ABSTRACT
Introduction: Since the onset of the COVID-19 pandemic, telemedicine has become an increasingly utilized resource in all fields of medicine, allowing greater access to and efficiency of medical care. This study seeks to quantify the average reduction in cost to patients and carbon footprint attributable to telemedicine for endocrine cancer care. Method(s): This retrospective cohort study includes telemedicine visits for in-state patients from April 1, 2020, to June 20, 2021, at the endocrine oncology clinic of a single National Cancer Institute-designated comprehensive cancer center. The primary outcome is cost savings of endocrine cancer care with use of telemedicine. This includes 2 components: (1) direct costs of travel (round-trip distance of car travel) and (2) loss of productivity due to the clinic visit (loss of income from travel and in-office visit time). The secondary outcome is reduction of carbon footprint (kg CO2 emissions) with use of telemedicine. Result(s): There were 3171 telemedicine visits for 2921 patients conducted within the designated time frame. Telemedicine was associated with total savings of 494,895 round-trip travel miles for patients (9734 hours total drive time). An additional 3613 hours were saved in accounting for time to park, enter the building, and wait. Telemedicine resulted in an average savings of $145/visit for patients under 65 years old and $111/visit for patients greater than 65 years old. Additionally, telemedicine reduced the carbon footprint by an average of 46.18 kg CO2 emissions per visit. Conclusion(s): As the costs of medical care continue to rise, further implementation of telemedicine may result in significant savings for patients. This study found that telemedicine is associated with reduction in financial burden caused by both travel and time costs. Additionally, implementation of telemedicine may significantly reduce the carbon footprint of endocrine cancer care. These data need to be interpreted in the context of clinical efficacy of the telemedicine visit, which will require additional study of clinical impact, patient satisfaction, and oncological outcomes.
ABSTRACT
BACKGROUND: Women with COVID-19 experienced numerous concerns and doubts about the safety of breastfeeding their babies, and lack of support may have impacted breastfeeding practices. This study aims to compare breastfeeding beliefs, practices, and contact with healthcare professionals regarding the level of postnatal feeding support provided during the COVID-19 pandemic in Brazil, South Korea, Taiwan, Thailand, and the United Kingdom. METHODS: A multi-country cross-sectional study was conducted with postnatal women in five countries. Women up to six months postpartum were invited to complete an online survey concerning the transmission of preventative measures, beliefs toward breastfeeding, infant feeding practices in the last 24 hours and experiences of postnatal infant feeding support between July to November 2021. Bivariate and multivariate analyses were performed to identify the association. RESULTS: Of the 3,253 eligible responses received, 39.5% of children were aged between one and two months, but in Taiwan (36%) and South Korea (42.8%) they were between three and four months. The mean of the belief score was significantly different among countries (p < 0.0001). Women in Brazil and the UK had a higher rate of breastfeeding at the breast (90.7% and 85.4%, respectively) compared to the three Asian countries (p < 0.0001) while feeding with expressed breastmilk in Thailand (59.9%), Taiwan (52.6%), and South Korea (50.4%) was higher than the others (p < 0.0001). Brazil and UK mothers (mean = 16.0 and 14.5 respectively) had a higher mean score for belief toward breastfeeding during the COVID-19 than the others. These results are inversely associated with breastfeeding but positively related to formula feeding practice. Postnatal feeding support during the COVID-19 pandemic was mainly provided by healthcare professionals (67.1%) and peers / family through face-to-face personal contact (51.6%) in all countries. CONCLUSION: Some differences were found in breastfeeding beliefs during the COVID-19 pandemic in Asian countries. A positive breastfeeding belief was associated with the practice of breastfeeding at the breast. Women from all countries received postpartum infant feeding support from health professionals and peers / family through personal contacts. Governments need to emphasize and disseminate the importance of breastfeeding safety, especially in Asian countries.