Total Number Of Visits Research Articles

Efficacy, Efficiency, and Acceptability of Telemedicine for Inflammatory Bowel Disease Patients’ Follow-Up Care during the COVID-19 Pandemic

Background: During the COVID-19 pandemic, ambulatory clinic visits were replaced by the implementation of telehealth modalities in most inflammatory bowel disease (IBD) units. Aims: The aim of this study was to assess the efficacy, efficiency, patient satisfaction, and acceptability of using telephone consultation in an IBD unit. Methods: A prospective cohort study was performed in IBD patients who underwent telephone consultation during COVID-19 lockdown (between 16th March and 13th April 2020). To assess the efficacy of this telephone consultation (lockdown visit), nonscheduled visits, emergency consultation, hospital admission, and surgery from lockdown visit to the next scheduled consultation (post-lockdown) were checked. To evaluate efficiency, the time between lockdown visit and post-lockdown consultation was compared with previous consultation (pre-lockdown), and the total number of visits 12 months before and after lockdown visit was checked. A telephone survey was designed to rate perception for a telephone consultation. Results: Out of a total of 274 patients, 220 patients (52.2% male; mean age 49 ± 16 years; Crohn’s disease, n = 126; ulcerative colitis, n = 83; indeterminate colitis, n = 11) were included. Only one patient was consulted at the emergency department, 11 patients needed to rearrange the visit, and none patient underwent surgery before the scheduled post-lockdown visit. The interval to post-lockdown visit compared to pre-lockdown visit increased in 37.7% of patients. The satisfaction survey (n = 185) revealed that 94.6% perceived it was effective. However, 44.4% of patients rather prefer on-site consultation for follow-up. Conclusions: Telemedicine during the COVID-19 pandemic was shown to be effective and efficient to care for IBD patients. In addition, telephone consultation is well accepted by patients in non-extended follow-up periods.

Trends in amphetamine prescriptions given at discharge in emergency departments: A national analysis (2012–2019)

ObjectivesIn parallel with the opioid epidemic, there has been a resurgence in abuse, medical complications, and deaths related to amphetamines. The opioid epidemic began with increasing rates of prescription products that evolved overtime to include heroin and more recently, fentanyl analogues. Current trends in amphetamine prescriptions are less well described. We sought to determine if there has been a change in amphetamine prescriptions given at discharge in U.S. emergency departments (EDs) in recent years. MethodsWe conducted a retrospective review of data provided by the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2012 to 2019. We computed total number of visits that were given amphetamine prescriptions (amphetamine salts, methylphenidate derivatives, and dexmethylphenidate) at discharge for each year. We computed the total number and rate of visits (of all ED visits) that had both amphetamines and opioids prescribed at discharge over the years. We computed data normality using Shapiro Wilke's test and used descriptive statistics such as mean to describe the data distribution as applicable. We used spearman's rho (SR) or pearson's correlation (PC) as applicable to describe trends in data. All p-values were one-tailed and were reported at a 0.05 significance level. All analyses were conducted in IBM SPSS version 28. Results/findingsFrom 2012 to 2019, there were an estimated 817,895 ED visits where an amphetamine prescription was given at discharge, with an overall strong increase in rate over time (SR = 0.71, p = 0.02). At the beginning of the study period (2012) there were 83,503 (0.06%) visits and in 2019 there were 186,539 (0.12%) visits (123% absolute increase). On average, there were 102,237 (SD: 52,725) visits with discharge amphetamine prescriptions per year. There was a strong, linear increase in number of visits that involved a discharge amphetamine salt prescription (PC = 0.92, p = 0.001). In 2012, there were a total of 23,676 visits and in 2019, a total of 124,773 visits (427% increase). There was no trend in visits where both an amphetamine and opioid were prescribed (PC: 0.61, p = 0.06). ConclusionThere have been increases in discharge prescriptions for amphetamines in the ED over time. This was largely driven by prescriptions for amphetamine salts. Future research initiatives should continue to monitor this trend and in prescriptions and associated abuse in the setting of rising amphetamine abuse.

New individualized aflibercept treatment protocol for branch retinal vein occlusion with macular edema

We evaluated the long-term (24-month) efficacy of a novel individualized treatment protocol with 2 mg aflibercept for treatment-naive BRVO with macular edema. Each patient received an initial aflibercept injection and was then examined every 2 weeks until recurrence of edema. At recurrence, each patient received a second injection of aflibercept. The period of efficacy was defined as the time between the first and second injections. Subsequently, each patient was examined and re-injected with aflibercept at their personalized treatment interval, which was defined as 1 week shorter than the period of efficacy. Thirty-seven eyes of 48 patients showed recurrence after the initial injection. The mean period of efficacy was 92.5 ± 40.8 days, and the mean number of visits before recurrence, 7.6 ± 2.9. The mean 24-month best corrected visual acuity (BCVA) was significantly better than the mean baseline BCVA but significantly worse than the best BCVA during the period of efficacy. The mean gain of BCVA at 24 months was 0.07 ± 0.18 logMAR. The mean 24-month central macular thickness (CMT) was significantly lower than the mean baseline CMT but showed no difference from the mean best CMT (p = 0.060). The mean total number of visits during the 24 months was 15.8 ± 3.4. We conclude that the individualized treatment protocol that was based on the period of efficacy in treatment-naïve BRVO eyes with macular edema achieved satisfactory long-term visual outcome.

Antarctic tourism: spatial structure and dynamics of international tourist flows (for the seasons of 2011-2020)


 
 
 The theoretical foundations of the origin and development of Antarctic tourism are considered. The first proposals for Antarctic tourism were recorded in 1910, but it was not until the 1920s that the first tourists were able to visit the mainland. The beginning of commercial tourism to the Antarctic was laid by Lars-Erik Lindblad on his cruise liner «Explorer», which in 1966 made the first commercial tourist flight to the continent. In the 1980s of the 20th century, Antarctica was visited annually by about 2,000 tourists. In the 1990s, Antarctic tourism became a mass phenomenon, flights over the Antarctic resumed. The Antarctic Treaty system is considered. In 1959, the Antarctic Treaty was concluded, and in 1961, it established the status quo, which prohibits the making of new territorial claims and the expansion of old claims made before 1959. The treaty declares the freedom of scientific research in the Antarctic. It has been analyzed that the current lack of territorial possessions of one or another country in the Antarctic facilitates the conduct of comprehensive scientific research. It has been established that in Ukraine only one dissertation study is devot- ed to the issues of Antarctic tourism. All other works of scientists are devoted to biological, gravimetric, mineralogical, geodetic, ocean- ographic, physical, geological research of the Antarctic. It has been proven that modern directions of regional complex geographical re- search of the Antarctic are closely related not only to the provision of national interests, but also to the solution of global environmental problems. An analysis of the spatial structure and dynamics of international tourist flows to the Antarctic was conducted for the seasons 2011-2020. During this period, 389,800 people visited the continent. There is a constant increase in the number of visitors. Travel by mode of transport is considered. During the entire period of the study, the largest number of visitors (71.5% of the total number) usedcruise ships / yachts with a landing on the shore with an excursion to the mainland. An analysis of the distribution of tourists by country of origin was carried out. The Top-20 places of Antarctica, which are the most visited, are considered. During the 2016-2017 – 2019-2020 seasons, the number of visits reached 7,086. The top five are occupied by Cuverville Island (9.07% of the total number of visits during the study period), Goudier Island (8.65%), Neko Harbor (8.55%), Whalers Bay (8.24%), Half Moon Island – Chinstrap Colony (7.83%). The station «Akademik Vernadsky” ranks 13th with 194 visits, which is 2.74%. The most popular tourist destinations in East Antarctica for the 2019-2020 season have been reviewed: Amundsen Sea with ship cruises, Cape Evans with small boat cruises and shore landings, Cape Adare with ship cruises, small boat cruises and shore landings from it to the shore. It is noted that at the current stage of the development of society, it is impossible to forecast the tourist flow to the Antarctic for the coming season with the help of economic and mathematical modeling in connection with the COVID-19 coronavirus pandemic.
 
 

Changes in consultation mode during different phases of the COVID-19 pandemic in Croatian family medicine: a cross-sectional study

ObjectivesTo describe the changes in the type, length and reasons for consultations in primary healthcare during the COVID-19 pandemic in Croatia. This study aimed to test a hypothesis regarding the...

Dynamic indicators of the use of puncture method for the treatment of acute maxillary sinusitis in healthcare institutions of the city of Moscow

According to the statistical forms medical and preventive treatment centres (MPTC), the analysis of dynamic indicators of the treatment of patients with acute sinusitis (AS) in outpatient polyclinic centers (OPC) and ENT hospitals in Moscow for the period from 2017 to 2021 was carried out. The total number of visits to an otorhinolaryngologist in the OPC in Moscow for 2017-2021 amounted to 6 834 952 patients, including 245 172 patients with AS (3.6%).The total number of hospitalizations in the departments of otorhinolaryngology for the same period amounted to 184 735 patients, including 12 906 patients with AS (7%).The number of patients with AS who was consulted by an otorhinolaryngologist from 2017 to 2021 decreased by 18.2%, which can be explained by a change in the routing of patients with mild form of AS to general practitioners. An analysis of the dynamic indicators of maxillary sinus punctures carried out in the medical and preventive treatment centres (MPTC) in Moscow during the period from 2017 to 2021 showed that there was a redistribution of this manipulation from ENT hospitals to the OPC. At the same time, the proportion of patients requiring puncture treatment in the OPC for 2017-2019 was stable and amounted to 9.3%. However, since 2020, there has been an increase in this indicator by more than 2 times (21.7%), which probably indicates an increase in the treatment of patients with moderate forms of AS in the OPC. The frequency of maxillary sinus punctures that were performed in ENT hospitals in 2017-2019 amounted to 83.5%, in 2020-2021 decreased to 63.4%. The average number of maxillary sinus punctures per patient in ENT hospitals from 2017 to 2019 was 13.3. Since 2020, this value has decreased by about 2 times and has become equal to 8.5. The decrease in the number of maxillary sinus punctures that were performed in ENT hospitals is probably due to the fact that patients with severe and complicated forms of acute sinusitis hospitalized from 2020 to 2021 required more radical surgical treatment.

Pediatric psychiatric emergency rooms during COVID-19: a multi-center study

BackgroundThe COVID-19 (SARS-CoV-2) pandemic has been a major stressor for the mental health and well-being of children and adolescents. Surveys and reports from hotlines indicate a significant rise in mental health problems. As the psychiatric emergency room (ER) is a first-line free-of-charge facility for psychiatric emergencies, we expected to see a significant increase in visits, specifically of new patients suffering from anxiety, depression, or stress-related disorders.MethodsData from two psychiatric hospital ERs and one general hospital were included. All visits of children and adolescents from the computerized files between March and December of 2019 were analyzed anonymously and compared to the same months in 2020, using multilevel linear modeling.ResultsThere was a significant decline in the total number of visits (p = .017), specifically among those diagnosed as suffering from stress-related, anxiety, and mood disorder groups (p = .017), and an incline in the proportion of visits of severe mental disorders (p = .029).DiscussionThe limited use of child and adolescent psychiatric emergency facilities during the pandemic highlights the importance of tele-psychiatry as part of emergency services. It also suggests the importance of the timeline of the emergence of clinically relevant new psychiatric diagnoses related to the pandemic. Future studies are needed to establish the long-term effects of the pandemic and the expeditious use of tele-psychiatry.

Temporal Trend and Spatial Distribution of Drug Poisoning in Semnan Province: A Retrospective Longitudinal Study

Background: Substance abuse and the risks of its consequences are the major public health problems in the world and Iran. Objectives: The objective of the present study is determination the epidemiological status and spatial distribution of high-risk and low-risk clusters along with estimating the relative risk of drug poisoning in Semnan in 8 years. Methods: A descriptive-analytical and retrospective longitudinal study was conducted that examined all 3360 poisoned patients who referred to the hospitals of Semnan province from 2011 - 2018. The total number of visits was received and analyzed by year with the relevant diagnostic code in ICD-10 from hospitals of the province, and data were analyzed using Joinpoint regression analysis, global Moran’s index and Kuldorff's spatial statistic scan at a significant level of 0.05. Results: The number of clients varied from 219 in 2011 to 570 in 2015. The patients' mean age was 26.7 years. The average annual number of cases per one hundred thousand individuals (annual cases/100000) was 598.4. The AAPC of the incidence of drug poisoning was 9.8 and significant in the whole province, demonstrating that the incidence of poisoning increased by an average of 9.8% per year in the whole province from 2011 to 2018. Semnan County with LLR = 533.07 was the most likely low-risk cluster, and Shahroud County was the most likely high-risk cluster with LLR = 219.94. Conclusions: Drug policies need to be adapted to the geographical differences in the place death. After clustering regions in poisoning incidents, the necessary interventions can be concentrated for these specific geographical locations.

Post hoc analysis of the results of KOLIBRI comparative observational clinical study in patients with knee and small hand joints osteoarthritis

Objective: to evaluate the effectiveness of therapy with AMBENE®Bio (AB) in comparison with the comparator drug (bioactive concentrate of small marine fish, BCSMF) in patients with osteoarthritis (OA) of large and small joints in routine clinical practice.Patients and methods. KOLIBRI multicenter, observational, non-randomized, comparative study included 233 patients with OA of the small hand joints (HJ) or knee joints (KJ) from three Russian centers (two in Moscow and one in Tula). Patients with a generalized form of OA were excluded from the analysis. The remaining patients were divided into two groups depending on the localization of OA. The first group included 174 patients with knee OA, 105 of them received AB, and 69 received the reference drug (BCSMF) according to the same regimen. The second group consisted of 21 women with HJ OA: 13 patients were prescribed AB, and 8 — the reference drug.The duration of the study averaged 330±14 days, the total number of visits was 4. The main indicator of effectiveness was the dynamics of pain during movement according to VAS (0—100 mm) 30±7 days after the start of treatment compared with the baseline value. All patients underwent radiography of the HJ and KJ, as well as ultrasound of the involved joints.Results and discussion. Both drugs provided significant clinical improvement in patients with OA, which is consistent with other studies with similar design and long follow-up. These data confirm the symptom-modifying properties of the presented group of combined drugs in the OA treatment. The Russian injectable drug AB in OA was not inferior in effectiveness to the foreign BCSMF. According to the OMERACT-OARSI criteria, 85.2% and 88.9% of patients, respectively, responded to treatment with AB and the reference drug. In both groups, half of the patients managed to stop further use of non-steroidal anti-inflammatory drugs (NSAIDs) on a regular basis.Conclusion. The use of AB was accompanied not only by a decrease in the severity of clinical symptoms of OA, but also by a decrease in the daily requirement for NSAIDs almost by 2 times.

1755. Interactive Provider Dashboards for Comparison of Outpatient Antimicrobial Prescribing for Respiratory and Otic Conditions in Urgent and Quick Care Clinics

Abstract Background Due to antibiotic overutilization, development of antimicrobial stewardship (AMS) in the outpatient setting has become a necessary focus for AMS programs. The cornerstone of AMS is utilization of antimicrobial prescribing data to provide feedback to individual providers and compare providers to each other in order to promote improved prescribing practices. Respiratory infections, especially conditions that never require antimicrobials, are a common target for this feedback. We aimed to create interactive data visualization dashboards of end-users prescribing for these respiratory and otic conditions in order for AMS and urgent/quick care program staff to identify potential areas of intervention. Methods A multidisciplinary work group consisting of data analysts, infectious diseases physicians, urgent/quick care physicians, and infectious diseases pharmacists determined dashboard content, layout, and comparison charts. Graph types were tested to determine optimal visual output. Using the electronic medical record ICD10 and antimicrobial prescription data was extracted for the encounter with focus on ICD10 codes for respiratory and otic conditions which never require antimicrobials. Rates were calculated as number of antimicrobial prescriptions over total number of visits for these conditions. Results A multi-faceted dashboard was developed in Tableau® to view antimicrobial prescribing rates. Dashboard capabilities include the option to view individual provider prescribing rates compared to other de-identified providers, overall clinic prescribing rate, or individual rate compared to clinic rate. This allows for quick direct comparison of antimicrobial prescribing on the same graph by clinic to identify outliers (Figure 1) and allows visualization of trends in prescribing rates by clinics and providers over time (Figures 2,3). Never Antimicrobial Prescribing Rate Comparison Scatter plot comparing individual prescribers rate of prescribing for never antimicrobial events Clinic Antimicrobial Prescribing Rate Trend Clinic prescribing rate trend over time for never antimicrobial events Prescriber and Clinic Antimicrobial Prescribing Rate Trend Individual prescriber rate compared to clinic rate over time for never antimicrobial events Conclusion We developed an interactive outpatient AMS dashboard to visualize prescribing of antimicrobials for never respiratory and otic conditions. These dashboards can be used by providers along with AMS and clinic leadership to determine areas of intervention in the urgent/quick care setting. Disclosures Kelly M. Percival, PharmD, Gilead Sciences Inc: Advisor/Consultant Patrick M. Kinn, PharmD, MPH, Gilead Sciences: Advisor/Consultant Dilek Ince, MD, Evergreen: Member of data monitoring board|Gilead Sciences: Grant/Research Support|Leidos: Grant/Research Support|Moderna: Grant/Research Support.

Integrity of the editing and publishing process is the basis for improving an academic journal’s Impact Factor

Journal Impact Factor™ (JIF) is often used to evaluate the relative reputation and quality of academic journals in their respective fields, and can greatly influence the quality and scope of subsequent manuscript submissions. Therefore, many if not all academic journals are interested in increasing their JIF, to improve their academic impact. To determine the importance of the integrity of the editorial and publication process in improving the academic influence of academic journals and the JIF of academic journals. In this paper, we describe our statistical analysis of bibliometric factors - including the 2021 JIFs released in the Journal Citation Report™ 2022, discipline rankings, received and published articles in 2019-2021, and webpage visits and downloads - for seven journals published by Baishideng Publishing Group (Baishideng) and indexed in Science Citation Index Expanded™; ultimately, we introduce and discuss the editing and publishing processes of Baishideng's journals in their entirety, as they form the basis for our objective of safeguarding and bolstering integrity in academic publication. For the seven journals assessed, their 2021 JIFs were basically unchanged from 2020, with the current metric ranging from 5.374 for World Journal of Gastroenterology (WJG) to 1.534 for World Journal of Clinical Cases (WJCC). Further assessments of the journals' bibliometrics from 2019 to 2020, showed that World Journal of Stem Cells has the highest self-citation rate (1.43%) and World Journal of Gastrointestinal Surgery has the lowest (0.21%). Additionally, the total 3012 articles published during this period were cited by more than 20000 articles in approximately 8000 academic journals. Of note, the 1102 articles published in WJG were cited by articles in 3059 journals, among which 171 journals have a JIF of > 10, including internationally renowned academic journals such as CA-A Cancer Journal for Clinicians (2021 JIF 286.130, record count: 1), Lancet (2021 JIF 202.731, record count: 4), Nature Reviews Immunology (2021 JIF 108.555, record count: 2), Nature Reviews Gastroenterology & Hepatology (2021 JIF 73.082, record count: 9), Lancet Gastroenterology & Hepatology (2021 JIF 45.042, record count: 8), Gastroenterology (2021 JIF 33.883, record count: 19), and Gut (2021 JIF 31.793, record count: 21). This suggests that Baishideng's journals have been widely recognized for their academic quality. In the Reference Citation Analysis (RCA) database, all seven Baishideng-published journals obtained a 2022 Journal Article Influence Index (JAII). For example, WJG has a 2022 JAII of 22.048, ranking 18th out of 102 journals in the field of gastroenterology & hepatology in the RCA, with 469909 total citations (6/102) and 21313 total articles (5/102). The numbers of manuscripts received and published in 2021 were both higher than those in 2019-2020. For example, WJCC received a total of 3650 manuscripts in 2021, which is 91.1% higher than those in 2019-2020 (average: 1910 papers/year). In 2021, WJCC published 1296 articles, representing an increase of 105.1% compared to those in 2019-2020 (average: 632 articles/year). The numbers of webpage visits and downloads received by the seven journals have increased year by year. For example, the number of total visits received by WJG in 2019-2021 was 1974052 in 2019, 2317835 in 2020 (increased by 17.4% compared with that in 2019), and 2652555 in 2021 (increased by 4.4% compared with that in 2020). The visitors were from more than 220 countries and regions worldwide, such as the United States, China, and the United Kingdom. Open access (OA) plays a vital role in improving the quality, efficiency, transparency, and integrity of academic journal publishing. From 2019 to 2021, a total of 5543 OA articles were published in the seven journals, of which 2083 (37.6%) were invited and published free-of-charge. During the same period, 1683 articles were published in WJG, and the authors were from more than 70 countries and regions. For the total 5543 articles published in the seven journals from 2019 to 2021, 3903 article quality tracking reports were received after the online publication of these articles. The quality of the articles was further evaluated through the Baishideng's article quality and author evaluation tracking system, with 4655 articles (84.0%) having received author evaluation and feedback, which contributes to tracking metrics for authors' satisfaction with the collective publication processes. From March 25, 2021 to June 28, 2022, the seven journals received a total of 424 reader evaluations and 229 letters from readers; this subsequent reader engagement demonstrates that the popularity of the published articles and the volume of their readership audience were improved through the reader evaluation system. Ultimately, the findings from our bibliometric assessments indicate that establishing, promoting and actively practicing processes that safeguard and bolster the integrity of the editing and publication process also help to improve the academic influence of academic journals, which itself is the cornerstone for improving JIF.

Complete Telehealth for Multidisciplinary Preoperative Workup Does Not Delay Time to Metabolic and Bariatric Surgery: a Pilot Study.

PurposeThe COVID-19 pandemic accelerated implementation of telehealth throughout the US healthcare system. At our institution, we converted a fully integrated multidisciplinary bariatric clinic from face-to-face visits to entirely telehealth video/telephone visits. We hypothesized telehealth would increase the number of provider/patient encounters and therefore delay time to surgery.MethodsThis is a retrospective review of consecutive patients who underwent total telehealth preoperative workup. Demographics, comorbidities, and surgical characteristics were compared to the same number of consecutive patients who underwent a face-to-face approach 12 months prior, using a Wilcoxon test for continuous variables and chi-square or Fisher’s exact test for categorical variables. Differences between time and surgery were compared using inverse probability of treatment-weighted estimates and number of preoperative visits using Poisson regression with distance to hospital as a confounder. Noninferiority margin for time to surgery was set to 60 days, and the number of visits was set to 2 visits.ResultsBetween March of 2020 and December of 2021, 36 patients had total telehealth workup, and were compared to 36 patients in the traditional group. Age, sex, body mass index, and comorbidities did not differ between groups. The average number of days to surgery was 121.1 days shorter in the telehealth group (90% bootstrap CI [− 160.4, − 81.8]). Estimated shift in the total number of visits was additional .76 visits in the traditional group (90% CI [.64, .91).ConclusionsThe total telehealth approach to preoperative bariatric multidisciplinary workup did not delay surgery and decreased number of total outpatient visits and time to surgery.Graphical abstract

Assessment Of Reported Covid-19 Cases Across European Leisure Centres And Fitness Clubs

The spread of SARS-CoV-2 resulted in a global health pandemic with extreme mobility restrictions and confinement. In these circumstances, EuropeActive developed a practical guide on safety and protective measures to guarantee that fitness centres had the highest safety possible, as European governments allowed them to reopen. PURPOSE: This study aimed to analyze the number of reported COVID-19 cases in members and staff in leisure centres and fitness clubs throughout Europe, considering several variables potentially influencing the transmission risk as they reopened from their COVID-19 shutdowns. METHODS: Total number of visits and number of reported COVID-19 cases in members and staff were collected in a sample of European leisure centres and fitness clubs (n = 4,360; 6.8% of all operators in Europe) during the first six months after reopening (weeks 19 to 43 of 2020). Chi-squared test was implemented to analyze several variables potentially influencing the transmission risk, such as the facility size (total squared meters), compliance with EuropeActive's practical guide (i.e., <75% vs >75% of the measures), and operator's profile (i.e., large vs small operators). RESULTS: A total of 115,384,737 member visits were obtained, with 1,092 positive COVID-19 cases reported in members and 196 in staff, resulting in 1.12 positive cases per 100,000 visits. There was an association between the number of positive cases and the size of the facility (p < 0.001), with a progressive reduction in cases as the facility size increased up to 1,000-2,000 m2, yet a progressive increase in cases was observed for facilities 1,000-2,000 m2 to >5,000 m2. There was also an association between the cases and the percentage compliance with safety and protective measures showing fewer cases with more compliance of measures (p < 0.001) and with the operator's profile, with fewer positive cases reported in large operators (p < 0.001). CONCLUSIONS: Leisure centres and fitness clubs reported a low and maintained incidence of positive cases of COVID-19 despite Europe experiencing a second and third wave with a progressive increase of COVID-19 in the general population. Leisure centres and fitness clubs with a size of 1,000-2,000 m2, complying with >75% of the EuropeActive safety measures, and of large operators showed less incidence of reported cases.

EP06.01-015 Will Virtual Care Stand the Test of Time; One Site’s Perspective on the Continuity of Virtual Care Post-Pandemic

EP06.01-015 Will Virtual Care Stand the Test of Time; One Site’s Perspective on the Continuity of Virtual Care Post-Pandemic

The efficiency of health resource allocation and its influencing factors: evidence from the super efficiency slack based model-Tobit model.

This study aims to analyze the health resource allocation efficiency in Sichuan Province from 2010 to 2018 and provide other countries with China's experience. We used the super efficiency slack based model (SBM) model and Malmquist index to analyze the super efficiency and inter-period efficiency of health resource allocation in 19 cities in Sichuan Province from 2010 to 2018 and propose the input-output optimization scheme of health resource allocation in 2018. Finally, the Tobit model was used to estimate the influencing factors of health resource allocation efficiency. The total allocation of health resources in Sichuan Province was increasing in addition to the total number of visits from 2010 to 2018. The super efficiency SBM results identified that the sample's average score was between 0.651 and 3.244, with an average of 1.041, of which 15 cities had not reached data envelopment analysis effectiveness. According to the Malmquist index, the average total factor productivity index of Sichuan Province was 0.930, which showed an imbalance in resource input, and its fluctuation was mainly related to the technological progress index and scale efficiency. The efficiency score was affected by the average annual income of residents, population density and education level. The amount of health resource allocation in Sichuan Province had shown an overall upward trend since 2010. However, resource allocation efficiency was not high, and there were problems such as significant regional differences, insufficient technological innovation capabilities and unscientific allocation of resource scale. To optimize the resource allocation structure, we suggest that the relevant departments pay attention to the impact of natural disasters, the average annual income of residents, population density and education level on efficiency to allocate health resources scientifically.

Fragmentation of ambulatory care among older adults: an exhaustive database study in an ageing city in Japan

ObjectivesContinuity of care is a core dimension of primary care, and better continuity is associated with better patient outcomes. Therefore, care fragmentation can be an indicator to assess the quality...

Effect of COVID-19 Lockdowns on Eye Emergency Department, Increasing Prevalence of Uveitis and Optic Neuritis in the COVID-19 Era.

Background: The COVID-19 pandemic led to the reorganization of the health care system. A decline in health- and life-saving procedures has been reported in various medical specialties. However, data on ophthalmic emergencies during lockdowns is limited. Methods: We conducted a retrospective, observational, case-control study of 2351 patients registered at the ophthalmic emergency department of a tertiary hospital in Poland during three national COVID-19 lockdowns (March/April 2020, November 2020, and March/April 2021) and corresponding months in 2019. Results: The total number of visits declined from a mean of 720/month in the non-COVID era to 304/month during COVID-19 lockdowns (p < 0.001). Ocular trauma incidence dropped significantly from 2019 (non-COVID months) to 2020/2021 (COVID group mean 201 vs. 97 patients monthly, respectively, p = 0.03). Of note, the percentage of foreign bodies removal was significantly higher during lockdowns than corresponding time in the non-COVID era. A downward trend for vitreous detachment and macular disorders cases was observed between COVID and non-COVID time. Uveitis and optic neuritis patients were seen more often during lockdowns (p < 0.001 and p = 0.0013, respectively). In contrast, the frequency of conjunctivitis and keratitis, potentially COVID-related problems, decreased significantly in COVID-19 time (mean 138 vs. 23 per month in non-COVID vs. COVID lockdowns, respectively, p < 0.001). Conclusions: The overall number of eye emergency visits declined during COVID-19 lockdowns. Conjunctivitis and keratitis rates dropped during the lockdowns. Interestingly, the frequency of immune-mediated ocular conditions (uveitis, optic neuritis) increased significantly which might be triggered by SARS-CoV2 infection.

Outpatient Visit Current Procedural Terminology Code Level Selection Trends in Hand Surgery Following Criteria Changes by the American Medical Association

Introduction: Beginning on January 1, 2021, the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS) implemented considerable revisions with regard to the outpatient evaluation and management (E/M) criteria dictating the Current Procedural Terminology (CPT) code level selection. The primary goal of the current study was to determine how the recent E/M coding criteria changes have impacted code level selection by orthopedic hand surgeons in the outpatient setting.Materials and methods: All outpatient visits within the hand and wrist surgery division of a single orthopedic practice were collected during two timeframes: March 1, 2019, to June 30, 2019, and March 1, 2021, to June 30, 2021. Procedure codes and insurance categories were collected for each visit. The primary endpoint analyzed was the visit level of care based on CPT E/M codes. For each timeframe, we determined the number of total visits that were coded at each level and expressed them as a percentage of the total visits for that time period. The insurance plan billed for each visit was recorded and classified as Medicare, Medicaid, Workers' Compensation, or commercial.Results: In 2019, prior to the billing level requirement changes, 7.2% of all visits were billed as level 2, 84.8% of all visits were billed as level 3, and 7.8% of all visits were billed as level 4. In 2021, 1.9% of visits were billed as level 2, 47.3% of visits were billed as level 3, and 50.5% of visits were billed as level 4. Level 1 and 5 visits did not exceed 0.5% in either timeframe. Within each insurance category, the proportion of visit levels of care followed a similar trend of reduced level 2 and 3 visits and increased level 4 visits from 2019 to 2021.Conclusion: We noted a significant trend toward higher code level selection following the recent code level changes, and we anticipate these recent code selection trends to have major financial implications moving forward.

Clinical characteristics and outcomes of healthcare workers with COVID-19 pre- and postvaccination.

Vaccines are the most effective strategy to control the spread of coronavirus disease‐2019 (COVID‐19). Data on COVID‐19 among healthcare workers (HCW) pre‐ and postvaccination are limited. This study aims to evaluate the clinical characteristics and outcomes of HCW with COVID‐19 pre‐ and postvaccination. Retrospective cohort study. All HCWs with suspected COVID‐19 were included. Demographic data, occupation, symptoms, work in COVID‐19 area, and vaccination status were collected. There were 22 267 HCW visits for suspected COVID‐19; 7879 (35.4%) tested positive, and 14 388 (64.6%) tested negative. Fever, cough, fatigue, and dyspnea were positive predictors of COVID‐19, and sore throat, headache, coryza, work in a COVID‐19 area, and COVID‐19 vaccination were negative predictors. Of the total number of visits, 41.2% were from vaccinated HCW and 58.8% were from unvaccinated HCW. Among HCWs with COVID‐19, 84 (1.1%) required hospitalization, 11 (0.1%) in an intensive care unit (ICU), with three (0.04%) deaths. Six hospitalizations occurred in vaccinated HCWs, being of short duration, with no need for ICU admission and no deaths. SARS‐CoV‐2 infection prevalence was high among HCW, and vaccinated HCW had fewer hospitalizations, need for ICU, and deaths. Therefore, vaccines may attenuate COVID‐19 severity, and efforts must be concentrated to ensure adequate vaccination for HCW.

Highly educated patients have lower dental compliance during the COVID-19 pandemic: an observational study

BackgroundThe outbreak of coronavirus disease 2019 (COVID-19) is rapidly changed medical habits, and dental clinics have been forced to adapt. This study explored the pandemic-induced changes in patient utilization of dental services to assist practitioners in responding efficiently to similar public crises as references in the future.MethodsWe retrospectively analyzed the correlation between patient profiles and dental visits attendance within 2 months before and during the outbreak.ResultsA total of 332 patients, 210 women and 122 men (total number of visits: 1068) were enrolled in this study. A significantly lower attendance rate was noted during the COVID-19 period (70.3%) than prior to the pandemic (83.4%). The rate of return visits for patients with a high education level during the COVID-19 period was significantly reduced from 96.5 to 93.1%. In addition, the number of days between two visits significantly increased during the pandemic.ConclusionsOur results indicate that, during the pandemic period, the attendance rates of return dental appointments decreased, and the rate of missed appointments for patients with a high educational levels was higher than that of patients with a low educational level.Clinical relevancePreventive management of these patients who are easy to miss dental appointments may enable more effective use of medical resources.