Peak Of Pandemic Research Articles

EGS P18 A Closed Loop Audit on the Management of Acute Cholecystitis During the Covid-19 Pandemic

Abstract Background The definitive management of acute cholecystitis is laparoscopic cholecystectomy on the same admission, if the patient is fit. However, as the Covid-19 pandemic emerged, evidence suggested adverse outcomes for asymptomatic Covid positive patients undergoing surgery, including increased mortality risk. Risks to theatre staff were also highlighted. This prompted changes in guidelines produced by the Association of Upper Gastrointestinal Surgeons (AUGIS) in March 2020, which strongly supported the conservative non-surgical management of acute cholecystitis. Methods This closed loop audit aimed to establish whether patients with acute cholecystitis were managed in accordance with AUGIS guideline changes at our hospital. It also aimed to assess the clinical outcomes of the guideline changes. This retrospective audit focused on patient admissions with acute cholecystitis at our hospital during the 2 peaks of the Covid-19 pandemic. The timeframe of the initial audit was 17th April - 14th May 2020 (4 weeks). The timeframe of the re-audit was 1st - 28th February 2021 (4 weeks). Handover sheets and clinical software were the data sources. The initial audit was presented at the General Surgery departmental clinical governance meeting in September 2020 and formed the educational intervention. Results 24 patients with acute cholecystitis were included in the initial audit, and 25 patients in the re-audit. The initial audit found that 15 patients (62.5%) with acute cholecystitis were managed conservatively with IV antibiotics, 4 patients (16.6%) had a percutaneous cholecystostomy, and 5 patients (20.8%) underwent laparoscopic cholecystectomy during their index admission. Following our educational intervention, the re-audit found that 22 patients (88%) were treated conservatively, 1 patient (4%) had a percutaneous cholecystostomy, and 2 patients (8%) underwent laparoscopic cholecystectomy. The mean length of hospital stay reduced from 5.67 days in the initial audit, to 3.88 days in the re-audit. 30 day readmission rates also reduced from 5 patients (20.8%) to 0 patients (0%). 2 patients aged >60 years died from unrelated causes during their index admission. They had Charlson Comorbidity Index scores >2. Conclusions Management of acute cholecystitis was more compliant with AUGIS guidelines following the educational intervention. Importantly, overall, conservative non-surgical management did not clinically disadvantage patients, and was not associated with the development of complications of acute cholecystitis, such as gallbladder empyema or perforation. Indeed, the re-audit revealed shorter length of hospital stay and lower 30 day readmission rate than the initial audit. For vulnerable patients at risk of serious complications from contracting Covid-19, this certainly had positive implications for wellbeing, reducing exposure to the hospital environment. There were also further beneficial implications for limited bed resources. Our findings, however, suggest that flexibility is required in decision-making in the management of acute cholecystitis. In carefully selected patients, for example younger patients with fewer comorbidities, emergency laparoscopic cholecystectomy might avoid future readmission with serious complications of gallstones, such as ascending cholangitis and pancreatitis. The evidence from our local audit suggests that AUGIS guideline changes may overall benefit and improve the clinical outcomes of patients with acute cholecystitis. However, decisions about management should be in the interests of, and tailored to, the individual patient.

Teen Suicide in One Province in Cordillera

As the teenage suicide was increasingly happening during the peak of the COVID-19 pandemic, this study was conducted purposely to determine the profile of victims of suicide as to age, sex, and educational background and identify the causes of teen suicide in one province in Cordillera. The qualitative design and snowball sampling method were used with the study. There were eight key informants composed of Philippine National Police (PNP) officers, teachers, and DSWD personnel. The study revealed that teens who committed suicide were between 1-21 years old and 22-41 years old. The majority of the suicide victims are males, senior high school, and college students. The causes of teenage suicide are the unseen image of suicide, depression, stress, personal problems, and promises not fulfilled due to poverty and hanging. This study finds that teen suicide can be prevented by giving importance to and acting upon family members’ unseen images of suicide. In the light of the findings, this study proposes an intervention program dubbed as “Psychosocial Intervention Program for Teen Suicide.” In the prevention of such acts, the family, along with government authorities such as the PNP and the DSWD, work hand in hand in helping individuals who are at the brink of their mental states to consider designing a psychosocial intervention geared toward this goal to incorporate activities that promotes prosocial behaviors and rekindling essential information on the unseen image of suicide.

ACCELERATION OF FINANCIAL TECHNOLOGY GROWTH IN ISLAMIC BANKS AS AN EXISTENCE EFFORT TO FACE THE PANDEMIC OF COVID-19

Financial Technology or what is familiarly called fintech is a platform that combines technology and finance into a technology-based financial business that makes it easier for customers so that there is no need for face-to-face transactions. Financial technology is currently trending in Indonesia, especially after the peak of the COVID-19 pandemic that occurred throughout 2020-2021, not only in banking but has begun to spread stand-alone financial technology in terms of payments and peer to peer landing. All technology-based financial institutions compete with each other, Islamic banking institutions in Indonesia, marked by the merger of three Islamic banks into one big force, namely Bank Syariah Indonesia which has optimized digital-based products to maximize the profitability of their companies. The purpose of this study is to find out the tips of Islamic Banking, especially Indonesian Islamic Banks in maximizing the profitability of their companies with fintech.

Burnout Among Chinese Anesthesiologists After the COVID-19 Pandemic Peak: A National Survey.

Evidence has shown that large-scale pandemics can have prolonged psychological impacts on health care professionals. The current study aimed to evaluate the prevalence of burnout after the coronavirus disease 2019 (COVID-19) epidemic peak and to explore the prolonged impact of COVID-19 on burnout among Chinese anesthesiologists. From August 2021 to October 2021, a nationwide cross-sectional survey was conducted. Burnout was measured using the Maslach Burnout Inventory-Human Service Survey. Basic demographic information, exposure to COVID-19, and perceived institutional support were documented. Validated tools measuring mental health status, including anxiety, depression, post-traumatic stress disorder (PTSD) and resilience, were also used to provide additional information on psychological distress. Of the 8850 anesthesiologists from the 218 institutions who were invited to participate, 6331 (74.93%) completed the surveys and were included in the analysis. A total of 52.7% (95% confidence interval [CI], 51.5-53.9) met the criteria for burnout. Depression, anxiety, and PTSD were positively associated with burnout. After pooled multivariate analysis adjusting for potential confounding factors, among the COVID-19 exposure parameters, redeployment outside normal professional boundaries remained associated with an increased risk of burnout (odds ratio, 0.84; 95% CI, 0.72-0.92; P = .039). Higher perceived institutional support and resilience could act as protective factors against burnout. The impact of the COVID-19 epidemic on the psychological well-being of anesthesiologists still exists more than 1 year after the outbreak. Building better institutional support and cultivating stronger resilience may be helpful future intervention measures.

Racial and ethnic variation in emergent surgical care and outcomes during the COVID-19 pandemic: post hoc analysis of an EAST MCT

ObjectivesThe COVID-19 pandemic highlighted concerns regarding the equity of medical care. We evaluated associations between race/ethnicity, timing of hospital presentation and outcomes of acute appendicitis (AP) and acute cholecystitis (AC)...

HPR30 Too Ultra-Rare for Care? Orphan Drug Availability for People Living With Ultra-Rare Respiratory Diseases in the Pre, Present and Post Pandemic Worlds

To compare the current and potential availability of treatments for seven index ultra-rare respiratory diseases before and after the peak of the COVID-19 pandemic. At the 2019 ISPOR EU Conference, a landscape review of available treatments for ultra-rare respiratory diseases was presented. Therefore, 3 years on, we sought to explore if treatment access has improved for ultra-rare respiratory diseases. A landscape review was undertaken to seek evidence of treatment developments for ataxia telangiectasia (AT), lymphangiomatosis (LYMF), pulmonary alveolar proteinosis (PAP), pleuroparenchymal fibroelastosis (PPFE), pulmonary alveolar microlithiasis (PAM), pulmonary dendriform ossification (PDO), and light chain deposition disorders (LCDD). Information from clinicaltrials.gov, orpha.net, the EMA and FDA archives and websites of five health technology assessment (HTA) bodies was narratively synthesised. The 2019 clinicaltrials.gov search identified 24 studies and the 2022 search 25 studies at various stages of the clinical trial process. They concerned PAP (2019/2022: 11/10), AT (6/10), LCDD (5/4), LYMF (1/0) and PPFE (1/1). No studies were identified for PAM or PDO. The 2019 review found treatments for AT and PAP were granted orphan status by the EMA and the FDA, and in 2021 the FDA granted orphan status to another AT treatment. Neither search found reimbursement submissions for any of the ultra-rare respiratory disease. There still remains an obvious lack of proven and available treatments for ultra-rare respiratory diseases. Over the past 3 years, only 1 new treatment has been granted regulatory approval and no treatments have yet to result in therapies that are licensed or approved by HTA bodies. It is our hope that as we enter the post-pandemic world, we as industry professionals and researchers start to adequately address the treatment needs of people living with these debilitating conditions.

Racial and Socioeconomic Differences in Heart Failure Hospitalizations and Telemedicine Follow-up During the COVID-19 Pandemic: Retrospective Cohort Study.

Low rates of heart failure (HF) hospitalizations were observed during the 2020 peak of the COVID-19 pandemic. Additionally, posthospitalization follow-up transitioned to a predominantly telemedicine model. It is unknown whether the shift to telemedicine impacted disparities in posthospitalization follow-up or HF readmissions. The aim of this paper is to determine whether the shift to telemedicine impacted racial and ethnic as well as socioeconomic disparities in acute decompensated heart failure (ADHF) follow-up and HF readmissions. We additionally sought to investigate the impact of the COVID-19 pandemic on the severity of ADHF hospitalizations. This was a retrospective cohort study of HF admissions across 8 participating hospitals during the initial peak of the COVID-19 pandemic (March 15 to June 1, 2020), compared to the same time frame in 2019. Patients were stratified by race, ethnicity, and median neighborhood income. Hospital and intensive care unit (ICU) admission rates, inpatient mortality, 7-day follow-up, and 30-day readmissions were assessed. From March 15, 2019, to June 1, 2020, there were 1162 hospitalizations for ADHF included in the study. There were significantly fewer admissions for ADHF in 2020, compared with 2019 (442 vs 720; P<.001). Patients in 2020 had higher rates of ICU admission, compared with 2019 (15.8% vs 11.1%; P=.02). This trend was seen across all subgroups and was significant for patients from the highest income quartile (17.89% vs 10.99%; P=.02). While there was a trend toward higher inpatient mortality in 2020 versus 2019 (4.3% vs 2.8%; P=.17), no difference was seen among different racial and socioeconomic groups. Telemedicine comprised 81.6% of 7-day follow-up in 2020, with improvement in 7-day follow-up rates (40.5% vs 29.6%; P<.001). Inequities in 7-day follow-up for patients from non-Hispanic Black racial backgrounds compared to those from non-Hispanic White backgrounds decreased during the pandemic. Additionally, those with telemedicine follow-up were less likely to be readmitted in 30 days when compared to no follow-up (13.8% vs 22.4%; P=.03). There were no major differences in HF ICU admissions or inpatient mortality for different racial and socioeconomic groups during the COVID-19 pandemic. Inequalities in 7-day follow-up were reduced with the advent of telemedicine and decreased 30-day readmission rates for those who had telemedicine follow-up.

The role of imaging in the diagnosis of acute appendicitis during the COVID-19 pandemic: a retrospective cohort study.

Acute appendicitis is one of the most common general surgical emergencies worldwide; however, its diagnosis remains challenging, with a high proportion of negative appendicectomies. The purpose of this study was to investigate the benefit of routine use of pre-operative imaging for the evaluation of suspected appendicitis. This retrospective cohort study included all cases of appendicectomies performed for suspected acute appendicitis during the first and second peaks of the COVID-19 pandemic, between March 2020 and February 2021. The control group included all cases of appendicectomies performed for suspected acute appendicitis in the previous 12months (March 2019-February 2020). One hundred and four patients underwent appendicectomy in the study group, compared to 209 in the control group, with similar gender distribution but a significantly higher median age in the study group (33 vs. 28, p = 0.001). The two groups had similar rates of perforation and similar median white cell count (WCC) and CRP. Imaging was used in 80.77% of the patients in the study group, compared to 61.72% in the control group (p = 0.001), with 55.77% of patients in the study group undergoing CT scans. Despite this, the negative appendicectomy rate (NAR) in the two groups did not differ significantly (11.54% vs. 15.79%, p = 0.320). The increase in the use of imaging for the diagnosis of acute appendicitis during the COVID-19 pandemic did not lead to a significantly lower negative appendicectomy rate. Registration: The study was pre-registered at ClinicalTrials.gov (NCT05205681).

Parental Assistance with Emotion Regulation Moderates Link Between COVID-19 Stress and Child Mental Health

ABSTRACT Objective The COVID-19 pandemic has severely impacted children’s mental health. All children have not been affected equally, however, and whether parental emotion socialization might buffer or exacerbate the impact of COVID-19 on children’s mental health remains an important question. Method During the first peak of the COVID-19 pandemic in the U.S. N = 200 parents of children ages 0–17 (52.5% female) completed questionnaires related to parental assistance with children’s emotion regulation, symptomatology, and exposure to COVID-19-related stress. Parents were 74% Non-Hispanic/Latino/a White, 13% Asian, 4.5% Hispanic/Latino/a, 4% Black/African American, 2.5% Native American, and 1.5% bi/multiracial; 0.5% of participants preferred not to state their race/ethnicity. In a series of linear regression analyses, we examined whether parental assistance with children’s execution of emotion regulation strategies – across a variety of prototypically-adaptive and -maladaptive strategies – moderates the association between children’s exposure to COVID-19-related stress and symptomatology. Results Results suggest that parental assistance with the execution of prototypically-adaptive strategies (i.e., acceptance, problem solving, behavioral disengagement) and prototypically-maladaptive strategies (i.e., suppression, rumination) may buffer or exacerbate, respectively, the impact of COVID-19-related stress on youth mental health. Conclusions Though interpretation of findings is constrained by limitations inherent in collecting data during a pandemic, results highlight the importance of supporting parents – who play a critical role of supporting children – during public health emergencies that affect family life. Interventions designed to improve child wellbeing during the ongoing pandemic may benefit from training parents to assist their children with specific emotion regulation strategies.

Prevalence and determinants of Italian physicians’ burnout in the “post-COVID-19” era

PurposeSeveral studies investigated prevalence and determinants of physicians’ burnout during the peak of the COVID-19 pandemic, but only a few during the chronic phase of the pandemic. This study thus aimed to examine this topic referring to the “post-COVID-19 era”, defined as a chronic and likely-to-be endemic status quo.MethodsA cross-sectional, online survey (November 2021–January 2022) was addressed to physicians in Lombardia (Northern Italy). Besides socio-demographic and COVID-19-related data, measures of personal, work- and patient-related burnout (Copenhagen Burnout Inventory; CBI), depression (Patient Health Questionnaire-8), anxiety (General Anxiety Disorder-7), and self-efficacy (General Self-Efficacy Scale) were collected. Linear/generalized linear models were run to test associations/predictions of interest.ResultsAmong the 958 respondents, burnout symptoms were clinically significant in 18.5% of them. Predictive models showed that female sex (OR = 0.73, 95% CI 0.42–1.27), younger age (OR = 0.94, 95% CI 0.59–1.48), shorter job tenure (OR = 1.01, 95% CI 0.62–1.65), trainee status (OR = 1.41, 95% CI 1.16–7.10), higher PHQ-8 (OR = 1.260, 95% CI 1.16–1.37), and GAD-7 scores (OR = 1.19, 95% CI 1.10–1.30) increased the risk to suffer from clinical burnout. COVID-19-related variables were mostly not related/associated to burnout levels.ConclusionIn Italy, physicians’ burnout is moderately prevalent also in the chronic phase of the pandemic, with its determinants being more intrinsic than environmental. The development of effective interventions is needed to help physicians cope with the new challenges of their job.

Emergency order allocation of e-medical supplies due to the disruptive events of the healthcare crisis

The availability of electronic (e-medical) homecare essentials, such as thermometers, oximeters, and oxygen concentrators during the peaks of the pandemic coronavirus disease (COVID-19), has been witnessed as critical in saving the lives of people across the world. This paper presents a supply order allocation strategy of e-medical homecare essentials (HCEs) in a multi-supplier environment by a distributor while ensuring sufficient and timely availability for emergency consumption during pandemic peaks. The results, based on the actual demand data of HCEs obtained from a regional HCE distributor during the pandemic peak of the second wave in India, i.e. April-May 2021, suggest that a minimum (maximum) average of 94% (98%) availability of e-medical HCEs respectively at pharmacies could be achieved during the peak demand period using the proposed emergency order allocation algorithm in this study. Conclusively, the analysis of this study could generate insightful implications for emergency operations decisions in the HCEs supply-distribution channel.

Downstream consequences of moral distress in COVID-19 frontline healthcare workers: Longitudinal associations with moral injury-related guilt

ObjectiveTo examine the longitudinal associations between dimensions of COVID-19 pandemic-related moral distress (MD) and moral injury (MI)-related guilt in a large sample of frontline COVID-19 healthcare workers (FHCWs).Methods: Data from a diverse occupational cohort of 786 COVID-19 FHCWs were collected during the initial peak of the COVID-19 pandemic in New York City and again 7 months later. Baseline MD and MI-related guilt at follow-up were assessed in three domains: family-, work-, and infection-related. Social support was evaluated as a potential moderator of associations between MD and MI-related guilt. ResultsA total of 66.8% of FHCWs reported moderate-or-greater levels of MI-related guilt, the most prevalent of which were family (59.9%) or work-related (29.4%). MD was robustly predictive of guilt in a domain-specific manner. Further, among FHCWs with high levels of work-related MD, those with greater perceptions of supervisor support were less likely to develop work-related guilt 7 months later. DiscussionMD was found to be highly prevalent in FHCWs during the initial wave of the COVID-19 pandemic and was linked to the development of MI-related guilt over time. Prevention and early intervention efforts to mitigate MD and bolster supervisor support may help reduce risk for MI-related guilt in this population.

199 (PB-112) Poster - A systematic review on management of breast cancer patients during the covid 19 pandemic: To assess if there was a clinical delay in treatment and patient perception on delayed treatment. Literature review of the current covid 19 management guidelines for breast cancer patients

Background: During the peak of Covid19 pandemic, healthcare organizations had to restructure to ensure management of covid 19 patients as well as cancer patients. The aim of this study is to assess if there were delays in the management of breast cancer patients in the United States of America, the United Kingdom and the Europe and did the patient report that there were delays in their treatment during the pandemic compared to pre pandemic.

Telehealth in Orthopedic Sports Medicine: A Survey Study on Patient Satisfaction and Experience.

Background: Telehealth has seen breakthroughs in many fields of medicine, but utilization remains limited in orthopedic sports medicine. The purpose of this investigation was to compare patient satisfaction, duration of care, and overall patient experiences with telehealth and in-person clinical visits for sports-related injuries. Methods: A cross-sectional survey study was conducted at an orthopedic sports medicine clinic during the peak of the COVID-19 pandemic between March and November 2020. Anonymous electronic surveys were used to record patient responses and statistical comparisons were drawn through two-sample t-tests. Results: A total of 175 patients (82 telehealth vs. 93 in-person) consented to participate in this investigation, and all were included in the final analysis. The overall composite satisfaction score, when compared between the two groups, did not differ (p = 0.63). Duration of care was significantly longer in the 93 patients who had in-person clinical visits as compared with the 82 patients who had telehealth visits (61/93: >31 min vs. 75/82: <30 min; p < 0.001). Finally, of the 82 patients who had telehealth, 3 respondents said they were "very unlikely" and "unlikely" to request another virtual clinical visit and/or recommend this mode of health care delivery to friends or family. Of the 93 patients had in-person clinical visits, only 15 respondents stated they were uninterested in telehealth under any circumstance. Conclusion: Most patients presenting to an orthopedic sports medicine clinic are open to telehealth, recognize its utility, and believe it to be just as comparable with in-person clinical visits. Level of Evidence: IV.

The impact of the first peak of the COVID-19 pandemic on childhood myopia control practice patterns among ophthalmologists-an international pediatric ophthalmology and strabismus council global perspective.

BackgroundThe prevalence of myopia keeps increasing during the COVID-19 pandemic. We aimed to map the worldwide treatment preferences of ophthalmologists managing myopia control during the first wave of the pandemic.MethodsAn online questionnaire inquiring about pharmacological and optical treatment patterns during the first half of 2020 was sent to pediatric ophthalmology as well as general ophthalmology memberships worldwide. The results among pediatric ophthalmologists were compared to a previous study we performed before the pandemic.ResultsA total of 2269 respondents from 94 countries were included. Most respondents were pediatric ophthalmologists (64.6%), followed by ophthalmologists from other subspecialties (32.3%). The preferred modality for all geographical regions was a combination therapy of pharmacological and optical treatments. When evaluated independently, the pharmacological treatment was more popular than the optical treatment in most regions other than East Asia (P < 0.001). Compared to a pre-pandemic questionnaire, the participation of pediatric ophthalmologists affiliated with non-university hospitals increased. Additionally, the prevalence of respondents utilizing either any type of pharmacological treatment and those that using only evidence-based treatments increased globally. Although a decline in the use of optical treatment was evident worldwide, the use of evidence-based optical treatments increased.ConclusionOphthalmologists around the world preferred a combination therapy of pharmacological and optical treatments. More pediatric ophthalmologists treated myopia progression and preferred a better evidence-based approach to control myopia. These trends reflect a positive response and more awareness of the rising prevalence of myopia due to the increased burden of myopia imposed by the COVID-19 pandemic. Supplementary InformationThe online version contains supplementary material available at 10.1007/s00417-022-05864-7.

Looking into the Laboratory Staffing Issues that Affected Ambulatory Care Clinical Laboratory Operations during the COVID-19 Pandemic.

Our New York City Municipal Public Health System-based multisite ambulatory and school-based Gotham Health clinics offer waived point-of-care tests and provider-performed microscopy to the local communities. Our Gotham Health laboratory service conducts system-wide centralized implementation, monitoring, and oversight of the POCT operations. Laboratory staffing has always been an issue for us as there is a decades-long shortage of laboratory staff, primarily licensed medical technologists and technicians, in New York, like many other states. Our clinical laboratory operations team struggled to hire qualified people even before the COVID-19 pandemic onset. It has faced more significant challenges with the emergence of SARS-CoV-2 pandemic cases in New York City and across the country since mid-March 2020. As staffing continues to be a struggle, it directly affected the POCT performances and a system-wide reduction in the test numbers during the pandemic. We investigated to identify the factors that made staffing more challenging. The impact on our POCT started after laboratory staff relocated to the acute care hospital laboratories to provide testing support during the pandemic's peak. That caused significant delays or complete cessation of POCT operations in the clinics due to a lack of oversight support. We also experienced the risk of more vacated positions where staff already feel overworked, overwhelmed, and emotionally drained, causing professional burnout. The significant challenges identified are noncompliance with vaccine mandates resulting in job dismissal and voluntary resignations in exchange for higher-paying laboratories. Finally, the other challenges identified were frequent sick calls due to mental fatigue, retirement of seasoned staff, and inability to attract qualified technologists to meet the demands of increasing test-ordering patterns. Determining the factors that culminated in the staffing issues becoming more challenging during the COVID-19 pandemic in our ambulatory care clinic laboratory operations will help us in future crisis planning and mitigation.

Novel Inpatient Radiation Oncology Consult Service Associated with Improved Prognosis-Appropriate Care

<h3>Purpose/Objective(s)</h3> Radiation therapy has an increasing role in the management of patients with metastatic cancer. The integration of ablative versus palliative techniques with surgical and systemic approaches is complex, and inefficient care delivery can lead to prolonged hospitalizations that are inconsistent with palliative goals. A dedicated Inpatient Radiation Oncology Consult (IROC) service was created to provide rapid access to palliative radiotherapy. We previously reported the short-term impact of the IROC service in reducing hospital length of stay (LOS), and here we provide an update on long-term improvements in patient care, focusing on quality-of-care metrics including hospital LOS, use of hypofractionated approaches, and prognosis-appropriate care. <h3>Materials/Methods</h3> We retrospectively compared inpatient radiation oncology consults placed in the 12 months preceding IROC (<i>N</i> = 1,507) to those placed during a 12-month period after IROC implementation (<i>N</i> = 1,509). The dates for calendar-matched cohorts were selected to minimize potential confounding from practice changes related to the first peak of the COVID-19 pandemic. We analyzed continuous variables using the Mann-Whitney test and categorical variables using the Fisher's exact test. <h3>Results</h3> The IROC service was associated with reduced hospital length of stay for all consults (mean difference 1.0 day, <i>P</i> = 0.045). IROC led to shorter inpatient radiotherapy courses (mean 5.8 vs. 5.0 days, <i>P</i> = 0.007, and this reduction was greatest for patients discharged to hospice (mean 5.2 vs. 3.7 days, <i>P</i> = 0.033). Compared to pre-IROC patients, IROC patients were more likely to receive hypofractionated treatment (<b>≤</b>5 fractions; pre-IROC, <i>N</i> = 405/551 (74%) vs. IROC, <i>N</i> = 433/528 (82%), <i>P</i> = 0.001). Notably, the trend toward fewer prescribed fractions was not due to increased uptake of inpatient stereotactic regimens (<i>N</i> = 84/551 (15%) vs. <i>N</i> = 87/528 (16%), pre-IROC vs. IROC, respectively, <i>P</i> = 0.560). Death within 60 days of inpatient radiation therapy decreased under IROC (pre-IROC, <i>N</i> = 227/551 (41%) vs. IROC, <i>N</i> = 184/528 (35%), <i>P</i> = 0.033). <h3>Conclusion</h3> A dedicated inpatient radiation oncology consult (IROC) service was associated with long-term reductions in hospital length of stay. Prognosis-appropriate care was improved through shorter treatment courses and decreased delivery of radiation to patients discharged to hospice or with limited survival. Our findings demonstrate the value of a dedicated program addressing the appropriate delivery of radiotherapy to hospitalized patients and highlight opportunities to stratify patients appropriate for ablative versus palliative treatments.

COVID-19 incidence on Emergency Departments accesses. Health need and fear of infection, what wins?

Abstract Introduction The COVID-19 pandemic has changed the patterns of access to the Emergency Department (ED), but it is unclear whether this change was due to COVID-19 incidence or the lockdown imposed by law. Aim To evaluate the association between trends of ED accesses and COVID-19 incidence in the period 1 January - 31 December 2020. Material and methods The data of accesses to the ED per month and severity triage code of 14 hospitals in the Southeast Tuscany (Italy, Provinces of Siena, Arezzo, Grosseto) were obtained from hospitals data warehouses. Data on new cases of COVID-19 infection (obtained by the Ministry of Health) for the 3 provinces were used to calculate the incidence of infection. Hospitals were classified in 4 categories based on beds number, medical specialties offered, services provided. Differences in ED accesses by month, triage code and hospital type were investigated by a Kruskal-Wallis analysis of variance. Association between ED accesses and COVID-19 incidence was evaluated using a random effect panel data analysis adjusting for hospital type and triage code. Results A total of 268,072 ED accesses have been studied. Their trends saw a strong decrease in correspondence of the first pandemic peak, subsequently they are increased and then decreased again until the minimum peak in November 2020. COVID-19 incidence appeared to overlap, but in the reverse direction, with ED admissions trends. Monthly differences of the ED accesses were significant (p &amp;lt; 0.01) except for most severity code. There is a statistically significant inverse association between ED accesses and COVID-19 incidence (Coef. = -0.074, p &amp;lt; 0.001) except for most severe cases (triage code 1: Coef. = -0.028, p = 0.154). Conclusions ED admissions trends followed the COVID-19 incidence independently from the period of lockdown except for the most severe cases. The fear to contract the infection seemed to discourage patients to access ED for diseases that were perceived as not serious. Key messages • The pandemic has changed the lifestyle of people worldwide, modifying even the perception that the patient has of own state of health and their access to Emergency Department. • The decrease in accesses involved less severe cases. Reflect on both the adequacy of accesses in the pre-pandemic period and on what is the best setting to manage these cases in the pandemic period.

Monkeypox: what do dental professionals need to know?

Infection control is critical for the safe delivery of dental care. Infection control practices must be responsive to emerging and re-emerging infectious diseases and outbreaks, as was clearly seen during the peak of the COVID-19 pandemic. An emerging global outbreak of the monkeypox virus has again raised potential challenges for infection control in dentistry. Monkeypox is an infectious disease, characterised by a rash affecting the skin and soft tissues, including the oral cavity. Previously, cases were mostly seen following contact with infected animals in Central and West Africa, with limited human-to-human transmission within and outside of these areas. However, since May 2022, sustained human-to-human transmission has occurred globally. Monkeypox can be transmitted via close contact with an infected person, contaminated objects and surfaces, or by droplets and possibly aerosols, which is therefore of potential importance to dental settings. This article discusses the relevance of monkeypox to dental professionals, the typical presentation of the disease, its potential impact on infection prevention and control practices and the delivery of dental services. The current monkeypox outbreak highlights the need for a more sustained programme of research into dental infection control that can provide a solid evidence base to underpin preparedness planning for future outbreaks and pandemics.

Eating Disorders in Hospitalized School-Aged Children and Adolescents during the COVID-19 Pandemic: A Cross-Sectional Study of Discharge Records in Developmental Ages in Italy.

Eating disorders (EDs) are characterized by behavioral and cognitive aspects that result in a significant impairment of an individual’s well-being. COVID-19 pandemic consequences negatively impacted healthcare services and people’s mental health. Particularly, in developmental ages, difficulties in coping with the situation could have had an impact on eating behaviors. Therefore, the aim of this study was to assess EDs’ hospitalization trend before, during and after the pandemic peak to evaluate whether it has been influenced. A retrospective cross-sectional study was conducted on the hospital discharge forms of patients from 5 to 19 years old in Piedmont, which is a region in northern Italy. Overall, hospitalization, age, and gender-specific rates due to EDs that occurred in 2020 and 2021 were compared to those that occurred in 2018–2019. Since 2020, there has been a 55% reduction in overall hospitalizations, while the total proportion of EDs admissions has doubled from 2020 to 2021 (from 13.9‰ to 22.2‰). Significant hospitalization rate increases were observed both in 15–19 and in 10–14 females’ age groups in 2021. Non-significant increases were observed in all males’ age groups. The increase in hospitalizations for EDs should be further investigated, as it might be the tip of an iceberg not yet acknowledged.