Monetary Burden Research Articles

Perceptions of PGY-2 Oncology Programs on Financial Toxicity Education and Preparedness.

Cancer patients experience a rising monetary burden due to increased direct and in-direct costs associated with cancer treatment. This as a result has an adverse effect on the financial well-being of a cancer patient, also known as financial toxicity. Currently, there is a lack of literature surrounding the implementation of financial toxicity in post-graduate oncology residency training for pharmacists. The objective of this study was to describe the perceptions of PGY-2 oncology pharmacy residents and residency program directors on the incorporation of financial toxicity within their training programs and to assess self-perceptions of their level of abilities and experience managing financial toxicity for patients.A qualitative RedCap electronic survey was emailed in December 2020 to resident and directors of PGY-2 oncology programs in the United States.Out of 40 respondents, 64% of residency program directors were highly comfortable with the concept of financial toxicity, while 73% of pharmacy residents were uncomfortable with the concept of financial toxicity within their program. Furthermore, a majority of residents were either uncomfortable or highly uncomfortable managing financial toxicity for patients. In addition, the most commonly utilized method of incorporating the concept of financial toxicity in all programs was through specialty pharmacy and patient assistance programs (PAPs); residents also preferred these methods along with guest speakers to provide this training.Financial toxicity concepts should be considered as an educational standard and incorporated through unique methods of education. We suggest introducing the concept through guest speakers, followed by practical applications integrated in specialty pharmacies and PAPs.

Spatiotemporal prediction of vancomycin-resistant Enterococcus colonisation

BackgroundVancomycin-resistant enterococci (VRE) is the cause of severe patient health and monetary burdens. Antibiotic use is a confounding effect to predict VRE in patients, but the antibiotic use of patients who may have frequented the same ward as the patient in question is often neglected. This study investigates how patient movements between hospital wards and their antibiotic use can explain the colonisation of patients with VRE.MethodsIntrahospital patient movements, antibiotic use and PCR screening data were used from a hospital in the Netherlands. The PageRank algorithm was used to calculate two daily centrality measures based on the spatiotemporal graph to summarise the flow of patients and antibiotics at the ward level. A decision tree model was used to determine a simple set of rules to estimate the daily probability of patient VRE colonisation for each hospital ward. The model performance was improved using a random forest model and compared using 30% test sample.ResultsCentrality covariates summarising the flow of patients and their antibiotic use between hospital wards can be used to predict the daily colonisation of VRE at the hospital ward level. The decision tree model produced a simple set of rules that can be used to determine the daily probability of patient VRE colonisation for each hospital ward. An acceptable area under the ROC curve (AUC) of 0.755 was achieved using the decision tree model and an excellent AUC of 0.883 by the random forest model on the test set. These results confirms that the random forest model performs better than a single decision tree for all levels of model sensitivity and specificity on data not used to estimate the models.ConclusionThis study showed how the movements of patients inside hospitals and their use of antibiotics could predict the colonisation of patients with VRE at the ward level. Two daily centrality measures were proposed to summarise the flow of patients and antibiotics at the ward level. An early warning system for VRE can be developed to test and further develop infection prevention plans and outbreak strategies using these results.

The Prevalence of Alcohol Consumption: A Cheap Liquor Consumers Perspective during Pandemic

The study was conducted using an established Alcohol use disorder identification test and accompanied by a face-to-face interview with the consented respondents. The main of this study is to understand motives of cheap liquor consumption among youngsters. The information has been gathered from 10 respondents from rural vicinity in Perak. The outcomes indicated the primary motive for consuming cheap liquor is because of the monetary burden faced by the drinkers. It was observed that male drinkers might devour alcohol to kill boredom and at the same time to release body aches after a day’s task. The findings of this study are imperative in providing direction for future studies on alcohol consumption amongst Malaysian adolescents and information for the strategy to reduce the harmful use of alcohol in the communities.

The second brain in Parkinson's disease: fact or fantasy?

The second brain in Parkinson's disease: fact or fantasy?

Tree Cover Ratio Effects on Users’ Perceptions, Impressions and Suitability Judgment for Different Activities in Privately Owned Public Spaces

People are drawn to natural settings because they instinctively associate them with providing, nurturing environments. Many studies have linked higher urban greenery ratios to social, psychological, economic, and human health improvements. While urban greenery benefits a large number of people, the monetary burden of its installation and maintenance falls typically to local governments or private entities, requiring urban designers to be able to justify the higher costs of implementation and maintenance.
 To date, there is still no precise data linking tree cover ratio and the specific effects it has on peoples’ perceptions and impressions of urban plazas or in the environment’s suitability for different activities. This study expands on the findings of previous studies to explore the effects of tree cover ratio and environment scale across twenty-three different evaluation scales.
 It used immersive virtual environments to control for confounding variables and head-mounted displays to present the stimuli, allowing participants to experience the environment in its totality as in a natural setting.
 Higher tree cover ratios improved participants’ willingness to stay and pay for goods, improved perception, impressions, and how suitable the environment was for different activities. The specific effects on five measurement scales for activities, nine measurement scales for impression and seven different measurement scales for perception are shown as well as the effects of the interaction of tree cover ratio and environment scale.The effects of sex and architectural background are also tested and discussed. Results offer designers with evidence for the definition of tree amount in relation to environment scale, based on the desired effect.

Urolithiasis in Germany: Trends from the National DRG Database

Introduction: Urolithiasis is a common disease leading to a high socioeconomic burden due to treatment costs and sickness leave. The aim of this study was to evaluate recent trends in the incidence of urolithiasis in Germany and in the use of therapeutic interventions. Methods: Treatment data for all in-patient hospital episodes for urolithiasis between 2005 and 2016 were extracted from the national DRG statistics at DESTATIS and analysed with regard to the corresponding procedures according to the OPS code. Results: Incidence for urolithiasis was stable at around 120,000 cases per year during the observation period with a male:female ratio of 2:1. Rising numbers were noted for patients >80 years. Nevertheless, the number of coded procedures rose significantly with a marked disproportionate transition from extracorporeal shock wave lithotripsy towards ureterorenoscopy. Percutaneous nephrolithotomy was performed more frequently on a smaller scale. Discussion/Conclusion: While the global incidence of urolithiasis is still rising, Germany, as other Western countries, has reached a plateau. There is a remarkable trend towards invasive treatment of even asymptomatic kidney stones. Besides the effects on individual patients with increased risk for complications, this results in a higher monetary burden to the health care system and society.

Intersections in Neuropsychiatric and Metabolic Disorders: Possible Role of TRPA1 Channels.

Neuropsychiatric disorders (NPDs) are a huge burden to the patient, their family, and society. NPDs have been greatly associated with cardio-metabolic comorbidities such as obesity, type-2 diabetes mellitus, dysglycaemia, insulin resistance, dyslipidemia, atherosclerosis, and other cardiovascular disorders. Antipsychotics, which are frontline drugs in the treatment of schizophrenia and off-label use in other NPDs, also add to this burden by causing severe metabolic perturbations. Despite decades of research, the mechanism deciphering the link between neuropsychiatric and metabolic disorders is still unclear. In recent years, transient receptor potential Ankyrin 1 (TRPA1) channel has emerged as a potential therapeutic target for modulators. TRPA1 agonists/antagonists have shown efficacy in both neuropsychiatric disorders and appetite regulation and thus provide a crucial link between both. TRPA1 channels are activated by compounds such as cinnamaldehyde, allyl isothiocyanate, allicin and methyl syringate, which are present naturally in food items such as cinnamon, wasabi, mustard, garlic, etc. As these are present in many daily food items, it could also improve patient compliance and reduce the patients’ monetary burden. In this review, we have tried to present evidence of the possible involvement of TRPA1 channels in neuropsychiatric and metabolic disorders and a possible hint towards using TRPA1 modulators to target appetite, lipid metabolism, glucose and insulin homeostasis and inflammation associated with NPDs.

Whole Grain Intakes Are Associated with Healthcare Cost Savings Following Reductions in Risk of Colorectal Cancer and Total Cancer Mortality in Australia: A Cost-of-Illness Model.

Whole grain consumption has been associated with the reduced risk of several chronic diseases with significant healthcare monetary burden, including cancer. Colorectal cancer (CRC) is one of the most common cancers globally, with the highest rates reported in Australia. Three servings of whole grains provide a 15% reduction in total cancer and 17% reduction in CRC risk; however, 70% of Australians fall short of this level of intake. The aim of this study was to assess the potential savings in healthcare costs associated with reductions in the relative risk of CRC and total cancer mortality following the whole grain Daily Target Intake (DTI) of 48 g in Australia. A three-step cost-of-illness analysis was conducted using input parameters from: (1) estimates of current and targeted whole grain intakes among proportions (5%, 15%, 50%, and 100%) of the Australian adult (≥20 years) population; (2) estimates of reductions in relative risk (with 95% confidence intervals) of CRC and total cancer mortality associated with specific whole grain intake from meta-analysis studies; and (3) estimates of annual healthcare costs of CRC and all cancers from disease expenditure national databases. A very pessimistic (5% of population) through to universal (100% of population) adoption of the recommended DTI in Australia were shown to potentially yield savings in annual healthcare costs equal to AUD 1.9 (95% CI 1.2–2.4) to AUD 37.2 (95% CI 24.1–48.1) million for CRC and AUD 20.3 (95% CI 12.2–27.0) to AUD 405.1 (95% CI 243.1–540.1) million for total cancers. As treatment costs for CRC and other cancers are increasing, and dietary measures exchanging whole grains for refined grains are not cost preclusive nor does the approach increase energy intake, there is an opportunity to facilitate cost-savings along with reductions in disease for Australia. These results suggest specific benefits of encouraging Australians to swap refined grains for whole grains, with greater overall adherence to suggestions in dietary guidelines.

Estimation of the monetary burden of treated human cystic echinococcosis in Pakistan

Cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus sensu lato tapeworms, continues to be a public health problem in many endemic countries, including Pakistan. Patient level data, including age, sex, and cyst(s) location for surgically managed CE patients for the years 2013-2016 from hospitals located in Punjab and Khyber Pakhtunkhwa provinces were obtained from medical charts. Direct and indirect costs associated with surgically managed CE patients treated in private and public hospitals were then estimated and applied to country-level case numbers estimated through the Global Burden of Disease Study. A total cost of US$4,068,666 (95% CI: US$3,097,684 – US$5,295,702) was estimated for the year 2017, with US$3,951,853 (95% CI: US$2,981,400 – US$5,177,610) attributable to direct diagnosis and treatment-related costs and US$117,137 (95% CI: US$91,841 – US$146, 979) attributable to wage losses during the treatment period. Mean direct cost per patient (US$1,056) was approximately 72% of the country's per capita gross domestic product (GDP). Surgical management continues to be the treatment of choice for CE patients in Pakistan. If physicians were to adhere to World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) cyst stage-specific treatment guidelines, it is likely that the number of surgical interventions would decrease as would treatment costs.

Annual dementia incidence and monetary burden attributable to fine particulate matter (PM2.5) exposure in Sweden

BackgroundAlzheimer’s disease (AD) and other dementias currently represent the fifth most common cause of death in the world, according to the World Health Organization, with a projected future increase as the proportion of the elderly in the population is growing. Air pollution has emerged as a plausible risk factor for AD, but studies estimating dementia cases attributable to exposure to fine particulate matter (PM2.5) air pollution and resulting monetary estimates are lacking.MethodsWe used data on average population-weighted exposure to ambient PM2.5 for the entire population of Sweden above 30 years of age. To estimate the annual number of dementia cases attributable to air pollution in the Swedish population above 60 years of age, we used the latest concentration response functions (CRF) between PM2.5 exposure and dementia incidence, based on ten longitudinal cohort studies, for the population above 60 years of age. To estimate the monetary burden of attributable cases, we calculated total costs related to dementia, including direct and indirect lifetime costs and intangible costs by including quality-adjusted life years (QALYs) lost. Two different monetary valuations of QALYs in Sweden were used to estimate the monetary value of reduced quality-of-life from two different payer perspectives.ResultsThe annual number of dementia cases attributable to PM2.5 exposure was estimated to be 820, which represents 5% of the annual dementia cases in Sweden. Direct and indirect lifetime average cost per dementia case was estimated to correspond € 213,000. A reduction of PM2.5 by 1 μg/m3 was estimated to yield 101 fewer cases of dementia incidences annually, resulting in an estimated monetary benefit ranging up to 0.01% of the Swedish GDP in 2019.ConclusionThis study estimated that 5% of annual dementia cases could be attributed to PM2.5 exposure, and that the resulting monetary burden is substantial. These findings suggest the need to consider airborne toxic pollutants associated with dementia incidence in public health policy decisions.

Innovative Nature of the Takaful Industry in Malaysia: Are We with The Conventional Insurance Industry?

Takaful has originated as an idea for preserving the care of people from financial damage. It can be employed as a risk management device to alleviate the hazards of regular life and trade activities. Furthermore, it gives significance to society’s worldwide economic growth as a tool of assembling funds in the economy. Takaful supports organizations to decrease their monetary burden. Businesses can buy Takaful to claim casualties acquired due to the misfortunes of workers in the workplace. Takaful takes responsibility for the protection and welfare of workers. Takaful has numerous products such as Motor Takaful, Family Takaful, and so on. However, Takaful products’ innovation is prolonged, causing the Takaful industry to lag behind the insurance industry, especially in marketing and pricing. Thus, this research aims to explore Shari’ah advisers’ views towards the innovation of Takaful products in Malaysia. A mixture of convenient sampling and purposive sampling methods are employed for choosing the Shariah advisers as the interviewees. The data for the research is collected via interviews with 11 Shariah advisers. The findings of this research show that Shariah advisers believed that many potentials need to be explored. One way to discover the potential is through innovation. Among the Takaful industry segments that need to be improved are products, marketing, pricing, customer services, and distribution channels. Moreover, the lack of awareness among customers on Takaful gives rise to many problems. Nevertheless, Shariah advisers contributed many reasonable clarifications to the current condition, suggesting that several Takaful industry areas could be improved to become an innovative industry

Socio-Economic Implications of COVID-19 Pandemic in South Asia: Emerging Risks and Growing Challenges.

The dramatic spread of COVID-19 has threatened human lives, disrupted livelihoods, and affected trade, economy and businesses across the globe. The global economy has begun to show major disruptions and is heading toward a severe recession with an unprecedented economic crisis. As the global economy is highly integrated and interdependent through the global supply chains, it has been profoundly affected by the COVID-19 pandemic. Although all countries have faced difficulties due to Covid-19, South Asian countries in particular have had to deal with a more challenging situation due to their large population, weak health facilities, high poverty rates, low socio-economic conditions, poor social protection systems, limited access to water and sanitation, and inadequate living space, necessary to maintain physical distancing and take other required measures to contain this pandemic. To contain the spread of the virus, South Asian countries have imposed stringent lockdowns, which have consequently affected the lives and livelihoods of millions of people in the region, where a third of world’s poor live. Against this backdrop, this paper examines the existing and prospective impacts, risks and challenges of Covid-19 on key social and economic sectors including migration, tourism, informal sector, agriculture and rural livelihoods. The analysis revealed that COVID-19 is likely to affect economic growth, increase fiscal deficit and monetary burden, increase the risks of macroeconomic instability, decrease migration and remittance, reduce income from travel and tourism, and result in dwindling micro-small and medium industries and informal businesses. This is likely to deepen poverty and increase unemployment and the risks of hunger and food insecurity. If not addressed properly, this may reinforce existing inequalities, break social harmony, and increase tension and turbulence. The economic and social costs of the COVID-19 outbreak are therefore likely to be significant and long-lasting in South Asia.

The Brunt of Too Much

This paper ponders on conducting the research on the monetary weight of the developing economies i.e., India, China, Brazil, Russia, and others, based on financial obligations, be it public or foreign. Developing economies have always been dependent on financial obligations to ignite economic progress. Prior to the pandemic the weight of monetary or financial burden lingering for years but the repayment of its services has been very slow. This has automatically pressurised the pre-growth process of the developing economies. Though the repayment has been slow, the brunt of the pandemic has brushed the economic progress and repayment of the financial burden of these developing economies under the carpet. The sudden need for loans and financial aid from IMF, World Bank, and advanced economies has taken a toll on their repayment of debt. What lies ahead is how much would they be able to handle, given the current pandemic scenario. This obviously scares the populace of developing economies to face chronic destitution post the pandemic. The use of the phrase ‘too much is to highlight the brunt of a monetary accumulation from pre and current pandemic atmosphere.

The COVID-19 Crisis: Implications for the Development and Growth of Agricultural Sector in EU countries and Russia

The COVID-19 crisis impacted negatively sustainable growth and the wellbeing of businesses and national economies. The economic outlook of 2020 and 2021 reflects a slowdown in the global economy, with poverty and unemployment rates ascending, national debts growing, and fiscal and monetary burden increasing. All the sectors of the economy have been affected across all of the EU countries, including the agricultural sector. Coronavirus posed unprecedented challenges for the agricultural sector, ranging from a labour shortage to demand changes. Lockdowns caused immense disturbances in farmers’ supply chains, causing them to doubt their long-term viability. Due to the social distancing and restrictions on social gatherings, marketplaces either closed or were devoid of customers. At the same time, the agricultural sector has proved quite resilient during the COVID-19 crisis. In this paper, we discuss the challenges which the agricultural sector has faced during the COVID-19 pandemic, and suggest that further growth and development can be sustained through innovation, more precisely, digital technology. The current conceptual research contributes to the body by exploring the effect of the novel COVID-19 virus on national economies and especially the agricultural sector.

Prevalence of Diabetes and Its Determinants in the Young Adults Indian Population-Call for Yoga Intervention.

BackgroundThe young Indian population, which constitutes 65% of the country, is fast adapting to a new lifestyle, which was not known earlier. They are at a high risk of the increasing burden of diabetes and associated complications. The new evolving lifestyle is not only affecting people’s health but also mounting the monetary burden on a developing country such as India.AimWe aimed to collect information regarding the prevalence of risk of diabetes in young adults (<35 years) in the 29 most populous states and union territories (7 zones) of India, using a validated questionnaire.MethodsA user-friendly questionnaire-based survey using a mobile application was conducted on all adults in the 29 most populous states/union territories of India, after obtaining ethical clearance for the study. Here, we report the estimation of the prevalence of the risk of diabetes and self-reported diabetes on 58,821 young individuals below the age of 35 years. Risk for diabetes was assessed using a standardized instrument, the Indian diabetes risk score (IDRS), that has 4 factors (age, family history of diabetes, waist circumference, and physical activity). Spearman’s correlation coefficient was used to check the correlations.ResultsThe prevalence of high (IDRS score > 60), moderate (IDRS score 30–50), and low (IDRS < 30) diabetes risk in young adults (<35 years) was 10.2%, 33.1%, and 56.7%, respectively. Those with high-risk scores were highest (14.4%) in the Jammu zone and lowest (4.1%) in the central zone. The prevalence of self-reported diabetes was 1.8% with a small difference between men (1.7%) and women (1.9%), and the highest (8.4%) in those with a parental history of diabetes. The south zone had the highest (2.5%), and the north west zone had the lowest (4.4%) prevalence.ConclusionsIndian youth are at high risk for diabetes, which calls for an urgent action plan through intensive efforts to promote lifestyle behavior modifications during the pandemics of both communicable and noncommunicable diseases.

PM2.5 Prediction Model Based on Combinational Hammerstein Recurrent Neural Networks

Airborne particulate matter 2.5 (PM2.5) can have a profound effect on the health of the population. Many researchers have been reporting highly accurate numerical predictions based on raw PM2.5 data imported directly into deep learning models; however, there is still considerable room for improvement in terms of implementation costs due to heavy computational overhead. From the perspective of environmental science, PM2.5 values in a given location can be attributed to local sources as well as external sources. Local sources tend to have a dramatic short-term impact on PM2.5 values, whereas external sources tend to have more subtle but longer-lasting effects. In the presence of PM2.5 from both sources at the same time, this combination of effects can undermine the predictive accuracy of the model. This paper presents a novel combinational Hammerstein recurrent neural network (CHRNN) to enhance predictive accuracy and overcome the heavy computational and monetary burden imposed by deep learning models. The CHRNN comprises a based-neural network tasked with learning gradual (long-term) fluctuations in conjunction with add-on neural networks to deal with dramatic (short-term) fluctuations. The CHRNN can be coupled with a random forest model to determine the degree to which short-term effects influence long-term outcomes. We also developed novel feature selection and normalization methods to enhance prediction accuracy. Using real-world measurement data of air quality and PM2.5 datasets from Taiwan, the precision of the proposed system in the numerical prediction of PM2.5 levels was comparable to that of state-of-the-art deep learning models, such as deep recurrent neural networks and long short-term memory, despite far lower implementation costs and computational overhead.

405 Crisis Stabilization Unit Reduces Admission Rates for Suicidal Patients in a Midwest Emergency Department

In an attempt to improve patient care and hospital operations, our institution implemented a crisis stabilization unit (CSU) to provide psychiatric stabilization and treatment in a setting other than the emergency department (ED). After initial evaluation and medical clearance by an emergency medicine provider, patients transfer from the ED to the CSU. The CSU aims to decrease the time, space, and monetary burdens on the ED, and to preserve the limited inpatient psychiatry beds for patients who truly need admission, as patients may discharge home from the CSU. The purpose of this study is to determine the effect on hospital admission rates for suicidal patients in the emergency department after the opening of the CSU in a rural academic medical center. We performed a before-and-after analysis of introducing the CSU within a Midwestern tertiary referral center. We evaluated study periods of November 15, 2017 to May 15, 2018 and November 15, 2018 to May 15, 2019 to examine patients pre- and post-CSU implementation. Adult patients presenting with suicidal ideation or suicidal attempt were included. The primary outcome was difference in proportion of inpatient psychiatric admission of suicidal patients presenting to the ED. Secondary outcomes compared were changes in proportion of any admission, use of code greens (code activated in cases where patient poses a threat, requiring immediate attention by psychiatry and security), incomplete admission (a bed request is made but the patient leaves prior to admission), restraint use, scheduling of follow-up within 30 days of discharge, ED returns within 30 days, and mean difference in ED boarding hours. We performed a descriptive analysis of patient visit characteristics presenting before and after CSU implementation. Association between categorical outcomes was determined to estimate relative risks (RR) and 95% confidence intervals (CI). Continuous outcomes were examined as the mean difference (MD) by time period. There were 962 patients presenting with suicidality (n=435 pre-CSU, n=527 post-CSU). There were no differences in population during the two study periods by age, sex, race, homelessness, or insurance. Compared to the pre-CSU period, there was a reduction in psychiatric admission (RR: 0.48; 95% CI: 0.40-0.56), any admission (RR: 0.65; 95% CI: 0.58-0.73), discharge after bed request (RR: 0.22; 95% CI: 0.11-0.43), 30-day return to the ED (RR: 0.74; 95% CI: 0.56-0.98), ED boarding time among admitted patients (MD: -9.0 hours; 95% CI: -13.5, -4.6) and incomplete admissions (MD: -12.5 hours; 95% CI: -21.3, -3.7). There was no significant difference in restraint use or code green use in the ED. There was a 60% increase in a 30-day follow-up being scheduled (RR: 1.60; 95% CI: 1.40-1.82). This study showed that the rate of any inpatient admission, discharge after bed request, 30-day ED return, and ED boarding time decreased after the implementation of the CSU.

Sphingolipid metabolism as a marker of hepatotoxicity in drug-induced liver injury

Drug-induced liver injury (DILI) has a substantial impact on human health and is a major monetary burden on the drug development process. Presently, there is a lack of robust and analytically validated markers for predicting and early diagnosis of DILI. Sphingolipid metabolism and subsequent disruption of sphingolipid homeostasis has been documented to play a key role contributing to hepatocellular death and subsequent liver injury. A more comprehensive understanding of sphingolipid metabolism in response to liver toxicity has great potential to gain mechanistic insight into hepatotoxicity and define molecular markers that are responsible for hepatocyte dysfunction. Here, we present an analytical platform that provides multidimensional mass spectrometry-based datasets for comprehensive structure characterization of sphingolipids extracted from human primary hepatocytes (HPH) exposed to toxic levels of acetaminophen (APAP). Sphingolipid metabolism as measured by characterization of individual sphingolipid structure was sensitive to APAP toxicity displaying a concentration-dependent response. A number of sphingolipid structures were differentially expressed across varying APAP exposures highlighting the unique role sphingolipid metabolism has in response to hepatotoxicity and its potential use as a molecular marker in DILI.

COVID 19 and laparoscopic surgeons, the Indian scenario - Perspective.

Coronavirus Disease 2019(COVID 19) had emerged as a global pandemic in recent times. The healthcare sector is at the epicentre of this unprecedented global pandemic challenge. Hospitals all over the world have reduced the number of non-emergency surgeries in order to utilise the staff and resources in a more efficient way. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is most transmitted via respiratory droplets, but risk of transmission is hugely increased while doing aerosol generating procedures (AGPs). Laparoscopy remains the preferred surgical approach for most surgical indications. There is theoretical possibility of generation of aerosols contaminated with COVID-19 from leaked CO2 and smoke generation after energy device use. The aim of this paper is to review available evidence evaluating the risk of spread of COVID-19 during necessary laparoscopic procedures and to compile guidelines from relevant professional organizations to minimize this risk.

SEER-Medicare study of early-stage triple-negative breast cancer: Real-world treatment patterns, survival, and expenditures 2010 to 2016.

e12512 Background: In the US, triple-negative breast cancer (TNBC) represents about 10–20% of breast cancers. Current information about the clinical and economic burden of early-stage TNBC in elderly patients is lacking. Methods: We used the SEER-Medicare database to identify patients with continuous Medicare Parts A/B enrollment, ≥66 years old, newly diagnosed between 2010 - 2015 (followed until 2016) with stage II-III TNBC, who initiated systemic neoadjuvant and/or adjuvant (including chemotherapy and radiation) therapy. Overall survival (OS) and event-free survival (EFS) from diagnosis were estimated using Kaplan-Meier (KM). Healthcare costs were determined during neoadjuvant and adjuvant periods. Results: Of 1569 patients ( &gt; 99% women), 94 (6%) received neoadjuvant therapy, 1162 (74%) received adjuvant therapy, and 313 (20%) received both (neo/adj; Table). Age and race/ethnicity distributions were comparable in the three cohorts. Primary tumor T stage was T1c/T2 for 43%, 83%, and 58% in neoadjuvant, adjuvant, and neo/adj, respectively, and T3 for 14%, 10%, and 15%, respectively. The most common systemic regimens in both neoadjuvant and adjuvant periods were a taxane +/- anthracycline; 21% and 67% of patients in adjuvant and neo/adj cohorts received radiation therapy after surgery. Most claims were for outpatient treatment; hospitalizations were uncommon. The total mean expenditures per patient per month were US$10,620 and $24,408 during neoadjuvant and adjuvant periods, respectively. Conclusions: This study provides insights into patient characteristics, as well as clinical and economic outcomes for elderly patients with early-stage TNBC, treated from 2010-2016 in the US, highlighting the high monetary burden of TNBC and poor outcomes associated with stage III patients. [Table: see text]