivery outside hospitals to alleviate the burden on inpatient care.

COVID-19 AND REGIONAL HEALTH INEQUALITIES IN BULGARIA

Purpose: The study aims to analyze regional health and socioeconomic inequalities in Bulgaria. Methods: An ecological epidemiological study was conducted. The 28 regions in Bulgaria were compared according to death rates due to COVID-19, the share of people 65+, availability of physicians, hospital beds for active and intensive care per 10,000 people, and the average annual salary of employed people /2021/. Data were statistically processed with SPSS v.26, the Pearson coefficient was used. Results: The death rates due to COVID-19 in Bulgaria vary widely, and the regions with the highest rates in 2021 are Kyustendil /642.440/0000/, Vidin /591.150/0000/, Montana /533.980/0000/, Gabrovo /533.480/0000/ and Vratsa /531.900/0000/. All five regions have ageing rates higher than the national average of the availability of physicians per population - lower than the average, respectively 36.60/0000, 35.50/0000, 34.90/0000, 37.60/0000 and 38.10/0000. Among the areas with high levels of death rates, Vidin stands out with very low availability of hospital beds for active and intensive treatment - 37.80/0000, but Gabrovo and Montana have higher. A moderate correlation was found between the death rate due to COVID-19 and the ageing of the population, but for other factors, no correlation was established. Conclusions: Reducing regional health inequalities in Bulgaria is one of the possible ways to control and reduce the death rate in the country, especially due to COVID-19.

The contribution of the private healthcare sector during the COVID-19 pandemic: the experience of the Lombardy Region in Northern Italy.

In Lombardy, the first European region hit by the COVID-19 pandemic, for decades the regional public healthcare service has followed a mixed delivery model with extensive involvement of private accredited providers. The study aimed at examining the role of the private sector in delivering healthcare services (diagnosis, hospitalization, and vaccination) during the pandemic. Healthcare system study. We analysed regional healthcare data referring to the period from March 2020 onwards to assess the availability of acute care and intensive care hospital beds, SARS-CoV-2 tests, and COVID-19 vaccinations. We specifically examined healthcare offered by private accredited providers within the region. Of the 12,306 converted beds for COVID-19 treatment, 4,975 (40%) were in accredited private hospitals. Intensive care beds increased by 95%, reaching 1,755, with 484 (28%) in accredited private hospitals. Since the pandemic onset, 28.9 million (62%) of SARS-CoV-2 tests were conducted by private accredited facilities including pharmacies. Private sector actively contributed to the COVID-19 vaccination campaign administering over 2.6 million doses in 2021, enhancing vaccination capacity to its peak. The longstanding relationship between the public and private sectors within the Lombardy regional healthcare service facilitated a rapid increase in hospital bed capacity, the upscaling of SARS-CoV-2 testing capacity, and the achievement of vaccination goals to address the COVID-19 emergency. Therefore, alongside a robust and adequately funded public healthcare service, the private sector serves as an asset to enhance the resilience of healthcare systems, in line with WHO indications.

Mapping Access to Children's Hospitals in Texas.

Vehicle access, travel time, and distance to hospitals and emergency rooms with sufficient patient beds are critical healthcare accessibility measures, especially for children who require specific pediatric services. In a large state like Texas with vast rural areas and limited public transit infrastructure, 75% of the children live over an hour from the closest facility that provides pediatric emergency services or specialty care. In view of this challenge, this study first sought to map the prevailing geographical accessibility to children's hospitals and, second, to model the hospital beds per capita for each hospital's service area within the state of Texas. The results showed disparities in accessing emergency pediatric care, especially in rural areas. However, despite major metro areas recording better geographical accessibility to pediatric healthcare, residents in these areas may experience limited hospital bed availability. The findings indicate an urgent need for more pediatric healthcare services in rural Texas. Given the increasing population growth in metro areas and their surroundings, there is also a need for the expansion of healthcare infrastructure in these areas.

Identifying Socio-Demographic and Behavioral Predictors of Prolonged Hospital Stay in an Urban Hospital in Northwest Indiana

Background: Hospital length of stay (LOS) is a crucial metric that impacts patient outcomes, healthcare resource utilization, and financial burden. In 2019 the CDC reported the average LOS in community hospitals was 5.4 days. Prolonged LOS is associated with an increased risk of hospital-acquired infections, decreased hospital bed availability limiting patient access to care, and cognitive impairment, particularly among the elderly. This indicates the importance of addressing LOS as a healthcare priority. This study examined the relationship between LOS and social determinants of health (SDOH), patient demographics, health behaviors, and health outcomes as part of a long-term Community Based Participatory Research partnership between IUSM-NW and St. Mary Medical Center (SMMC).
 Methods: This retrospective study analyzed EPIC™-generated data for adult inpatient visits at an urban hospital in Northwest Indiana from January 2021 to March 2023. Data analysis was performed using SPSS 28.0, consisting of descriptive statistics, bivariate analysis (One-way ANOVA, Independent T-tests, Kruskal Wallis H; p<0.05), and Simple Linear Regression. This study was granted an exemption by the Indiana University Human Research Protection Program (IRB #14040).
 Results: The sample comprised of 10,916 predominantly white (77.7%) patients with a median age of 65 (IQR=22) and a median LOS of 4 days (IQR= 5). Bivariate analysis revealed LOS was significantly associated with age (p<0.001), race (p<0.033), sex (p<0.012), insurance type (p<0.001), physical inactivity (p<0.001), and smoking tobacco (p<0.001). After controlling for all factors in the multivariate analysis, age (p<0.020), physical inactivity (p<0.013), and insurance type (p<0.013) retained their significance.
 Conclusions: These findings highlight the significance of demographic, behavioral, and social factors in relation to hospital LOS. Understanding these factors holds immense potential to guide the development of targeted interventions and healthcare strategies to optimize patient care and reduce LOS.

DYNAMIC CHANGES IN HEALTH INDICATORS OF THE POPULATION OF THE SIBERIAN FEDERAL DISTRICT

HighlightsThe results of the study revealed a recent increase in the mortality of the rural population in the Siberian Federal District, and in Russia in general, which required a separate study to identify its causes. Thus, new management solutions should be developed to improve the resource capacity of the healthcare system in the context of the COVID-19 pandemic. AbstractBackground. Currently, the main strategic goals include increasing life expectancy, reducing mortality rates of the country`s population and improving medical and demographic indicators. This task is becoming especially relevant in rural areas.Aim. To analyze changes in public health indicators of the rural population in the context of the COVID-19 pandemic using the Siberian Federal District data.Methods. The research methods that were used in this study are as follows: statistical and comparative analysis, and generalization on the basis of prior experience. For the analysis the statistical data and reports from the Ministry of Health of Russia, Federal State Statistics Service, and the Siberian Federal District were selected.Results. The analysis of demographic indicators in the Siberian Federal District for the period from 2018 to 2021 showed higher mortality rates compared to the national average, especially in the Altai Territory (1.2 times higher). In 2020 the overall incidence in rural areas both in the Russian Federation as a whole and in the Siberian Federal District decreased for almost all types of diseases (respiratory diseases -2.4%, digestive diseases -13.4%, diseases of the circulatory system -5.3%, infectious and parasitic diseases -11.8%, malignancies -5.3%, injuries and poisoning -5.2%) compared to 2019, whereas there was a growth of the indicator in 2021 in the district being 14% higher than in the Russian Federation. The incidence rate of new coronavirus infection (COVID-19) and life expectancy at birth in the rural population are given, but it should be noted that although the incidence rate of COVID-19 in 2021 in the Omsk region was lower than the national average, mortality from this disease remains the highest in the Siberian Federal District and it exceeded the national average by 1.4 times. To assess the availability of medical care in rural areas, the indicators of the availability of medical personnel and hospital beds were analyzed, showing a steady downward trend.Conclusion. The results of this study make it possible to identify new directions and initiatives for the development of management strategies to improve the resource capacity of the healthcare system at the federal and regional levels.

Spatial patterns of mortality among the able-bodied population in the Republic of Bashkortostan

BACKGROUND: Regional differentiation adds complexity to the issue of high mortality among the working-age population. The identified regional patterns of mortality causes are typically not confined to specific areas, but rather influenced by spatial factors.
 AIM: To study temporal trends in spatial patterns of mortality of the working-age population mortality from the main causes of death in the Republic of Bashkortostan. In addition, we identified territorial factors associated with the mortality patterns and trends.
 METHODS: Mortality data on 6 main causes of death from 54 municipal districts, 20 urban districts and urban settlements were collected for the period from 2002 through 2020. The analysis included estimation of the Moran's index and the spatial panel data modeling.
 RESULTS: Spatial mortality patterns were evident for mortality from diseases of the circulatory system, infectious and parasitic diseases, and external causes. The impact of crime levels in a specific region (male: p=0.046; female: p=0.019) negatively affected mortality rates from circulatory diseases among working-age men and women. Additionally, for men, the volume of gross municipal product (GMP) had an additional effect (p=0.046). Factors that contribute to a decrease in mortality from external causes among able-bodied men and women included the growth of GMP (male: p=0.010; female: p=0.003 — for women), an increase in the number of doctors per 10,000 people in the population (male: p=0.001; female: p=0.037), and the availability of nursing staff (male: p=0.026; female: p=0.005). Furthermore, crime rates had a significant impact on mortality from external causes for men (p=0.028), while the availability of hospital beds played a crucial role for women (p=0.030).
 CONCLUSION: The study provides the evidence on the presence of spatial autocorrelation in the context of causes of death, as well as common and differing factors influencing male and female mortality in Bashkortostan. The findings provide a solid foundation for further analysis of spatially determined factors contributing to mortality among working-age population.

Real-World Study in Acute Leukemia: Epidemiology, Treatment Patterns and Outcomes for Newly Diagnosed AML in Adult Patients from Latin America - Loyal Study

Introduction. Acute myeloid leukemia (AML) is the most frequent leukemia among adults and representing 90% of all cases of acute leukemia in adults. Differences in incidence and burden of AML among regions of the world have been reported. When compared with registries from the US, UK and Sweden, Latin-America (LA) AML has a younger age at diagnosis (median age of 40-47 versus 64 -67 years old). Furthermore, single center studies have suggested poor treatment outcomes in LA. For example, Silveira et al reported a median age at diagnosis of 46 y, frequency of favorable cytogenetics of 26% and median overall survival (mOS) of 12 months in the Brazilian cohort of patients with newly diagnosed AML (nAML) whereas the respective values at Oxford University were 51.5y, 11% and 48 months in British patients. However, wider studies across the region are scarce and there is a need to further explore AML patient characteristics and treatment outcomes in LA. Methods. This is a non-interventional, retrospective multicenter study that aims to describe the epidemiology, clinical and demographic characteristics, treatment patterns, survival outcomes and healthcare resource use of adult patients with nAML in Argentina, Brazil, Chile, and Colombia. Data from medical records of eligible patients that met the inclusion criteria (≥ 18 years old at diagnosis, confirmed diagnosis of nAML between 01 January 2015 and 31 December 2019, and receiving at least one line of treatment) in these LA countries were considered for the analysis, which was descriptive in nature as no hypothesis has been tested. Results: A total of 518 nAML patients were included in the study, 166 from Argentina, 205 from Brazil, 63 from Chile, and 84 from Colombia. Table 1 shows the demographics and clinical characteristics. At treatment initiation, an evaluation of fitness (eligibility) for intensive chemotherapy was available for 94% of the patients (n=489). The majority were considered fit (75.5%; n=391) and received standard 7+3 therapy. About 11% of patients (n=9) were refractory to induction therapy. Median OS for fit patients was 11.9 months, whereas for unfit patients was 5.8 months. Mutational status of genes listed by the European LeukemiaNet (ELN) Classification of 2017 was not available for the majority of cases; risk categories were assigned based on cytogenetics. Patients in the favorable-risk category had a mOS of 30.5 months, whereas those in the intermediate- and unfavorable-risk had 11.1 and 9.1 months, respectively (Figure 1). The probability of 5year OS rates for favorable, intermediate- and unfavorable-risk groups were of 38.8%, 16.6% and 20.9%, respectively. Eighty-six patients (17%) discontinued treatment with reasons being adverse event/toxicity (33%; n=28), death (32%; n=27), and disease progression (17%; n=14). Only 24% of patients (n=125) underwent a subsequent stem cell transplantation (SCT), mainly allogenic (98%; n=121). For SCTs, identical (matched) related (50%; n= 59) and haploidentical donor (35%; n=41) were the most common. Patients not eligible to intensive chemotherapy were treated with HMA (9%; n=47) and LDAC (5%; n=25), with 10% of the patients receiving palliative/supportive care. The most common treatment protocols used in relapsed or refractory (R/R) patients were high-dose cytarabine (HDAC) (31%; n=85), followed by FLAG-IDA (24%; n=66). Conclusions: This study of newly diagnosed acute leukemia characterizes real-world treatment patterns and outcomes in LA clinical practices. Prior to this study, there has been limited published data on the epidemiology and treatment patterns across LA. This study highlights that for nAML patients, the most common treatment in LA is 7+3 and most patients are classified as fit. The vast majority of patients had their risk accessed by cytogenetics analysis only, reflecting the limited access to molecular tests. Fewer patients underwent stem cell transplantation as part of the treatment compared to that reported in US and Europe, probably due to restricted availability of hospital beds dedicated to bone marrow transplantation. When evaluating the overall survival, the study shows higher mOS for favorable risk. In addition, mOS for intermediate and poor cytogenetic risk were similar. A broader access in the region to molecular tests, transplant and new therapies are needed in order to reduce the gap in outcome, especially for patients with intermediate-risk.

Capizzi Vs HDMTX in the Intermediate Maintenance Phase in Patients with Intermediate-Risk ALL in a 3rd Level Hospital in Northeastern Mexico

INTRODUCTION: Methotrexate is a fundamental drug in the treatment of acute lymphoblastic leukemia (ALL), playing an important role in CNS prophylaxis. Two strategies of methotrexate intensification have been studied: high-dose regimens (with leucovorin salvage) and Capizzi regimen (escalating doses, without salvage, with addition of L-asparaginase). Fifty-five percent of pediatric patients with ALL in Mexico are treated in general hospitals, with limited hospital bed availability, which may represent a deferral of treatment. We wanted to explore a feasible, economical and accessible ambulatory scheme, which may represent an option for those centers that do not have the infrastructure for maintenance with HDMTX. OBJECTIVE: Evaluate the efficacy of methotrexate/L-asparaginase combination therapy based on the Capizzi scheme versus standard high-dose methotrexate (HDMTX) in the intermediate maintenance phase of a cohort of patients diagnosed with intermediate-risk B- ALL. METHODS: From January 2017 to June 2023, all patients diagnosed with ALL between 0 and 15 years of age, at a single center in northeastern Mexico, were collected in a prospective hospital registry. Based on risk stratification, patients received an adjusted treatment protocol with variations in intensity and duration for the different phases, based on the BFM. The type of intermediate maintenance received (Capizzi vs HDMTX scheme), duration time of the intensive phase, patients' overall survival and relapse events were evaluated. Demographic data were reported by distribution analysis and the Kaplan-Meier method was used to analyze and predict OS and EFS. RESULTS: Forty-four pediatric patients with a diagnosis of B-ALL and intermediate risk were included, 32 patients from the Capizzi group (G1) and 12 from the HDMTX group (G2). The median age at diagnosis was 7.5 years, 60% of patients were male. No statistically significant differences were found with respect to the duration of the intensive phase of treatment between the groups (p=0.58). Two deaths were recorded (Capizzi 1, HDMTX 1), with no differences in the type of treatment used (p=0.90). The risk of relapse according to the type of scheme used was not statistically significant (Capizzi 3 vs HDMTX 2, p=0.46, OR 0.51, 95% CI 0.07-3.55) (Table 1). Overall survival of patients during the study time (intensive treatment phase) was 90.9%, being 90.6% in the Capizzi group and 91.7% in the HDMTX group (p=0.851) (Figure 1). CONCLUSIONS: According to our results, no difference was found regarding the temporality of the 2 schemes (p=0.58), risk of relapse (p=0.46) or mortality (p=0.90). It is useful in our center because it provides us with an ambulatory, feasible and economical option that equals the results of the standard risk treatment. Due to the limited number of patients included in the study, it is recommended to increase the population in order to corroborate these results.

COVID’s First and Second Waves in India: Lessons and Policy Implications

In this article, we argue that in a supply-deficient situation, a vaccination strategy that makes use of an analysis of the different stages of the COVID waves and the pattern of their geographical spread can prove to be far more effective than the current non-transparent mechanism of inter-state allocation of the vaccines. We divide the spread of the COVID waves into three stages: (a) seeding stage, (b) explosion stage and (c) subsiding and diffusion stages. In the seeding stage, two critical determinants of seeding the virus into the population are (a) the inter-state pattern of arrival of international passengers and (b) the inter-state pattern of the continuing active COVID-affected population from the previous wave. The explosion stage induces a policy response in the form of lockdowns which is followed by the wave starting to subside. But the lockdown also results in the migration of labour out of the state into the rural and less populated areas, leading to the diffusion stage. We advocate a vaccination strategy targeting universal coverage with strategic sequencing in which prioritisation is given to ‘saturation vaccination’ of high-density and high COVID-intensity urban areas. This would not only minimise the economic costs in terms of duration and spread of lockdowns but also the pressures on the inadequate health infrastructure in terms of availability of hospital beds, ambulances, oxygen and drugs. This strategy may be implemented in curbing the COVID’s subsequent waves which may hit India while its population is still only partially vaccinated.

(462) Penile Implant Cancellations During the COVID-19 Pandemic- A Retrospective Cohort Study

Abstract Introduction During the early stages of the COVID-19 pandemic, hospitals prioritized the availability of ventilators, anesthesia personnel, hospital beds, and personal protective equipment; consequently, widespread recommendations were made to postpone or cancel all elective procedures [1,2]. Determination of what was considered “elective” in urology was ill-defined, though there was consensus by international and European urologic societies that the “lowest priority” tier of procedures included those for functional and reconstructive urology, urogynecology, infertility, and prosthetic surgery [3,4]. Though these are indicated for benign conditions, the long-term impact of remaining under-treated is unknown. No data in the existing literature describe the effect of prosthetic surgery cancelations on patient outcomes during the COVID-19 pandemic. Objective To determine the primary reasons for cancelation of penile prosthetic implantation during the COVID-19 pandemic and to assess subsequent patient outcomes. Methods In this retrospective cohort study, all male patients ≥18 years old scheduled for implantation of a penile prosthesis at our institutions during a 2-year span (1/1/20 to 1/1/22) were eligible for inclusion. Data were abstracted from Epic with ICD-10 and CPT codes for erectile dysfunction and penile prostheses, respectively. Information collected about patients included age, ethnicity, marital status, SHIM score, prior penile implant status, prostate cancer history and therapy, initial date of surgery, cardiac/medical clearance status, cancelation status and cause, whether surgery was rescheduled, and if the surgery ultimately occurred. Crude and adjusted associations between factors related to cancellations were assessed using binary logistic regression and summarized as odds ratio (OR) along with 95% confidence intervals (CI). All statistical analyses were performed using SPSS 28.0.1. Results Of the 284 patients that met inclusion criteria, 77 (27.1%) had their surgeries canceled; of those, 33 (42.9%) were later rescheduled, with 31 (93.9%) ultimately undergoing the procedure. There was no significant difference in the average age or SHIM score of those who were and were not canceled. Only 9 (11.7%) of the cancelations were ordered by the hospital, with 4 (5.2%) canceled because of the restriction on elective procedures and 4 (5.2%) due to patients testing positive for COVID. 68 (88.3%) of the cancelations were at the behest of patients; 3 (3.9%) elected not to undergo surgery during the pandemic. The remaining 65 (84.4%) canceled for a variety of reasons, including not getting a pre-procedure UA or COVID test. Patients who did not receive cardiac/medical clearance were three times more likely to cancel (OR 3.04; 95% CI = 1.72-5.37; P<0.001). This association remained statistically significant after adjusting for insurance status (OR 2.32; 95% CI = 1.24-4.34; P=0.009). Conclusions Our data revealed that most cancelations of penile prosthetic implantations during COVID-19 were patient-instigated, with few cancelations due to COVID-19 infection or reluctance to have surgery during the pandemic. Most cancelations appeared secondary to difficulties with pre-procedure labs/testing, likely to have been an indirect consequence of the COVID-19 pandemic. Severely limited availability of PCP or lab appointments caused patients increased difficulty obtaining the necessary testing before surgery. Nevertheless, many of the canceled patients were able to reschedule, with nearly all ultimately undergoing the procedure. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Rigicon, Coloplast, Baxter.

Home Oxygen and Monitoring for COVID-19 Patients: A Multidisciplinary Team Approach.

During the initial COVID-19 pandemic peak, Stamford Hospital implemented a home oxygen program (HOP) to create a comprehensive, multi-disciplinary outpatient initiative without sacrificing a safe discharge. Primary care physicians monitored program participants, whose only indication for remaining admitted was an oxygen requirement. We retrospectively examined participant co-morbidities and outcomes, including death and readmission rates to evaluate HOP safety. A retrospective analysis of program participants discharged between April 2020-Janurary 2021 was performed. Variables included demographics, oxygen requirement, days enrolled in the HOP, and major comorbidities such as cardiovascular disease (CVD), diabetes (DM), hypertension (HTN), obesity, chronic kidney disease, malignancies and underlying chronic obstructive pulmonary disease (COPD). Among the 138 HOP participants, ages ranged from 23 to 96 (Mean 65.5), with 47.1% female and 52.9% male. The most represented ethnicity included White (48.6%), Hispanic (29.7%), and Black (15.2%). Patients' average time in the HOP was 19 days, requiring an average of 1.7 L/min of home oxygen. Thirteen patients (9.4%) were readmitted to the hospital with 2.9% secondary to worsening COVID-19 hypoxia, but no deaths occurred at home. A significant relationship was found between age and highest home oxygen need. Patients with COPD, HTN, and DM had significantly higher oxygen requirements (P-value <0.05). Increasing age, underlying COPD, HTN, and DM were associated with higher oxygen requirements in participants. Given limited availability of hospital beds, and no occurrences of death at home, Stamford Hospital HOP safely helped provide care for sicker patients and enhanced resource allocation.

COVID-19- A Challenge for Urology Subspecialty in an overwhelmed public sector hospital: A Descriptive Review

Background: COVID-19 has brought unprecedented changes in every aspect of life throughout the world including the healthcare delivery system. After a grinding halt in surgical practice due to this pandemic, the conventional protocols needed a thorough overhaul before kick-starting formal services. This study discusses ways and procedure changes adopted at the Urology department to navigate this crisis and extend adequate urological care to patients at the same time. Aim: To share our experience of patient management in the era of the COVID-19 pandemic. Methods: It’s a descriptive review article based on patient management protocols and clinical audit in the era of COVID-19 pandemic at the Departmentof Urology, MTI, Lady Reading Hospital from 20th Marchto 20th June 2020. Clinical implication the benefit of this study is how to organize things and continue health care provision in a deadly pandemic. Furthermore, it will set a precedence that how to cope with such a pandemic in the future. Conclusion: All surgical patients should be screened for COVID-19, with preference given to PCR tests. All elective surgeries should be put on hold as a result of the limited availability of ventilators, manpower, and hospital beds. Only semi-elective, lifesaving and oncologic surgeries that cannot be delayed should be done with full PPEs provided to every personnel frequenting operating theaters during the procedure. Furthermore, more efforts are needed to lift the infrastructure of hospitals and make them capable to face problems of such proportions in the future. Keywords: COVID-19, Urology, Public sector hospital, Pandemic, Oncological surgeries

A prolonged wait: The impact of COVID-19 on elective surgeries in India, a prospective study

Background: The continuing Coronavirus Disease 2019 (COVID-19) pandemic has had a massive impact on healthcare systems all around the globe. There is no exception in the demographics of elective surgery also. Like any other medical professionals, surgeons and post-graduates are redirected to the management of patients with COVID-19. The purpose of this study is to determine how the COVID-19 pandemic affected elective surgeries, surgeon skills, and post-graduate training. Methods: This prospective study was done among 320 participants through a 15-question online cross-sectional survey sent primarily to surgeons practicing in six states of India that were most affected by the pandemic according to recent statistics and also to surgeons in other states via email or other online messaging services. Results: In our study, the following observations were made: Patient/ patient attendant dissatisfaction in a reduction in the availability of hospital beds, shortage of medical oxygen and lack of availability of surgical implants. Conclusions: All these factors showed significant p-values with statistical significance, thereby indicating the impact of the COVID-19 pandemic on the healthcare system and healthcare delivery. The pandemic also had a significant impact on post-graduate training.

Covid-19: did higher trust societies fare better?

Social trust—between governments and people and between individuals—and trust in science were proposed as prerequisites for tackling covid. Others suggested less democratic societies were more able to impose strict rules stopping the virus. These propositions were tested for a group of mainly advanced countries.The dependent variable is cumulated deaths from covid. Findings are broken down between (a) OECD member countries, (b) these and countries having cooperation agreements with it, and (c) all these plus China. They are also broken down by time—between (a) the period before the appearance of “new variants” in late 2020 and (b) the period from then until end September 2021.The best, most parsimonious, models explain nearly half of the changes in the level of deaths. Trust in government improves outcomes, as does interpersonal trust. Vaccine antipathy does not play a role. Also, there is little indication that authoritarian regimes performed better than higher trust societies. In the first period, increasing wealth inequality—indicating a more divided society—is related to higher death rates. Hospital bed availability is important then, but not thereafter. Furthermore, as the pandemic persisted, the importance of pre-existing levels of social trust declined.The paper warns that institutions and cultures cannot easily be transferred from one country to another. Nor would all transfers be desired. It also suggests that some other lessons of what contributed to better outcomes under covid might be relevant for the monkeypox virus—its successor public health emergency.

Abstract Number ‐ 195: Impact of COVID‐19 on Stroke Treatment in Latin America

Introduction Ischemic stroke is a neurological disease that affects people worldwide, and it occurs when there is a loss of blood to the brain due to either an artery burst or blood clot. The COVID‐19 pandemic has negatively impacted stroke treatment, specifically mechanical thrombectomy, across the world but especially in Latin and Central America. The objective of this research project is to determine the barriers that COVID‐19 has imposed on stroke treatment in the Latin America region. Methods First, data was collected from articles through NCBI and local news. The data on COVID‐19 and stroke provided input on the number of COVID‐19 cases in Latin America and the overall rate of stroke incidences in each region. Then, the countries in Latin America were divided into three different groups to determine which regions had the most Covid cases, sub‐optimal stroke treatments, and more well‐known health resources. Mexico was zeroed in on as the central region because more data and stroke resources were readily available. A survey was created which contained critical questions on the overall situation of stroke in Mexico and potential barriers, and these surveys were emailed to neurologists and other physicians who were experts in the region. Ultimately, two physicians from Mexico agreed to be interviewed, and important information was received on the status of stroke treatment in these areas. Results From the surveys and interviews, the two doctors revealed important information regarding the specific barriers to stroke treatment. The first doctor interviewed is a physician in a tertiary medical center for specialized neurological conditions. She raised concern about the lack of awareness among the general population about the early recognition of stroke and its symptoms. Additionally, she indicated that her center has the necessary endovascular equipment to offer mechanical thrombectomies, but patients are often unable to reach the hospital on time. Ambulances have been typically unavailable or delayed as they have been prioritized for transporting COVID patients. Additionally, there has been a lack of rehabilitation resources for stroke patients during the pandemic due to the shortage of beds and staff. The second doctor interviewed was additionally concerned about the lack of timely use of equipment for mechanical thrombectomies. When a patient is in need of thrombectomy treatment, the doctor has to contact the intermediary vendor, who brings the equipment for use, hence delaying treatment. He also stated that during the pandemic, a third of the beds were occupied by COVID patients, limiting the availability of hospital beds for other illnesses. Conclusions In conclusion, the COVID‐19 pandemic has negatively impacted stroke treatment in Mexico. The main barriers to stroke treatment include the limited awareness among the general population about the recognition of stroke, a lack of sufficient rehabilitation services, insufficient medical thrombectomy services and the delayed ambulance response. Based on this data, the intervention we are developing is an app that will display stroke‐specific resources and information. This platform will include information on how to recognize stroke, specific stroke‐care hospitals in the region, and helplines.

Coping with COVID-19: the role of hospital care structures and capacity expansion in five countries.

This contribution examines the responses of five health systems in the first wave of the COVID-19 pandemic: Denmark, Germany, Israel, Spain and Sweden. The aim is to understand to what extent this crisis response of these countries was resilient. The study focuses on hospital care structures, considering both existing capacity before the pandemic and the management and expansion of capacity during the crisis. Evaluation criteria include flexibility in the use of existing resources and response planning, as well as the ability to create surge capacity. Data were collected from country experts using a structured questionnaire. Main findings are that not only the total number but also the availability of hospital beds is critical to resilience, as is the ability to mobilise (highly) qualified personnel. Indispensable for rapid capacity adjustment is the availability of data. Countries with more centralised hospital care structures, more sophisticated concepts for providing specialised services and stronger integration of the inpatient and outpatient sectors have clear structural advantages. A solid digital infrastructure is also conducive. Finally, a centralised governance structure is crucial for flexibility and adaptability. In decentralised systems, robust mechanisms to coordinate across levels are important to strengthen health care system resilience in pandemic situations and beyond.