Search Results (37)

Background/Objectives: Healthcare accounts for approximately 4.4% of global carbon emissions. Gastroenterology is a particularly heavy producer, with professional organisations outlining targets to move towards carbon neutrality. Missed hospital appointments, associated with poor medical outcomes, also represent physical and economic waste to the sector. COVID-19 expedited the shift toward virtual clinics, but tele-diagnostics have not expanded similarly. We aimed to assess the feasibility of a virtual C13 urea breath test clinic for H. pylori in Ireland. Methods: C13 urea breath test kits were provided to patients in the community, who were subsequently invited to book an online video appointment with a GI lab technician to assist them in performing the test at home. Completed tests were returned to the hospital via local GP, by post, or a specified hospital drop-off point, and analysed using our standard protocol. Results: 423 virtual appointments were reviewed. 135 (32%) were male, and the mean age was 42 years. The test positivity rate was 22%, similar to a matched in-person testing cohort (21%). In all, there were no non-attenders, and two cancellations. Virtual patients were more likely to attend their appointments (OR = 153.9, p = 0.0004) than in-person patients. Virtual UBT appointments saved 9943.5 Km of road journeys, equivalent to 254 person-hours of travel time and 1.24 metric tonnes of CO₂. Additionally, 300 (71%) patients returned a feedback questionnaire, of which 276 (92%) rated the overall home breath test experience as ‘good’ or ‘excellent’. Conclusions: Home testing for H. pylori is effective, acceptable, and reduces both reliance on invasive procedures such as endoscopy and carbon emissions. Full article

The COVID-19 pandemic and related public health and hospital restrictions directly influenced Canadian perinatal healthcare. This study aimed to evaluate predictors of pandemic-related pregnancy and postpartum stress in Canada. A sample of 398 women with Canadian pandemic pregnancy experiences completed an online cross-sectional survey between September 2021 and February 2022. Demographic factors, perinatal healthcare characteristics, and psychometric measures including Oslo Social Support Scale (OSSS-3) and Brief COPE were analyzed by independent hierarchical generalized linear models (GLM) to identify predictive variables associated with prenatal and postpartum pandemic-related pregnancy stress scales (PREPS). Respondents reported low social support, low–moderate Problem-Focused and Emotion-Focused Coping scores, with low Avoidant Coping. Middle income and canceled prenatal care appointments were associated with prenatal PREPS-Preparedness Stress, with provider satisfaction negatively associated. Avoidant Coping was positively associated with both prenatal and postpartum Preparedness Stress and Infection Stress scores, whereas Problem-Focused Coping was associated with both prenatal and postpartum Positive Appraisal. High COVID-19 rates and region of healthcare were associated with prenatal and postpartum Infection Stress. Our findings that perinatal healthcare characteristics and psychometric measures, rather than demographic characteristics, were greater predictors of pandemic-related stress reflect the broad societal disruptions that shaped Canadian pregnancy experiences in our sample of mostly high income, well-educated, non-racialized women. Full article

Background: The increasing demand for elective surgery makes optimizing preoperative assessment a priority. Value-based healthcare aims to provide the highest value for patients at the lowest possible cost through various mechanisms, including reorganizing care into integrated practice units (IPUs). However, few studies have analyzed the effectiveness of implementing virtually led IPUs for preoperative assessment. Methods: We performed a retrospective observational cohort study including patients undergoing elective surgery at a teaching hospital in Madrid, Spain from 1 January 2018 to 31 December 2023, analyzing changes in surgical complications, efficiency, and patient satisfaction between the pre-implementation (2018–2019) and post-implementation (2020–2023) periods. Anesthesiologists’ satisfaction with the virtual assessments was described. During the post-implementation period, preoperative assessment was reorganized as a virtually led IPU. At the IPU appointment, preoperative testing and physical (including airway) examinations were performed by a nurse anesthesiologist. The results were uploaded to the electronic health records, and asynchronous virtual anesthesiologist assessment using a store-and-forward approach was performed. Digital patient education was carried out over the Patient Portal mobile application. Results: A total of 40,233 surgical procedures were included, of which 31,259 were from the post-intervention period. During the post-intervention period, no increase in surgical complications was observed, while same-day cancellations decreased from 4.3% to 2.8% of the total procedures (p < 0.001). The overall process time did not increase, despite the rising number of surgical procedures per year. Patient satisfaction improved. The median time to complete anesthesiologist assessment was significantly lower for virtual assessment (4.5 versus 10 min (p < 0.001), signifying estimated time savings of 716 person-hours per year. Anesthesiologists agreed that virtual assessment was more efficient than in-person evaluation, and half of the participants agreed that virtual preoperative care improved their work–life balance and reduced burnout. Conclusions: A digitally enhanced value-based model of preoperative care can improve efficiency and satisfaction metrics, reducing unnecessary costs and potentially improving the quality of care. Full article

This paper examines how mobility can be re-examined within four communities that face substantial transport barriers. Four case study communities facing mobility exclusion were investigated: (i) an ageing community in South Wales; (ii) a community of people with learning difficulties from across Wales; (iii) female university students in Pakistan; (iv) a deprived neighbourhood in mid-Wales. Using an illuminative evaluation, collating a variety of information from documents associated with the communities, it was identified that transport creates freedom, independence, and contributes to sense of purpose, worth, and can help create community. Barriers to public transport include inaccessibility of the first/last mile, services not running at required times, being delayed, and cancelled. Barriers to active travel include poor infrastructure. Not being able to be mobile affects health, not just with a lack of active travel but also missed health appointments and a lack of access to healthy foods. Already marginalised communities are further disadvantaged by the barriers reducing access to jobs, education, services, shops, and leisure. Communities want support to develop their knowledge into a package that actors can use to develop a solution, often citing the need for quantitative skills, however, other ways of utilising experiential knowledge might be more appropriate. Full article

The COVID-19 pandemic has had a significant impact on healthcare systems worldwide, including the postponing or canceling of appointments and procedures for type 2 diabetes (T2D) care by general practitioners (GPs) in the Netherlands. The aim of this study was to investigate the impact of the COVID-19 pandemic on primary healthcare use and clinical measurements for people with T2D. Additionally, we aimed to determine if changes were observed among specific risk groups: (1) persons 70 years or older, or below 70 years, (2) patients who were meeting their HbA1c targets and those who were not, and (3) patients with high-risk and non-high-risk T2D. This retrospective cohort study among persons with T2D was conducted using data from the DIAbetes MANagement and Treatment (DIAMANT) data infrastructure, deriving data from electronic medical records of Dutch GPs. The study assessed GP visit counts, and counts and values of clinical measurements, including hemoglobin A1c (HbA1c), body mass index (BMI), low-density lipoprotein (LDL) cholesterol, and systolic blood pressure (SBP). Adjusted negative binomial (NB) regression and generalized estimating equations (GEE) models were used to estimate GP visit counts and population averages of clinical measurements, respectively, comparing 2019 (pre-pandemic) with 2020 (during the pandemic). Changes in specific groups were examined by stratifying outcomes for the aforementioned subgroups. The cohort consisted of 182,048 patients with T2D (47% female, mean age 69 ± 13 years) on 1 March 2019, of which 168,097 persons (92%) still contributed follow-up data in 2020. We observed an increase in total GP visits in 2020, with an adjusted rate ratio (RR) of 1.09 (95% CI 1.08–1.09). The frequency increased for office visits (RR 1.06; 1.06–1.07) and phone calls (RR 1.33; 1.31–1.35) but remained stable for home visits (RR 1.02; 0.99–1.04). On both population and individual levels, HbA1c values increased in 2020 by 1.65 (1.59–1.70) mmol/mol compared to 2019. Observed changes in 2020 for BMI, LDL, and SBP values were also statistically significant but small. Subgroup stratifications showed higher scores of all clinical measurements in younger persons (<70 years), those who met their HbA1c target, and non-high-risk T2D patients than their respective high-risk subgroups. During the first year of the COVID-19 pandemic in the Netherlands, changes in primary healthcare use were observed among persons with T2D, with an increase in GP office visits and phone calls and a decreased number of clinical measurements and GP home visits. HbA1c levels increased among patients with T2D in 2020. Further research is necessary to determine the impact of the COVID-19 pandemic on long-term clinical outcomes and (long-term) T2D complications. Full article

Background: In 2020, health systems across the world responded to the COVID-19 pandemic by making rapid changes to reduce the risk of exposure in patients and healthcare professionals. The use of point-of-care tests (POCT) has been a central strategy in dealing with the COVID-19 pandemic. The aims of this study were to evaluate the impact of POCT strategy (1) on maintaining elective surgeries by removing the risk of delayed pre-appointment testing and turn-around times and (2) on time dedicated for end-to-end appointment and management, and (3) to assess the feasibility of using the ID NOW^® among healthcare professionals and patients in a primary care setting, requiring pre-surgical appointment and minor ENT surgery in the Townsend House Medical Centre (THMC), Devon, United Kingdom. Methods: A logistic regression was performed to identify factors associated with the risk of canceled or delayed surgeries and medical appointments. Second, a multivariate linear regression analysis was conducted to calculate changes in the time dedicated to administrative tasks. A questionnaire was developed to assess the acceptance of POCT in patients and staff. Results: 274 patients were included in this study; 174 (63.5%) in Group 1 (Usual Care) and 100 (36.5%) in Group 2 (Point of Care). Multivariate logistic regression showed that the percentage of postponed or canceled appointments was similar between the two groups (adjusted OR = 0.65, [95%CI: 0.22–1.88]; p = 0.42). Similar results were observed for the percentage of postponed or canceled scheduled surgeries (adjusted OR = 0.47, [95%CI: 0.15–1.47]; p = 0.19). The time dedicated to administrative tasks was significantly lowered by 24.7 min in G2 compared to G1 (p < 0.001). 79 patients in G2 (79.0%) completed the survey, and the majority agreed or strongly agreed that it improved care management (79.7%), decreased administrative time (65.8%), reduced the risk of canceled appointments (74.7%) and the traveling time to do COVID-19 test (91.1%). Having point-of-care testing in the clinic in the future seemed more than welcome by 96.6% of patients; 93.6% declared to be less stressed by having the test at the clinic than waiting for the results of the test realized elsewhere. The five healthcare professionals of the primary care center completed the survey, and all agreed that the POCT positively influences the workflow and can be successfully implemented into routine primary care. Conclusions: Our study shows that NAAT-based point-of-care SARS-CoV-2 testing significantly improved flow management in a primary care setting. POC testing was a feasible and well-accepted strategy by patients and providers. Full article

Dental anxiety is a common health problem among children. It creates major issues for patients, parents, and dental professionals. Children who cancel or otherwise miss their dental appointments generally do so due to fear of the unknown and lack of understanding of what they can expect from the environment and treatment when they arrive there. Some distraction interventions are already used by dental professionals, such as using clown doctors, watching cartoons, and utilizing the tell–show–do (TSD) technique. Still, the problem is common, and the fail to attend (FTA) rates at clinics are high. Familiarizing children with the dental setting and procedures in advance may help to manage their anxiety. This paper aims to help in managing children’s dental anxiety in a simple, attractive, and age-appropriate way through the use of augmented reality (AR) and virtual reality (VR) technologies. The developed system is named “Dr. Barea”. It targets Arabic-speaking children aged from 7 to 10 years old. It uses model–view–control (MVC) as its architectural design pattern. The proposed solution consists of three main sections: a 360° VR video that simulates a dental clinic environment, an educational description on dental tools using AR technology, and interactive educational stories that educate children about dental hygiene. The system performance was evaluated using unit, integration, performance, and user acceptance testing. The results demonstrate that the proposed solution, which performed reasonably, achieved the usability requirements and was engaging for learning information about dental hygiene. A feasibility study with 16 children was conducted to evaluate the effectiveness of the proposed system. The Child Fear Survey Schedule—Dental Subscale (CFSS-DS) was used to measure children’s dental anxiety level. The T test was used to evaluate the differences between groups, and Fisher’s exact test was used to compare the distributions of gender and age between the groups. The CFSS-DS index in the VR group decreased after dental consultation (35.04 ± 9.14 before consultation and 32.32 ± 8.32 after consultation, p = 0.041). The implications of this study shall be beneficial to patients, parents, and dental professionals. Full article

Background and Objectives: The purpose was to provide the patients’ perspective on the monitoring of their wet age-related macular degeneration (wet AMD) during coronavirus disease 2019 (COVID-19) and the importance of telemedicine. Materials and Methods: Wet AMD patients that underwent intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in two Swiss ophthalmology clinics, completed two questionnaires after the first confinement due to COVID-19 in Switzerland. The first evaluated their views concerning their adherence to scheduled injections during the confinement, and the application of telemedicine in the future. The second, adapted from the National Eye Institute Visual Function Questionnaire-25, assessed their opinions on visual function change during confinement. Results: From a total of 130 patients, 8.5% responded they did not respect their assigned schedule (group 1) while 91.5% responded they did (group 2). A total of 78.7% of group 2 considered treatment reception as more relevant compared to the risk of COVID-19 contraction. During the pre-lockdown period, group 2 patients required more help from others than group 1 patients (p = 0.02). In the possibility of another lockdown, 36.3% of group 1 and 8.7% of group 2 would choose telemedicine to monitor their wet AMD (p = 0.02), 54.5% and 86.9% would rather visit the clinic (p = 0.02), while 9.0% and 4.3% would cancel their appointment, respectively. It was found that 70% of group 1 and 33.6% of group 2 would prefer to use the telemedicine services than visiting a telemedicine centre (p = 0.04). Conclusions: During circumstances similar to the COVID-19 confinement, most patients would prefer to visit the clinic. Group 1 would prefer wet AMD monitoring via telemedicine at a higher rate than group 2. Full article

The objective of this study was to describe pregnancy- and birth-related experiences of postpartum women during the third wave of the COVID-19 pandemic and their association with mental health outcomes. An online questionnaire was distributed in five European countries (Belgium, The Netherlands, Norway, Switzerland, UK) between June and August 2021. Participants were recruited though social media platforms including pregnancy- and motherhood-related websites, pregnancy fora, and apps. Postpartum women were asked eleven specific questions about pregnancy- and birth-related changes and the presence of support during delivery. The Edinburgh Depression Scale was used to assess depressive and anxiety symptoms. Covariates included sociodemographics, health and reproductive characteristics, and COVID-19 status. Associations were estimated with logistic regression. The study included 1730 postpartum women. Frequent changes included the exclusion of the partner from pregnancy care appointments (83.2%), changed prenatal care settings (64.4%), and cancellation of hospital information visits (42.7%). Few women, however, were without support apart from medical staff during delivery (1.4%). The number of pregnancy- and birth-related changes was associated with each woman’s mental health status, as well as the type of change. Experiencing changes related to delivery and cancellation or reduction of prenatal examination was associated with a doubling in the odds of symptoms of major depression and anxiety postpartum. These findings highlight the importance of ensuring adequate maternity care for women’s mental health postpartum, as well as during a pandemic. Full article

Despite the efforts of the World Health Organization, blood transfusions and delivery are still the crucial challenges in blood supply chain management, especially when there is a high demand and not enough blood inventory. Consequently, reducing uncertainty in blood demand, waste, and shortages has become a primary goal. In this paper, we propose a smart platform-oriented approach that will create a robust blood demand and supply chain able to achieve the goals of reducing uncertainty in blood demand by forecasting blood collection/demand, and reducing blood wastage and shortage by balancing blood collection and distribution based on an effective blood inventory management. We use machine learning and time series forecasting models to develop an AI/ML decision support system. It is an effective tool with three main modules that directly and indirectly impact all phases of the blood supply chain: (i) the blood demand forecasting module is designed to forecast blood demand; (ii) blood donor classification helps predict daily unbooked donors thereby enhancing the ability to control the volume of blood collected based on the results of blood demand forecasting; and (iii) scheduling blood donation appointments according to the expected number and type of blood donations, thus improving the quantity of blood by reducing the number of canceled appointments, and indirectly improving the quality and quantity of blood supply by decreasing the number of unqualified donors, thereby reducing the amount of invalid blood after and before preparation. As a result of the system’s improvements, blood shortages and waste can be reduced. The proposed solution provides robust and accurate predictions and identifies important clinical predictors for blood demand forecasting. Compared with the past year’s historical data, our integrated proposed system increased collected blood volume by 11%, decreased inventory wastage by 20%, and had a low incidence of shortages. Full article

COVID-19 is a well-known respiratory disease that has spread worldwide since January 2020, causing many deaths and massive pressure on health systems. This pandemic’s appearance compromised health service sustainability and quality as many procedures were postponed or canceled, with an expected increase of adverse events like nosocomial infections, in-hospital deaths, and the worsening of the patient’s clinical status. For instance, the year 2020 featured an increase in undesirable results in Portugal: a rise of 10% in delayed first medical appointments, 0.02% in avoidable bloodstream infections, and more than 100 post-operative pulmonary embolisms and septicemia cases per 100,000 inpatients. Therefore, assessing whether the healthcare providers’ performance has changed is paramount. In this case, we evaluated public hospitals in Portugal. To this end, we developed a network data envelopment analysis model relating to efficiency and effectiveness. We observed consistent drops in efficiency when the pandemic started, followed by a recovery to levels above the pre-pandemic ones. Regarding effectiveness, we observed a positive trend during the evaluated period. We conclude that, apart from the great resilience of public healthcare providers, the Portuguese state was unprepared for a pandemic like COVID-19, but still the actions taken (including massive vaccination) were beneficial. Full article

The coronavirus (COVID-19) has presented Germany with major challenges and has led to concerns about patient safety. We conducted an observational, population-based, nationwide, repeated cross-sectional survey on patient safety in Germany in 2019, 2020, and 2021. Each of the three samples consisted of 1000 randomly recruited adults. Self-reported data via computer-assisted telephone interviews were taken from TK Monitor of Patient Safety. Perceptions, experience, and knowledge relating to patient safety were assessed. The majority of respondents considered medical treatment to involve risks to patient safety. This proportion decreased during the pandemic. The majority also had a high degree of self-efficacy regarding the prevention of medical errors, whereby the percentage that felt well informed with regard to patient safety rose throughout the pandemic. The proportion of persons that suspected they had in the past experienced an error in their treatment remained steady at one third as well as the reported errors. In 2020, 65% of respondents thought health communication with service providers (e.g., extent and comprehensibility of information) remained unchanged during the pandemic, while 35% reported that medical appointments had been cancelled or postponed. This study is the first to assess patient safety from a general population perspective during the coronavirus pandemic in Germany. COVID-19 had a positive impact on perceived patient safety but no impact on suspected and reported errors. Self-efficacy with regard to medical error prevention steadily increased in the general population, and people considered themselves well informed. Full article

This study examines the access to healthcare for children and adolescents with three common chronic diseases (type-1 diabetes (T1D), obesity, or juvenile idiopathic arthritis (JIA)) within the 4th (Delta), 5th (Omicron), and beginning of the 6th (Omicron) wave (June 2021 until July 2022) of the COVID-19 pandemic in Germany in a cross-sectional study using three national patient registries. A paper-and-pencil questionnaire was given to parents of pediatric patients (<21 years) during the routine check-ups. The questionnaire contains self-constructed items assessing the frequency of healthcare appointments and cancellations, remote healthcare, and satisfaction with healthcare. In total, 905 parents participated in the T1D-sample, 175 in the obesity-sample, and 786 in the JIA-sample. In general, satisfaction with healthcare (scale: 0–10; 10 reflecting the highest satisfaction) was quite high (median values: T1D 10, JIA 10, obesity 8.5). The proportion of children and adolescents with canceled appointments was relatively small (T1D 14.1%, JIA 11.1%, obesity 20%), with a median of 1 missed appointment, respectively. Only a few parents (T1D 8.6%; obesity 13.1%; JIA 5%) reported obstacles regarding health services during the pandemic. To conclude, it seems that access to healthcare was largely preserved for children and adolescents with chronic health conditions during the COVID-19 pandemic in Germany. Full article

Pregnancy monitoring is vital to guaranteeing that both the foetus and the mother are in optimal health conditions. WHO protocols recommend at least eight medical examinations during the pregnancy period. While the cancellation or reduction of appointments during pregnancy due to the pandemic may help reduce the risk of infection, it could also negatively influence perinatal outcomes and the birthing process. The aim of this research was to analyse the differences in perinatal outcomes and birth characteristics in two groups of pregnant women: women who gave birth before and during the pandemic, and whether these differences are due to changes in pregnancy monitoring because of the COVID-19 situation. A retrospective study was carried out from July 2018 to December 2021, at the Santo Domingo Hospital (Dominican Republic). A total of 1109 primiparous pregnant women were recruited for this study during the birthing process and perinatal visits. The results describe how women who gave birth before the pandemic had greater control and monitoring of their pregnancy, more doctor visits (p = 0.001), fewer caesarean sections (p = 0.006), and more skin-to-skin contact after birth (p = 0.02). During the COVID-19 pandemic, pregnant women’s attendance at routine pregnancy monitoring, both doctor visits and ultrasound scans, has decreased, leading to an increase in the number of caesarean and instrumental deliveries. At the perinatal level, processes such as skin-to-skin contact after birth between mother and newborn or the introduction of early breastfeeding in the delivery room have also been reduced. Full article

Occult spinal dysraphism (OSD) comprises different forms of failure in embryogenic development that can lead to genitourinary, spinal, or lower limb alterations, thus determining progressive neurological deterioration. The correct management of children harboring OSD represents a significant issue during their life up to adulthood. However, patients often have to entertain individual consultations with each specialist. We settled on a multidisciplinary team comprising pediatric neurosurgeons, urologists, neurologists, orthopedists, and other supporting physicians. We present the results of such actions by analyzing a series of 141 children with OSD subjected to neurosurgical procedures, evaluating the impact of multidisciplinary management on outcomes. We also evaluated the specific actions according to the different ages of OSD patients from birth to adulthood to provide a schematic plan that could represent a basis for establishing and disseminating the need for a multidisciplinary approach in OSD management. The multidisciplinary team allows all consultants to see the patient together, covering specific aspects of history and examination pertinent to their management. Offering a one-stop service prevents coordination issues between the different medical teams, avoids delays or cancellations of the various appointments, optimizes cost-effectiveness, and improves efficiency and parents’ satisfaction. Full article